From the FDA Drug Label
Intractable Hiccups– 25 mg to 50 mg t.i.d. or q.i.d. If symptoms persist for 2 to 3 days, parenteral therapy is indicated. The treatment for synchronous diaphragmatic contractions (hiccups) is Chlorpromazine 25 mg to 50 mg t.i.d. or q.i.d. If symptoms persist, parenteral therapy may be necessary 1.
- Initial dose: 25 mg to 50 mg
- Frequency: t.i.d. or q.i.d.
- Alternative therapy: Parenteral therapy if symptoms persist for 2 to 3 days
From the Research
For synchronous diaphragmatic contractions (hiccups), the most effective treatment approach involves a combination of home remedies and, if necessary, medical treatment with medications such as chlorpromazine, metoclopramide, or baclofen, with vagus nerve stimulation being a novel option for intractable cases. When considering treatment options, it's essential to prioritize methods that are least invasive and most likely to improve quality of life while minimizing morbidity and mortality. The initial approach should include simple home remedies such as:
- Holding breath for 10-20 seconds
- Drinking a glass of cold water quickly
- Gargling with ice water
- Breathing into a paper bag for a few minutes
- Pulling gently on the tongue These methods work by either interrupting the hiccup reflex or stimulating the vagus nerve, which can stop the diaphragm spasms causing hiccups 2. For persistent hiccups lasting more than 48 hours, medical treatment may be necessary, with medications like:
- Chlorpromazine (25-50mg orally)
- Metoclopramide (10mg orally three times daily)
- Baclofen (5-10mg orally three times daily) being prescribed, as they can reduce nerve impulses to the diaphragm or relax the muscles involved 3, 4. In rare cases of intractable hiccups, more invasive procedures such as nerve blocks, phrenic nerve crushing, blockade, or pacing, and even surgical intervention might be considered 5. It's also crucial to stay hydrated and avoid triggers like carbonated beverages, alcohol, and spicy foods, which can exacerbate hiccups. If hiccups persist beyond 48 hours or are accompanied by other symptoms like chest pain or difficulty breathing, seeking medical attention promptly is advised. Given the variety of treatment options and the importance of individualizing care based on the underlying cause of hiccups, the patient's comorbidities, and the specific properties of the drugs, a tailored approach is necessary, with the most recent and highest quality evidence guiding the decision-making process 3.