From the Guidelines
Chlorpromazine is the most effective medication for treating intractable hiccups, as evidenced by its use in clinical practice 1.
Treatment Options
When considering treatment for intractable hiccups, it's essential to prioritize medications that have a strong evidence base for efficacy.
- Chlorpromazine, a phenothiazine, is specifically mentioned as a treatment option for intractable hiccups due to its effectiveness in clinical settings 1.
- The dosage and administration route can vary, but typical recommendations include 25-50 mg intravenously or intramuscularly, or 25 mg orally three times daily.
Mechanism of Action
Chlorpromazine works by targeting dopamine antagonism, which contributes to its effectiveness in treating hiccups.
Important Considerations
Before initiating treatment with chlorpromazine or any other medication, it's crucial to identify and address any underlying causes of the hiccups, such as gastroesophageal reflux, medication side effects, or metabolic disorders.
Alternative Options
While chlorpromazine is the primary recommended treatment, other medications like baclofen, metoclopramide, gabapentin, and benzodiazepines may also be considered, although their use is based on less direct evidence for intractable hiccups compared to chlorpromazine 1.
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. INTRACTABLE HICCUPS If symptoms persist for 2-3 days after trial with oral therapy, give 25 to 50 mg (1-2 mL) IM. Should symptoms persist, use slow IV infusion with patient flat in bed: 25 to 50 mg (1-2 mL) in 500 to 1000 mL of saline. For the treatment of ... relief of intractable hiccups;
The medication used to treat intractable hiccups (singultus) is chlorpromazine. The recommended dosage is 25 mg to 50 mg orally, three to four times a day, or intramuscularly, 25 to 50 mg, if symptoms persist after oral therapy 2, 3.
From the Research
Medications for Intractable Hiccups
The following medications have been used to treat intractable hiccups:
- Chlorpromazine, which is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 4, 5
- Metoclopramide, an antidopaminergic drug commonly used for the treatment of hiccups 4, 5, 6, 7
- Baclofen, a GABA analog that has been successful in treating hiccups 4, 6, 8
- Gabapentin, which has been used to treat hiccups, although it may cause adverse effects such as somnolence 4, 8
- Olanzapine, an atypical antipsychotic that has been used in combination with baclofen to treat intractable hiccups 6
- Tetrabenazine, a drug that has been used to treat intractable hiccups in a patient with a history of stroke 8
- Lansoprazole, clonazepam, and dimenhydrinate, which have been used in combination to treat intractable hiccups in a patient with gastritis and reflux esophagitis complicated with myocardial infarction 7
- Amitriptyline, haloperidol, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid, which have been found in the literature to be successful in treating hiccups 4
Treatment Approaches
Treatment of intractable hiccups often involves a trial-and-error approach, as there is no single medication that is effective for all patients 4, 5, 6. The choice of medication should be based on the individual patient's underlying comorbidities, etiology of hiccups, and the properties of the drugs 4. In some cases, combination therapy may be necessary to achieve effective treatment 6, 7.