Do Haldol (haloperidol) or Zofran (ondansetron) have efficacy in the treatment of hiccups?

Efficacy of Haloperidol and Ondansetron in the Treatment of Hiccups

Chlorpromazine is the only FDA-approved medication for hiccups, but haloperidol has demonstrated efficacy for intractable hiccups while ondansetron has not shown significant evidence for hiccup treatment. 1

Haloperidol for Hiccups

• Haloperidol, a butyrophenone antipsychotic, has demonstrated efficacy in treating persistent and intractable hiccups based on clinical evidence 2
• The mechanism likely involves central action on dopamine receptors in the hiccup reflex arc 3
• Typical dosing for hiccup treatment ranges from 1-2 mg orally every 4-6 hours as needed 1
• Haloperidol can be considered as an alternative to chlorpromazine, which is the only FDA-approved medication specifically for hiccups 4

Side Effects and Monitoring with Haloperidol

• Common side effects include extrapyramidal symptoms (dystonic reactions), orthostatic hypotension, sinus tachycardia, and other dysrhythmias 1
• QTc prolongation is a significant concern, requiring ECG monitoring in at-risk patients 1
• When using haloperidol for hiccups, close clinical observation is recommended, especially in patients with cardiac risk factors 1
• Diphenhydramine (25-50 mg PO or IV every 4-6 hours) may be needed to manage dystonic reactions 1

Ondansetron for Hiccups

• There is no substantial evidence supporting ondansetron's efficacy in treating hiccups 2, 5
• Ondansetron is primarily indicated for chemotherapy-induced and radiation-induced nausea and vomiting 1
• Standard dosing for ondansetron is 8 mg orally or IV for antiemetic purposes, but this has not been established for hiccup treatment 1
• Ondansetron is also listed as a QT-interval prolonging medication, which should be considered when evaluating treatment options 1

Treatment Algorithm for Hiccups

1. First-line options:

   • Chlorpromazine (the only FDA-approved medication for hiccups) 4
   • Baclofen (supported by small randomized controlled trials) 5
   • Gabapentin (favorable efficacy and tolerability profile) 4, 5

2. Second-line options:

   • Haloperidol (1-2 mg PO or IV every 4-6 hours as needed) 1, 2
   • Metoclopramide (supported by small randomized controlled trials) 5

3. For intraoperative hiccups:

   • Chlorpromazine has been shown to be effective even under general anesthesia (5 mg IV total dose) 6

Important Considerations

• Treatment should target the underlying cause of hiccups when identifiable 5
• For intractable hiccups, a trial of anti-reflux therapy may be appropriate before moving to neuroleptic agents 5
• Baclofen and gabapentin may have better safety profiles than neuroleptic agents like haloperidol for long-term therapy 5
• When using haloperidol, monitor for QTc prolongation, especially if combined with other QT-prolonging medications 1
• Chlorpromazine remains the standard FDA-approved treatment, but its side effect profile may be less favorable than newer agents 4