Is Compazine (prochlorperazine) effective for treating hiccups?

Prochlorperazine (Compazine) for Hiccups: Efficacy and Recommendations

Prochlorperazine (Compazine) is not the first-line treatment for hiccups despite being an effective antiemetic agent. While it belongs to the phenothiazine class that has been used for hiccups, chlorpromazine is the only FDA-approved medication specifically for hiccups treatment 1.

Efficacy for Hiccups

• Prochlorperazine (Compazine) is primarily indicated for nausea and vomiting rather than hiccups, though it has been used off-label for this purpose 2.
• Chlorpromazine, another phenothiazine, is the only FDA-approved medication specifically for treating hiccups 1, 3.
• Case reports suggest that prochlorperazine may be ineffective for persistent hiccups in some patients, particularly those with neurological causes 4.

Preferred Treatments for Hiccups

• First-line treatment: Chlorpromazine has been established as the standard first-line pharmacologic treatment for persistent hiccups, with documented efficacy even under general anesthesia 5.
• Alternative options when chlorpromazine fails or is contraindicated:
  • Baclofen has shown superior efficacy in some cases, particularly for hiccups associated with lateral medullary syndrome 4.
  • Gabapentin has demonstrated effectiveness and favorable tolerability in rehabilitation patients 3.
  • Metoclopramide has been studied in randomized controlled trials for hiccups treatment 1.

Administration and Dosing

• When prochlorperazine is used for other indications such as nausea and vomiting, typical dosing is 5-10 mg orally or intravenously, 3-4 times daily 2.
• For hiccups specifically, there is insufficient evidence to recommend a specific prochlorperazine dosing regimen 1.

Adverse Effects and Precautions

• Prochlorperazine, like other phenothiazines, may cause:
  • Extrapyramidal symptoms including dystonic reactions 2
  • Sedation and drowsiness 2
  • QT interval prolongation, which can lead to cardiac arrhythmias 2
  • Orthostatic hypotension 2
• Paradoxically, there is a case report of another phenothiazine (perphenazine) actually causing hiccups rather than treating them 6.

Clinical Decision Making

• For persistent hiccups, consider the following approach:
  • First try chlorpromazine as it is FDA-approved specifically for hiccups 1, 3
  • If ineffective or contraindicated, consider baclofen (5 mg three times daily) which has shown efficacy in neurologically-based hiccups 4
  • Gabapentin is another alternative with favorable tolerability in rehabilitation patients 3
  • Consider metoclopramide which has been studied in randomized controlled trials 1
  • Use prochlorperazine only if other options have failed or are unavailable 1, 4

Special Considerations

• In patients with cancer pain or chemotherapy-induced nausea who also have hiccups, prochlorperazine may serve dual purposes as both an antiemetic and potential hiccup treatment 2.
• For patients with cyclic vomiting syndrome who also experience hiccups, prochlorperazine may be considered as part of an "abortive cocktail" 2.
• Monitoring for extrapyramidal symptoms is essential when using phenothiazines like prochlorperazine 2.

Remember that treatment selection should be guided by the underlying cause of hiccups, patient comorbidities, and potential drug interactions 1.