What is the treatment for hiccups?

Treatment for Hiccups

For intractable hiccups, chlorpromazine 25-50 mg three to four times daily is the most effective pharmacological treatment, while simple physical maneuvers should be tried first for acute hiccups. 1

Classification of Hiccups

Hiccups can be categorized based on duration:

• Acute hiccups: Last less than 48 hours and are usually self-limited 2
• Persistent hiccups: Last more than 48 hours but less than 2 months 2
• Intractable hiccups: Last more than 2 months 2

First-Line Treatment for Acute Hiccups

For most cases of acute hiccups, non-pharmacological approaches should be tried first:

• Physical maneuvers that stimulate the pharynx or disrupt diaphragmatic rhythm: 3
  • Holding breath
  • Breathing into a paper bag (rebreathing CO2)
  • Drinking water rapidly or from the opposite side of a glass
  • Stimulating the uvula or pharynx
  • Pulling on the tongue

Treatment for Persistent or Intractable Hiccups

When hiccups persist beyond 48 hours, a more structured approach is needed:

Pharmacological Treatment

1. First-line medication:

   • Chlorpromazine: 25-50 mg orally three to four times daily 1
   • FDA-approved specifically for intractable hiccups 1

2. Alternative medications if chlorpromazine is ineffective or contraindicated: 2, 4

   • Gabapentin
   • Baclofen
   • Metoclopramide (prokinetic agent)
   • Serotonergic agonists
   • Lidocaine

Non-Pharmacological Interventions for Refractory Cases

For cases that don't respond to medication: 2

• Nerve blockade (phrenic nerve)
• Pacing
• Acupuncture

Special Considerations

Pediatric Patients

• Chlorpromazine can be used in children over 6 months of age at a dose of ¼ mg/lb body weight every 4-6 hours as needed 1
• Should generally not be used in children under 6 months except in potentially life-saving situations 1

Underlying Causes

Always consider and treat potential underlying causes of persistent hiccups: 2, 5

• Gastroesophageal reflux disease
• Gastritis
• Stomach distension
• Central nervous system disorders (stroke, tumors)
• Myocardial ischemia
• Herpes zoster infection
• Medication side effects

Treatment Algorithm

1. For acute hiccups (< 48 hours):

   • Try physical maneuvers first 3
   • Most resolve spontaneously without intervention 5

2. For persistent hiccups (> 48 hours):

   • Evaluate for underlying causes 2
   • Start chlorpromazine 25-50 mg three to four times daily 1
   • If ineffective after 2-3 days, consider alternative medications 2, 4

3. For intractable hiccups (> 2 months):

   • Continue pharmacotherapy with chlorpromazine or alternatives 1, 2
   • Consider referral for specialized interventions like nerve blockade if medications fail 2

Monitoring and Adverse Effects

When using chlorpromazine: 1

• Monitor for hypotension, particularly in elderly patients
• Watch for extrapyramidal symptoms
• Adjust dosage to the lowest effective maintenance level after symptoms are controlled