Baclofen Dosing for Hiccups
The recommended dose of baclofen for treating hiccups is 5-10 mg three times daily, with a typical effective total daily dose of 30-60 mg. 1
Dosing Guidelines
- Initial dosing should start at 5 mg three times daily 2, 3
- Dose can be titrated up to 10 mg three times daily if needed 4, 5
- Total daily dose range is typically 15-60 mg, with most patients responding in the 30-60 mg range 1
- Treatment duration varies based on response, but can range from short-term (1 week) to longer courses (several weeks) 3
Mechanism of Action
- Baclofen is a GABA-B receptor agonist that works as a muscle relaxant 1
- Its effectiveness in hiccups is believed to be due to inhibition of the hiccup reflex arc through GABA-mediated neural inhibition 6
- The drug contains both GABA and phenylethylamine properties that activate inhibitory neurotransmitters, which may block the hiccup stimulus 6
Evidence Base
- Baclofen has demonstrated effectiveness in treating chronic hiccups in multiple studies 4
- In one large series, baclofen produced complete resolution or significant decrease of hiccups in 28 of 37 patients with chronic hiccups (average duration 4.6 years) 4
- Some case reports show resolution of intractable hiccups within 24-48 hours of starting baclofen therapy 2, 3
Clinical Considerations
Monitor for common side effects, particularly in older adults:
Baclofen should be used with caution in patients with:
Avoid abrupt discontinuation as this may cause central nervous system irritability 1
Alternative Options
- If baclofen is ineffective or poorly tolerated, consider:
Important Caveats
- Older adults may require lower doses (start at 5 mg twice daily) due to increased sensitivity to side effects 1
- Baclofen is the only medication for alcohol abstinence that has been specifically studied in patients with alcoholic liver disease, which may be relevant if hiccups are related to alcohol use 1
- Treatment should be discontinued if no benefit is observed after an adequate trial (1-2 weeks) 5