What is the recommended dose of gabapentin (Neurontin) for treating hiccups?

Gabapentin Dosing for Hiccups

For persistent or intractable hiccups, gabapentin should be initiated at 100-300 mg twice daily, with most patients responding to this low dose range without requiring further titration. 1, 2

Evidence for Gabapentin in Hiccups

Gabapentin has emerged as an effective second-line treatment option for persistent or intractable hiccups, with several key advantages:

• Gabapentin shows positive outcomes in all reported cases of hiccup treatment, with evidence suggesting a temporal effect 1
• Low doses (100-300 mg twice daily) are typically effective, unlike the higher doses needed for neuropathic pain conditions 2, 3
• Rapid onset of action, with some cases reporting resolution within 24 hours of initiation 2
• Well-tolerated with minimal side effects at the low doses used for hiccups 1
• Lacks significant drug interactions with other medications, making it particularly valuable in transplant recipients and patients on multiple medications 2

Dosing Protocol

The recommended dosing approach for gabapentin in hiccups:

• Starting dose: 100-300 mg twice daily 1, 2
• Duration: Short courses (3-7 days) have been effective in many cases 3
• Some patients may require continuation for 3-4 weeks 2
• No titration is typically needed beyond the initial dose for hiccups, unlike the higher doses required for neuropathic pain (where doses up to 2400-3600 mg/day are common) 4

Clinical Considerations

When using gabapentin for hiccups, consider these important factors:

• Gabapentin works by possibly modulating diaphragmatic activity and reducing nerve impulse transmission involved in the hiccup reflex arc 5
• Patients with renal impairment require dose adjustment 4
• Most common side effects include somnolence and dizziness, though these are less common at the low doses used for hiccups 1
• Gabapentin should be considered as a second-line agent after chlorpromazine (the only FDA-approved medication for hiccups) 6
• Particularly useful in stroke rehabilitation patients or palliative care settings where chlorpromazine side effects are undesirable 1

Case Evidence

Several case reports provide compelling evidence for gabapentin's efficacy:

• A heart transplant recipient with 2 months of intractable hiccups achieved complete resolution within 24 hours of starting gabapentin 100 mg twice daily, with sustained benefit after 3 weeks of therapy 2
• Patients with hiccups due to ischemic lesions of the medulla experienced immediate disappearance of hiccups with a short course (6 days) of gabapentin, with benefits maintained at 36-month follow-up 3
• Multiple cases of aripiprazole-induced hiccups responded well to low-dose gabapentin 5

Comparison to Other Treatments

While several medications have been used for hiccups, gabapentin offers specific advantages:

• Better side effect profile than chlorpromazine, especially in elderly or medically complex patients 1
• More rapid onset of action than baclofen, which often requires 6+ weeks of therapy 2
• Lower doses needed compared to neuropathic pain treatment (100-300 mg twice daily for hiccups vs. up to 2400-3600 mg/day for neuropathic pain) 4, 1