Metoclopramide for Hiccups
Metoclopramide is effective for treating intractable hiccups and should be considered as a first-line pharmacologic intervention when non-pharmacologic measures fail. 1, 2
Efficacy and Evidence
- Metoclopramide has demonstrated dramatic relief of intractable hiccups in patients with diverse serious illnesses, with effects observed within 30 minutes and lasting up to 8 hours 1
- It is one of the few agents studied in a prospective manner and in randomized controlled trials for hiccup management 2
- The drug works primarily through its prokinetic effects on the gastrointestinal tract and competitive dopaminergic antagonism 3
Dosing and Administration
- Typical oral dosing is 10 mg every 6-8 hours as needed for hiccups 1
- Can be administered orally or parenterally (IV/IM) for more rapid onset of action in severe cases 1
- For persistent cases, regular dosing may be more effective than as-needed administration 4
Clinical Considerations
- Metoclopramide is particularly useful when hiccups are associated with gastrointestinal disorders or gastroparesis, as it improves gastric motility 5
- It may be especially beneficial when hiccups are accompanied by nausea or vomiting, addressing both symptoms simultaneously 3
- Has been successfully used to prevent recurrence of steroid-induced hiccups (such as those caused by dexamethasone) 4
Safety Considerations and Limitations
- FDA has issued warnings about serious adverse effects with prolonged use (>12 weeks), including extrapyramidal symptoms such as:
- Acute dystonic reactions
- Drug-induced parkinsonism
- Akathisia
- Tardive dyskinesia 5
- Should be used cautiously in patients with seizure disorders, GI bleeding, or GI obstruction 5
- Use with caution in elderly patients and those with renal or hepatic impairment 5
- Monitor for drowsiness, diarrhea, and muscle weakness 5
Alternative Options
- Chlorpromazine is the only FDA-approved medication specifically for hiccups 2
- Other pharmacologic options with some evidence of efficacy include:
- Baclofen
- Gabapentin
- Haloperidol
- Midazolam
- Nifedipine 2
Practical Approach
- Start with non-pharmacologic measures for brief episodes of hiccups
- For persistent or intractable hiccups, metoclopramide 10 mg orally three times daily is a reasonable first-line option 1
- Limit treatment duration to avoid risk of tardive dyskinesia and other extrapyramidal side effects 5
- Consider alternative agents if metoclopramide is ineffective or contraindicated 2
- For steroid-induced hiccups, low-dose metoclopramide may be used prophylactically 4
Metoclopramide offers an effective option for treating hiccups with a relatively rapid onset of action, though careful consideration of potential adverse effects is necessary, particularly with extended use.