First-Line Treatment for Hiccups
Chlorpromazine (25-50 mg three to four times daily) is the first-line treatment for hiccups, as it is the only FDA-approved medication for this condition. 1
Treatment Algorithm
Non-pharmacological interventions (try first for brief hiccups):
- Physical maneuvers that stimulate the uvula/pharynx or disrupt diaphragmatic rhythm 2:
- Breath holding
- Breathing into a paper bag
- Drinking water from the opposite side of a glass
- Swallowing granulated sugar
- Gentle pressure on eyeballs
Pharmacological treatment (for persistent hiccups):
First-line: Chlorpromazine
Alternative options (if chlorpromazine is ineffective or contraindicated):
Underlying Causes to Consider
Hiccups result from irritation of the phrenic nerve, vagus nerve, or central hiccup center. Common causes include:
- Gastroesophageal reflux disease (GERD) - most common cause 5
- Central nervous system disorders (stroke, tumor, trauma) 4
- Thoracic disorders (myocardial ischemia, pneumonia) 4
- Metabolic disorders 4
- Medication side effects 4
Important Considerations
- For brief, self-limited hiccups, non-pharmacological measures are usually sufficient 2
- For persistent hiccups (>48 hours) or intractable hiccups (>2 months), pharmacological intervention is typically required 4
- GERD is the most common cause of chronic hiccups, so a trial of PPI therapy is reasonable if hiccups persist 5
- Treatment should address any identified underlying cause while providing symptomatic relief 3, 4
Monitoring and Follow-up
- Evaluate response to treatment within 24-48 hours
- If hiccups persist despite chlorpromazine treatment, consider alternative medications or further investigation for underlying causes 3, 6
- For intractable cases unresponsive to medication, consider specialty referral for nerve blocks or other interventional procedures 4