What tablets can be used to treat hiccups?

Pharmacological Treatment Options for Hiccups

Chlorpromazine is the first-line medication for treating hiccups, with a recommended dosage of 25-50mg orally three to four times daily. 1

First-Line Treatment Options

• Chlorpromazine is the only FDA-approved medication specifically for hiccups, typically administered at 25-50mg orally three to four times daily 1
• For intractable hiccups that persist beyond 48 hours, chlorpromazine can be continued, with dosages up to 50mg three times daily 1, 2
• Elderly patients should receive lower doses of chlorpromazine due to increased susceptibility to hypotension and neuromuscular reactions 1

Second-Line Treatment Options

• Baclofen is an effective alternative for persistent hiccups, with a starting dose of 5-10mg three times daily 3, 4
• Metoclopramide 10-20mg orally or IV every 4-6 hours can be effective, particularly when hiccups are related to gastric distention or gastroesophageal reflux 3, 5
• Gabapentin has shown success in treating persistent hiccups and may be considered when other options fail 6, 4

Additional Pharmacological Options

• Haloperidol 0.5-2mg daily can be effective for persistent hiccups, particularly in patients with neurological causes 7, 8
• Olanzapine 2.5-5mg daily may be beneficial for hiccups, with the additional benefit of antiemetic properties 3, 7
• Amitriptyline, nifedipine, and valproic acid have been reported as successful treatments in case reports, though with lower levels of evidence 6

Treatment Algorithm

1. Start with chlorpromazine 25-50mg three times daily as first-line therapy 1
2. If ineffective after 48 hours or poorly tolerated, switch to baclofen 5-10mg three times daily 3, 4
3. For patients with gastroesophageal reflux or gastric distention contributing to hiccups, add metoclopramide 10mg three to four times daily 3, 5
4. For refractory cases, consider gabapentin starting at 300mg daily and titrating up to 1800mg daily in divided doses 6, 4
5. If neurological causes are suspected, consider haloperidol 0.5-2mg daily 7, 8

Special Considerations

• Monitor for extrapyramidal symptoms with chlorpromazine and other antipsychotics, particularly in elderly patients 1, 8
• Baclofen may cause sedation and should be started at lower doses in elderly patients or those with renal impairment 4, 5
• Patients with liver disease may require dose adjustments for medications metabolized hepatically 7
• Consider the underlying cause of hiccups when selecting therapy - for example, prokinetics like metoclopramide may be more effective when gastric distention is the cause 3, 2

Common Pitfalls

• Failing to identify and treat the underlying cause of persistent hiccups (such as gastroesophageal reflux, stroke, or medication side effects) 6, 4
• Using inadequate doses or discontinuing therapy too early before therapeutic effect is achieved 2
• Not monitoring for side effects, particularly sedation, hypotension, and extrapyramidal symptoms with antipsychotic medications 1, 8
• Overlooking drug interactions, especially when combining multiple agents with CNS effects 7