What is the treatment for acute hiccups?

Treatment for Acute Hiccups

For acute hiccups, first-line treatment includes physical maneuvers and addressing underlying causes, with chlorpromazine 25-50 mg three to four times daily recommended for intractable cases. 1

First-Line Approaches

• Avoid alcohol and spicy foods which can trigger gastroesophageal reflux, a common cause of acute hiccups 2
• Physical maneuvers that stimulate the uvula/pharynx or disrupt diaphragmatic rhythm are often effective for benign, self-limited hiccups 3
• Common physical techniques include:
  • Holding breath
  • Breathing into a paper bag
  • Drinking water quickly
  • Swallowing dry bread or granulated sugar 4

Pharmacological Treatment

• For hiccups persisting beyond simple measures:
  • Chlorpromazine 25-50 mg three to four times daily is FDA-approved for intractable hiccups 1
  • Baclofen is considered a first-line medication based on limited clinical trial data 5
  • Metoclopramide has shown efficacy in small randomized controlled trials 5
  • Gabapentin may be effective with fewer side effects than neuroleptics for longer-term use 5

Special Considerations

• Monitor patients with hiccups approaching 48 hours for signs of respiratory compromise 6
• For severe cases with respiratory compromise:
  • Consider applying continuous positive airway pressure with 100% oxygen 2
  • Larson's maneuver (pressure at the "laryngospasm notch") may be helpful 2
  • Propofol 1-2 mg/kg IV may be needed for persistent cases with oxygen desaturation 2

Treatment Algorithm

1. Start with physical maneuvers for acute hiccups (holding breath, drinking water)
2. If hiccups persist beyond a few hours, consider anti-reflux therapy if GERD is suspected
3. For hiccups persisting beyond 24 hours, consider pharmacological intervention:
   • Chlorpromazine 25-50 mg TID or QID (first-line FDA-approved medication) 1
   • Alternative options: baclofen, metoclopramide, or gabapentin 5
4. For severe cases with respiratory compromise, consider more aggressive interventions including CPAP or propofol 2

Caution

• Persistent hiccups (>48 hours) or intractable hiccups (>2 months) may indicate underlying pathology requiring investigation 4
• Elderly patients should receive lower doses of medications like chlorpromazine due to increased susceptibility to hypotension and neuromuscular reactions 1
• Monitor for respiratory complications in all cases of persistent hiccups, especially in patients with pre-existing conditions 6