From the Research
Thorazine (chlorpromazine) is not the first-line treatment for hiccups, but it can be used to treat persistent hiccups that don't respond to other treatments, as evidenced by the study published in 2017 1. For hiccup treatment, typical dosing ranges from 25-50 mg given orally three to four times daily, or 25-50 mg administered intramuscularly for more severe cases. Treatment duration is usually short-term until hiccups resolve. Thorazine works by affecting dopamine receptors in the brain's chemoreceptor trigger zone and may interrupt the hiccup reflex arc. As an antipsychotic medication, it carries potential side effects including drowsiness, dizziness, dry mouth, blurred vision, and in rare cases, movement disorders or drops in blood pressure. Patients should be monitored for these effects, especially when first starting treatment. Thorazine should be used cautiously in elderly patients and those with certain medical conditions like liver disease, heart problems, or seizure disorders. While effective, it's generally considered a second or third-line treatment after trying simpler remedies like holding breath, drinking water from the opposite side of a glass, or medications like baclofen or gabapentin, as suggested by the study published in 2012 2. The most recent and highest quality study, published in 2017 1, identified 26 articles involving 10 pharmacologic treatment options, including chlorpromazine, and found that baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner. However, no specific recommendations can be made for treating intractable and persistent hiccups with the evidence currently available in the literature, and therapy selection should be specific to individual patients, their underlying comorbidities, etiology of hiccups, and take into account the individual properties of the drugs. It is also worth noting that, although chlorpromazine is often used to treat hiccups, other medications like perphenazine, which is also a dopamine antagonist, can induce hiccups as a side effect, as reported in the study published in 1999 3. In terms of treatment approach, the study published in 2012 2 suggests that an effective treatment of persistent hiccup may be established upon the correct diagnosis of the lesion responsible for the serious event, and that pharmacotherapy, including chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics, and lidocaine, as well as non-pharmacological approaches like nerve blockade, pacing, acupuncture, and measures to hold breathing, can be successful. Ultimately, the choice of treatment for hiccups should be based on the individual patient's needs and medical history, and should be guided by the most recent and highest quality evidence available, as suggested by the study published in 2017 1.
Some key points to consider when treating hiccups with Thorazine (chlorpromazine) include:
- Typical dosing ranges from 25-50 mg given orally three to four times daily, or 25-50 mg administered intramuscularly for more severe cases
- Treatment duration is usually short-term until hiccups resolve
- Potential side effects include drowsiness, dizziness, dry mouth, blurred vision, and in rare cases, movement disorders or drops in blood pressure
- Patients should be monitored for these effects, especially when first starting treatment
- Thorazine should be used cautiously in elderly patients and those with certain medical conditions like liver disease, heart problems, or seizure disorders
- Therapy selection should be specific to individual patients, their underlying comorbidities, etiology of hiccups, and take into account the individual properties of the drugs.