From the FDA Drug Label
INTRACTABLE HICCUPS If symptoms persist for 2-3 days after trial with oral therapy, give 25 to 50 mg (1-2 mL) IM. Should symptoms persist, use slow IV infusion with patient flat in bed: 25 to 50 mg (1-2 mL) in 500 to 1000 mL of saline. INTRACTABLE HICCUPS– 25 mg to 50 mg t.i.d. or q.i.d. If symptoms persist for 2 to 3 days, parenteral therapy is indicated.
The causes of postoperative (post-op) hiccups are not specified in the drug label. The treatment for postoperative hiccups is not directly stated, but for intractable hiccups, the treatment is:
- Oral: 25 mg to 50 mg t.i.d. or q.i.d.
- If symptoms persist for 2 to 3 days, parenteral therapy is indicated: 25 to 50 mg IM or slow IV infusion with patient flat in bed: 25 to 50 mg in 500 to 1000 mL of saline 1 2.
From the Research
Postoperative hiccups can be effectively managed with chlorpromazine, as evidenced by a recent case report in 2022 3, which demonstrated the efficacy of chlorpromazine in treating hiccups under general anesthesia. The causes of postoperative hiccups are multifactorial and can include phrenic nerve irritation, gastric distention, or diaphragmatic irritation following surgery, as well as other factors such as electrolyte imbalances or gastroesophageal reflux disease 4, 5, 6. Some key points to consider in the management of postoperative hiccups include:
- Physical maneuvers such as holding breath, breathing into a paper bag, or gentle pressure on the eyeballs can be tried as first-line treatments
- Medications such as baclofen, chlorpromazine, or metoclopramide can be effective for persistent hiccups
- Addressing underlying causes such as electrolyte imbalances or gastric distention is crucial
- Further evaluation may be necessary if hiccups persist beyond 48 hours despite treatment to rule out more serious underlying conditions
- In severe cases, vagus nerve stimulation may be considered as a novel surgical option for intractable hiccups, as reported in a case study in 2021 7. It is essential to prioritize the most recent and highest-quality study, which in this case is the 2022 study on the effective treatment of intraoperative hiccups with chlorpromazine under general anesthesia 3. The treatment approach should be individualized based on the underlying cause and severity of the hiccups, with a focus on minimizing morbidity, mortality, and improving quality of life. In terms of specific treatment options, the 2022 study 3 provides strong evidence for the use of chlorpromazine in treating hiccups under general anesthesia, while other studies 4, 5, 6, 7 provide additional insights into the causes and management of postoperative hiccups.