From the Guidelines
Chlorpromazine is a recommended treatment option for intractable hiccups due to its effectiveness in treating nausea/vomiting and intractable hiccups, as noted in the study published in Pediatrics in 2016 1.
Treatment Options for Intractable Hiccups
Intractable hiccups, which are persistent and uncontrollable, require a comprehensive treatment approach. The treatment options can be categorized into non-pharmacological and pharmacological interventions.
Non-Pharmacological Interventions
Non-pharmacological interventions are typically the first line of treatment and include physical maneuvers such as:
- Breath holding
- Valsalva maneuver
- Breathing into a paper bag
- Drinking cold water
- Stimulating the back of the throat with a cotton swab
Pharmacological Interventions
If non-pharmacological interventions fail, pharmacological treatments are considered. Some of the effective pharmacological options include:
- Chlorpromazine, which can be used to treat intractable hiccups due to its anticholinergic properties, as mentioned in the study 1
- Other medications like baclofen, gabapentin, and metoclopramide may also be considered, but chlorpromazine is specifically noted for its effectiveness in treating intractable hiccups
Important Considerations
It is essential to address any underlying causes of intractable hiccups, such as gastroesophageal reflux disease, central nervous system disorders, metabolic disturbances, or medication side effects. Patients should be monitored for medication side effects, particularly sedation, and dosages should be adjusted based on response and tolerability.
Monitoring and Adjustments
Given the potential cardiac adverse effects of antipsychotics, such as QTc prolongation, close clinical observation, cardiorespiratory monitoring, pulse oximetry, and/or an electrocardiogram should be considered when administering these medications, as noted in the study 1.
From the FDA Drug Label
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 treatment option for intractable hiccups is chlorpromazine with a dosage of 25 mg to 50 mg taken three to four times a day. If symptoms persist for 2 to 3 days, parenteral therapy is indicated 2.
From the Research
Treatment Options for Intractable Hiccups
- Pharmacologic interventions:
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 3
- Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 3
- Baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner, while only baclofen and metoclopramide were studied in randomized controlled trials 3
- Non-pharmacological interventions:
- Acupuncture techniques have been studied in the treatment of persistent and intractable hiccups, but all four studies had a high risk of bias and did not compare the intervention with placebo 4
- Cervical phrenic nerve block under electromyography has been reported as a useful and discrete method for treating intractable hiccups 5
Specific Treatment Regimens
- Combination therapy with baclofen and low-dose olanzapine has been reported to be effective in treating intractable hiccups 6
- Monotherapy with baclofen has also been reported to be effective in treating intractable hiccups 7
Limitations of Current Evidence
- Strong evidence for a specific treatment regimen for intractable hiccups is lacking in the primary literature 6
- There is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non-pharmacological interventions 4
- The paucity of high-quality studies indicates a need for randomized placebo-controlled trials of both pharmacological and non-pharmacological treatments 4