Metoclopramide Dosing for Hiccups
For treating hiccups, metoclopramide should be administered at a dose of 10 mg three times daily for up to 15 days. 1
Evidence-Based Dosing Recommendations
- The most recent and highest quality evidence comes from a multicentre, randomized controlled pilot study that demonstrated significant efficacy of metoclopramide at a dose of 10 mg three times daily for 15 days for treating intractable hiccups 1
- Metoclopramide has been shown to be effective for both treatment and prevention of hiccups with a relative risk of 2.75 (95% CI: 1.09-6.94) compared to placebo 1
- For patients experiencing hiccups related to dexamethasone therapy, low-dose oral metoclopramide has been shown to effectively prevent recurrence of hiccups 2
Administration Routes and Considerations
- Metoclopramide can be administered:
Safety Considerations
Common adverse effects of metoclopramide when used for hiccups include:
- Fatigue
- Upset mood
- Dizziness 1
More serious but less common adverse effects may include:
- Extrapyramidal symptoms (particularly with prolonged use)
- Tardive dyskinesia (with long-term use)
- QT interval prolongation 3
Alternative Treatments
If metoclopramide is ineffective or contraindicated, consider:
- Baclofen: Has been studied in randomized controlled trials for hiccups 4
- Gabapentin: Has shown efficacy in prospective studies 4
- Chlorpromazine: The only FDA-approved medication specifically for hiccups 4
Clinical Pearls
- Metoclopramide works through both central dopamine antagonism and peripheral effects on gastric motility, which may explain its efficacy in treating hiccups 4
- While metoclopramide is commonly used for hiccups, it is important to identify and treat any underlying cause of persistent hiccups 4
- For patients requiring colonoscopy preparation who may be prone to hiccups, metoclopramide 10 mg can be administered intravenously approximately 30 minutes before the purge for its prokinetic and antiemetic properties 3