What are the treatments for getting rid of hiccups?

How to Get Rid of Hiccups

For acute, self-limited hiccups, start with the HAPI (Hiccup relief using Active Prolonged Inspiration) technique: inspire maximally and continue attempting to inspire with an open glottis for 30 seconds, followed by slow expiration, which provides immediate relief in most cases. 1

Non-Pharmacological Approaches for Acute Hiccups

Simple physical maneuvers should be your first-line treatment:

• The HAPI technique involves maximal inspiration held for 30 seconds while continuing to attempt inspiration with an open glottis, followed by slow expiration—this was successful in eliminating hiccups in 21 out of 21 patients studied, including one with prolonged hiccups 1

• Larson's maneuver (applying deep pressure between the posterior border of the mandible and mastoid process while performing jaw thrust) can terminate hiccups 2

• Traditional measures that stimulate the uvula/pharynx or disrupt diaphragmatic rhythm (such as breath-holding maneuvers) are simple and often effective for benign, self-limited hiccups 3

Pharmacological Treatment for Persistent/Intractable Hiccups

If hiccups persist beyond 48 hours or simple measures fail, initiate chlorpromazine as it is the most established pharmacological treatment:

• Chlorpromazine 25-50 mg orally three to four times daily is FDA-approved specifically for intractable hiccups 4

  • If symptoms persist for 2-3 days on oral therapy, parenteral administration may be indicated 4
  • Important caveat: Chlorpromazine can cause hypotension, sedation, extrapyramidal symptoms, and QT interval prolongation 5

• Alternative pharmacological agents when chlorpromazine is contraindicated or ineffective include:

  • Baclofen has emerged as a safe and often effective treatment 6
  • Metoclopramide is widely employed 3, 6
  • Gabapentin is another option 7

When to Investigate Further

Persistent hiccups (>48 hours) or intractable hiccups (>2 months) require diagnostic evaluation to identify underlying causes:

• Upper gastrointestinal pathology (gastric/duodenal ulcers, gastritis, esophageal reflux) is commonly observed and should be investigated systematically with endoscopy, pH monitoring, and manometry 6

• Central nervous system causes include brain tumors, traumatic brain injury, and stroke 5, 7

• Peripheral causes include myocardial infarction, phrenic nerve irritation, and various medications 7, 6

• Untreated persistent hiccups can lead to weight loss, depression, and sleep deprivation 5, 6

Special Situations

For hiccups occurring during anesthesia or in the perioperative period:

• Propofol 1-2 mg/kg IV may be effective 2
• If associated with laryngospasm, follow the laryngospasm treatment algorithm including positive pressure ventilation with 100% oxygen 8, 2