From the Guidelines
For recurrent hiccup treatment, octreotide, alone or in combination with a corticosteroid, is a reasonable option. This approach is based on the most recent evidence from 2022, as outlined in a clinical practice guideline published in the Journal of Thoracic Oncology 1.
When considering treatment for recurrent hiccups, it's essential to prioritize interventions that are evidence-based and have a strong potential to improve morbidity, mortality, and quality of life. In this context, the use of octreotide, with or without a corticosteroid, emerges as a viable treatment strategy for managing uncontrolled diaphragmatic contractions.
Key points to consider in the management of recurrent hiccups include:
- The importance of evidence-based treatment options, such as octreotide, which has been considered in the context of patients with specific types of tumors 1.
- The potential for combination therapy, including the use of corticosteroids alongside octreotide, to enhance treatment efficacy.
- The need for a thorough medical evaluation to rule out underlying conditions that may be contributing to the recurrence of hiccups, ensuring that the treatment approach addresses the root cause of the symptom.
Given the potential for significant distress and impact on quality of life associated with recurrent hiccups, adopting a treatment strategy that includes octreotide, as supported by recent clinical guidelines 1, is a prudent approach. This recommendation prioritizes the most recent and highest quality evidence available, aiming to optimize outcomes in terms of morbidity, mortality, and quality of life for patients experiencing recurrent hiccups.
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 for recurrent hiccup (uncontrolled diaphragmatic contractions) is chlorpromazine at a dose 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 Recurrent Hiccup
- Pharmacologic interventions, such as chlorpromazine, amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid, have been proposed for the treatment of intractable and persistent hiccups 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
- A systematic review of interventions for treating persistent and intractable hiccups in adults found that there is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non-pharmacological interventions 4
- Metoclopramide has been reported to have effects on intractable hiccup, but there is limited evidence that describes the efficacy and safety of metoclopramide in the treatment of intractable hiccup 5
- A systematic review of the pathogenesis and pharmacological treatment of hiccups found that baclofen and metoclopramide are supported by small randomized, placebo-controlled trials, and observational data suggest that gabapentin and chlorpromazine are also effective 6
- First-line therapy for persistent and intractable hiccups may involve a proton pump inhibitor (PPI) and appropriate gastrointestinal consultation, with other etiologies such as central causes explored if symptoms persist 7
Non-Pharmacological Interventions
- Acupuncture techniques have been studied in the treatment of persistent and intractable hiccups, but the evidence is limited and of poor quality 4
- Physical maneuvers can often terminate acute hiccups, but are less effective for persistent and intractable hiccups 6
Future Research Directions
- There is a need for randomized, placebo-controlled trials of both pharmacological and non-pharmacological treatments for persistent and intractable hiccups 4, 5
- Further research is needed to determine the efficacy and safety of metoclopramide and other pharmacological agents in the treatment of intractable hiccup 5