Baclofen Dosing for Hiccups
Start baclofen at 5-10 mg three times daily (total 15-30 mg/day), with most patients requiring titration to 30-60 mg/day for effective hiccup control. 1
Initial Dosing Strategy
- Begin with 5 mg three times daily in older adults or patients at higher risk for side effects (sedation, cognitive impairment), as this population shows increased sensitivity to baclofen 1
- Standard starting dose is 10 mg three times daily for most adult patients, which represents the most commonly prescribed regimen 1, 2
- The therapeutic range typically falls between 30-60 mg total daily dose, though some patients respond at lower doses (15-30 mg/day) 1
Dose Titration Protocol
- Increase by 10 mg/day weekly if initial dosing proves inadequate, up to a maximum of 30 mg/day during titration 1
- Most patients who respond to baclofen will show improvement within 48 hours of reaching an effective dose 3
- The total daily dose range extends from 15-60 mg, with the majority of responders falling in the 30-60 mg range 1
Evidence Quality and Expected Outcomes
The evidence for baclofen's efficacy is mixed. A large 2024 multisite study of 301 patients found only 35% achieved hiccup palliation with baclofen, falling short of the 75% threshold for true clinical benefit 2. However, this same study suggested baclofen may be more effective for chronic hiccups (>48 hours duration) compared to acute cases 2. Earlier European data from 1995 showed more promising results, with 76% of patients (28 of 37) achieving complete resolution or considerable decrease in chronic hiccups 4.
Critical Monitoring Parameters
- Sedation and drowsiness are the most common adverse effects, particularly in older adults 1
- Monitor for cognitive impairment, muscle weakness, and urinary dysfunction, especially in elderly patients 1
- Renal impairment requires dose adjustment, as baclofen is renally cleared 1
- Use caution in patients with hepatic encephalopathy, as baclofen may worsen mental status 1
Important Caveats
- Never discontinue baclofen abruptly due to risk of central nervous system irritability and withdrawal symptoms 1
- If baclofen monotherapy fails after adequate trial at 30-60 mg/day, consider combination therapy with olanzapine (low-dose), which has shown success in refractory cases 5
- Baclofen appears more likely to benefit patients with chronic hiccups (>48 hours) rather than acute episodes 2
- The most distressing aspect for patients is typically interference with nutrition, sleep, and daily activities, making prompt treatment essential 3