From the Guidelines
Chlorpromazine is the recommended injectable treatment for intractable hiccups, with a typical dose of 25-50mg IV or IM, due to its effectiveness and rapid onset of action within 5-10 minutes 1.
Key Considerations
- Chlorpromazine, a phenothiazine, has been used to treat nausea/vomiting and intractable hiccups, making it a suitable option for patients with these conditions.
- The medication works by targeting dopamine receptors, which are involved in the hiccup reflex.
- Potential side effects include sedation, hypotension, and extrapyramidal symptoms, emphasizing the need for careful monitoring of vital signs during administration.
Alternative Options
- Haloperidol (2-5mg IV or IM) can be used as an alternative when chlorpromazine is unavailable or contraindicated.
- Benzodiazepines, such as midazolam (2-5mg IV) or lorazepam (1-2mg IV), may be effective for patients with anxiety-related hiccups.
- Baclofen (5-10mg IV) can be used for hiccups related to neurological disorders, acting as a GABA-B agonist.
Administration and Monitoring
- Treatment duration is typically short-term until hiccups resolve, with transition to oral therapy if needed for persistent cases.
- Monitoring vital signs, particularly blood pressure, is essential during administration, especially with chlorpromazine due to its potential to cause hypotension.
From the Research
Injectable Treatment for Intractable Hiccups
- Metoclopramide has been reported to have effects on intractable hiccup, with a study showing its effectiveness and safety in treating patients with intractable hiccup 2.
- A systematic review identified 10 pharmacologic treatment options, including metoclopramide, that were successful in treating hiccups, although no specific recommendations can be made due to limited evidence 3.
- A multicentre, randomised, controlled pilot study found that metoclopramide was effective in treating patients with intractable hiccups, with a higher total efficacy compared to placebo 4.
- Other pharmacologic agents, such as risperidone, have also been reported to be effective in treating intractable hiccups, suggesting that the serotonergic system may be involved in the pathophysiology of some hiccup cases 5.
- The following pharmacologic agents have been found to be successful in treating hiccups: