From the Research
For hiccups persisting after dexamethasone treatment, consider metoclopramide 10mg three times daily as a first-line medication option, as it has been shown to be effective in relieving hiccups in patients receiving dexamethasone 1.
Treatment Options
- Metoclopramide 10mg three times daily can be used to relieve hiccups in patients receiving dexamethasone 1
- Alternative medications include baclofen 5-10mg three times daily, chlorpromazine 25-50mg orally or intramuscularly, gabapentin 300-900mg daily in divided doses, or haloperidol 1-2mg twice daily
- Non-pharmacological approaches worth trying include breathing into a paper bag for a few minutes, drinking water from the opposite side of a glass while bending forward, or stimulating the pharynx with a nasopharyngeal swab
Underlying Causes
- Persistent hiccups after dexamethasone may be due to steroid-induced gastric irritation or central nervous system effects
- If hiccups persist beyond 48 hours despite these interventions, consider consulting a gastroenterologist or neurologist to evaluate for underlying causes such as phrenic nerve irritation, central nervous system disorders, or gastrointestinal issues
- Addressing any underlying acid reflux with proton pump inhibitors like omeprazole 20mg daily may also help resolve steroid-induced hiccups
Important Considerations
- Dexamethasone can cause persistent hiccups, which can be severely uncomfortable and significantly diminish patient quality of life 2
- Termination of dexamethasone can gradually relieve hiccups, but alternative treatments may be necessary to manage symptoms 2
- Corticosteroid rotation to alleviate dexamethasone-induced hiccup may be an effective strategy, as switching to an equipotent dosage of either methylprednisolone or prednisolone has been shown to resolve hiccups while maintaining adequate control of chemotherapy-induced nausea and vomiting 3