From the Guidelines
For persistent hiccups, chlorpromazine is a viable treatment option due to its effectiveness in treating intractable hiccups, as noted in the study published in Pediatrics 1. When considering treatment options for persistent hiccups, it's essential to evaluate the potential benefits and risks of each medication.
- Chlorpromazine, a phenothiazine, has been used to treat nausea, vomiting, and intractable hiccups, making it a potential option for patients with persistent hiccups.
- The study published in Pediatrics 1 highlights the importance of monitoring patients who receive antipsychotics, including chlorpromazine, due to potential cardiac adverse effects such as QTc prolongation.
- However, in the context of treating persistent hiccups, the benefits of chlorpromazine may outweigh the risks, especially if other treatment options have been exhausted. Some key points to consider when treating persistent hiccups include:
- Simple remedies like drinking cold water, gargling with ice water, or stimulating the back of the throat with a spoon may be effective in some cases.
- Medical treatments like baclofen, metoclopramide, or gabapentin may be considered if simple remedies are ineffective.
- For severe cases lasting more than a month, nerve blocks or surgical interventions might be necessary.
- Underlying conditions like gastroesophageal reflux should be evaluated and treated accordingly, as they may be contributing to the persistence of hiccups. It's crucial to consult a healthcare provider for hiccups lasting more than 48 hours to determine the best course of treatment and rule out any underlying conditions that may require specific attention, as noted in the study 1.
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. For intractable hiccups, the recommended dosage of chlorpromazine is 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
Options for Persistent Hiccoughs or Hiccups
There are several options available for treating persistent hiccoughs or hiccups, including:
- Pharmacologic interventions:
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 3
- Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 3
- Non-pharmacologic interventions:
- Surgical interventions:
- Phrenic nerve crushing, blockade, or pacing have been used to treat intractable hiccups, but these procedures are rarely undertaken 4
Pharmacologic Treatment Options
Some pharmacologic treatment options that have been studied for their effectiveness in treating persistent hiccoughs or hiccups include:
- Metoclopramide:
- A multicentre, randomised, controlled pilot study found that metoclopramide was effective in treating patients with intractable hiccups, with a higher total efficacy and overall efficacy compared to placebo 6
- A systematic review and meta-analysis protocol has been developed to evaluate the effectiveness and safety of metoclopramide in treating patients with intractable hiccup 7
- Baclofen and gabapentin:
- These agents have been studied in prospective trials and randomized controlled trials for their effectiveness in treating intractable and persistent hiccups 3
Limitations of Current Evidence
There is limited evidence available to guide the treatment of persistent or intractable hiccups, and most studies have a high risk of bias 5. Further research is needed to determine the effectiveness and safety of different interventions for treating persistent hiccoughs or hiccups.