Metoclopramide for Hiccups
Metoclopramide is an effective treatment option for hiccups, particularly when associated with gastrointestinal disorders or gastroparesis, but should be limited to short-term use (less than 12 weeks) due to serious FDA warnings about extrapyramidal side effects including tardive dyskinesia. 1
When to Use Metoclopramide
- Metoclopramide is particularly useful when hiccups are associated with gastrointestinal disorders or gastroparesis, as it improves gastric motility. 1
- The drug has demonstrated effectiveness in case reports and observational studies, with relief typically occurring within 30 minutes of administration and lasting up to 8 hours. 2
- Both baclofen and metoclopramide are the only agents studied in randomized controlled trials for hiccups, giving them stronger evidence than other pharmacologic options. 3
Dosing and Administration
- Low-dose oral metoclopramide can effectively prevent and treat hiccups without requiring high doses. 4
- The drug can be administered orally or parenterally depending on clinical circumstances. 2
Critical Safety Warnings
- The FDA has issued serious warnings about prolonged use (>12 weeks) of metoclopramide, including extrapyramidal symptoms such as tardive dyskinesia. 1
- The drug is contraindicated in patients with seizure disorders, GI bleeding, GI obstruction, and pheochromocytoma. 1, 5
- Use with extreme caution in elderly patients and those with renal or hepatic impairment, as these populations are at higher risk for adverse effects. 1
- Regular neurological monitoring for signs of extrapyramidal symptoms is essential, especially with any extended use. 5
- Monitor for drowsiness, diarrhea, and muscle weakness during treatment. 1
Alternative Treatment Options
- Gabapentin is an alternative pharmacologic option with evidence of efficacy for hiccups and may be preferred for longer-term management given metoclopramide's safety concerns. 1
- Haloperidol and midazolam are other alternatives, though chlorpromazine remains the only FDA-approved drug specifically for hiccups. 1, 3
- Baclofen has been studied in randomized controlled trials and represents another evidence-based option. 3
Clinical Pitfalls to Avoid
- Do not use metoclopramide for more than 12 weeks due to the risk of irreversible tardive dyskinesia. 1
- Do not overlook contraindications, particularly seizure history and GI obstruction, as these can lead to serious complications. 5
- Do not assume all hiccup cases require the same treatment—therapy selection should account for underlying etiology (e.g., GI-related vs. neurologic vs. medication-induced). 3