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.
To treat intractable hiccups, use chlorpromazine (PO) with a dosage of 25 mg to 50 mg taken three or four times a day. If symptoms persist for 2 to 3 days, consider parenteral therapy 1.
From the Research
To treat hiccups, baclofen (5-10mg three times daily) is the most recommended medication due to its efficacy and safety profile, as supported by the most recent and highest quality study 2. When treating hiccups, it's essential to consider the potential underlying causes and the patient's overall health status. Simple home remedies such as sipping cold water slowly, holding your breath for 10-20 seconds, breathing into a paper bag for a few minutes, or gargling with ice water can help reset the diaphragm's normal rhythm by interrupting the spasm cycle. For persistent hiccups, swallowing a teaspoon of granulated sugar dry may stimulate the vagus nerve and stop the hiccup reflex.
If hiccups last longer than 48 hours, medical treatment may be necessary. Medications that doctors might prescribe include:
- Baclofen (5-10mg three times daily)
- Metoclopramide (10mg)
- Chlorpromazine (25-50mg) These medications work by either reducing diaphragm irritability or affecting the nerves involved in the hiccup reflex. It's crucial to note that most hiccups are harmless and resolve on their own, but persistent hiccups may indicate an underlying medical condition that requires evaluation.
The use of baclofen is supported by several studies, including a systematic review that found it to be effective in treating persistent and intractable hiccups 3. Additionally, a case report found that baclofen was unsuccessful in alleviating hiccups, but chlorpromazine was effective in providing relief 2. However, based on the most recent and highest quality study, baclofen remains the most recommended medication for treating hiccups.
Some key points to consider when treating hiccups include:
- Identifying and addressing any underlying medical conditions that may be contributing to the hiccups
- Using a step-wise approach to treatment, starting with simple home remedies and progressing to medical treatment if necessary
- Selecting medications based on their efficacy, safety profile, and potential interactions with other medications the patient may be taking
- Monitoring the patient's response to treatment and adjusting the treatment plan as needed.