From the Guidelines
Chlorpromazine, a phenothiazine, is known to be used to treat intractable hiccups, but on the other hand, certain medications such as antipsychotics, particularly those with anticholinergic properties, may worsen or cause intractable hiccups.
Medications Causing Intractable Hiccups
Several medications can cause intractable hiccups, including:
- Antipsychotics, due to their anticholinergic properties 1
- Certain antibiotics, such as macrolides and fluoroquinolones, which can prolong the QT interval and potentially lead to hiccups 1
- Antiemetics, like ondansetron and dolasetron, which can also prolong the QT interval 1
- Other medications, including mood-stabilizing agents, antihistamines, and respiratory tract medications 1
Mechanism and Risk Factors
These medications can trigger hiccups by irritating the vagus or phrenic nerves, affecting the central nervous system's hiccup reflex arc, or causing electrolyte imbalances that disrupt normal diaphragm function. The risk of medication-induced hiccups varies based on dosage, individual sensitivity, and concurrent medical conditions.
Management and Treatment
If you develop persistent hiccups while taking any medication, don't stop the medication abruptly but consult your healthcare provider, who may adjust your dosage, switch to an alternative medication, or prescribe treatments specifically for the hiccups, such as chlorpromazine 1.
From the Research
Medications Causing Intractable Hiccups
There are several medications that can cause intractable hiccups, including:
- Dopamine-blocking medications, such as haloperidol and chlorpromazine 2, 3
- Certain antidepressants, such as amitriptyline 2
- Anticonvulsants, such as gabapentin and valproic acid 2, 4
- Muscle relaxants, such as baclofen and cyclobenzaprine 5, 2
- Benzodiazepines, such as midazolam and lorazepam 5, 2
Mechanism of Action
The exact mechanism of action for these medications in causing intractable hiccups is not fully understood, but it is thought to involve the disruption of normal neurotransmitter activity in the brain and spinal cord 5, 4. For example, dopamine-blocking medications may interfere with the normal functioning of the phrenic nerve, which controls the diaphragm 2.
Treatment Options
Treatment options for intractable hiccups caused by medications include:
- Discontinuing the offending medication, if possible 6
- Trying alternative medications, such as baclofen or gabapentin, which have been shown to be effective in treating intractable hiccups 5, 2, 3
- Using other pharmacological agents, such as metoclopramide or chlorpromazine, which have been reported to be effective in some cases 2, 3