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. The assessment and management of intractable hiccups with chlorpromazine (PO) involves administering a dose of 25 mg to 50 mg three to four times a day. If symptoms persist for 2 to 3 days, consideration should be given to parenteral therapy 1.
- Key points:
- Initial dose: 25 mg to 50 mg
- Frequency: t.i.d. or q.i.d.
- Duration: Reassess after 2 to 3 days if symptoms persist
- Alternative route: Parenteral therapy may be indicated if symptoms persist 1.
From the Research
Hiccups should be managed with a stepwise approach starting with simple physical maneuvers before progressing to medications if persistent. For acute hiccups, try physical techniques such as breath holding, drinking cold water, gargling with ice water, or stimulating the posterior pharynx with a soft object 2. If hiccups persist beyond 48 hours, consider pharmacological treatment. First-line medications include baclofen (5-10 mg three times daily), chlorpromazine (25-50 mg intramuscularly or intravenously), or metoclopramide (10 mg three times daily) 3. For refractory cases, gabapentin (300-900 mg daily in divided doses), pregabentin (150-600 mg daily in divided doses), or valproic acid (250-500 mg twice daily) may be effective 4.
Some key points to consider in the management of hiccups include:
- Always investigate underlying causes of persistent hiccups, including gastroesophageal reflux disease, central nervous system disorders, metabolic disturbances, or medication side effects 2.
- Treatment should address these underlying conditions when identified.
- In severe cases lasting more than a month (intractable hiccups), consider referral to a specialist for evaluation of interventional procedures such as phrenic nerve block or surgical intervention.
- Hiccups result from involuntary contractions of the diaphragm followed by glottic closure, often due to irritation of the vagus or phrenic nerves, which explains why treatments targeting these pathways are effective 2.
It's also important to note that while various medications can be used to treat hiccups, the evidence for their effectiveness is not always strong, and treatment selection should be individualized based on the patient's specific situation and underlying conditions 3, 4. Studies such as 5 and 6 provide information on the pharmacology of certain medications that might be used in the treatment of conditions associated with hiccups, but they do not directly address the management of hiccups themselves. Therefore, they are not directly relevant to the stepwise approach recommended for managing hiccups.