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 treatment for intractable hiccups is chlorpromazine (PO) 25 mg to 50 mg t.i.d. or q.i.d. If symptoms persist for 2 to 3 days, parenteral therapy is indicated 1.
From the Research
For hiccups, the most effective treatment approach is to try simple remedies first, and if they persist, consider medication such as baclofen or gabapentin, as they have shown promise in treating persistent and intractable hiccups with minimal side effects 2.
Treatment Approach
When dealing with hiccups, it's essential to start with non-pharmacological interventions. Simple remedies like drinking a glass of cold water quickly, 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 hiccup reflex.
Medication
If hiccups persist beyond 48 hours, medication may be necessary. Based on the most recent and highest quality study, baclofen and gabapentin are considered first-line therapy for persistent and intractable hiccups due to their efficacy and safety profile 2. Baclofen can be administered at a dose of 5-10mg orally three times daily, while gabapentin can be given at a dose of 100-300mg orally three times daily. Metoclopramide and chlorpromazine may also be considered, but they are generally reserved for cases where baclofen and gabapentin are not effective or tolerated.
Severe Cases
In severe cases of hiccups lasting days or weeks, a nerve block procedure may be considered. However, this should only be done under the guidance of a healthcare professional.
Importance of Medical Attention
It's crucial to seek medical attention if hiccups persist beyond two days or interfere with eating, sleeping, or breathing. Hiccups can be a symptom of an underlying condition, and prompt medical attention can help identify and treat the underlying cause. Some key points to consider when treating hiccups include:
- Starting with simple remedies before moving to medication
- Considering baclofen and gabapentin as first-line therapy for persistent and intractable hiccups
- Reserving metoclopramide and chlorpromazine for cases where baclofen and gabapentin are not effective or tolerated
- Seeking medical attention if hiccups persist or interfere with daily activities.