From the Guidelines
Chlorpromazine is the most effective medication for treating intractable hiccups, as evidenced by its use in various clinical settings 1. When considering the treatment of hiccups, it's essential to differentiate between brief episodes and persistent or intractable cases. For brief episodes, physical maneuvers such as holding your breath, breathing into a paper bag, or stimulating the back of the throat can be effective. However, for persistent hiccups, medication therapy is often necessary.
Medication Options
Some key medication options for treating hiccups include:
- Chlorpromazine, a phenothiazine that can be used to treat nausea/vomiting and intractable hiccups, as mentioned in the study 1
- Other medications like baclofen, metoclopramide, gabapentin, or pregabalin may also be considered for refractory cases
Important Considerations
It's crucial to identify and treat any underlying causes of hiccups, such as gastroesophageal reflux disease, medication side effects, or metabolic disorders. If hiccups persist beyond two weeks, specialty consultation is recommended, as nerve blocks or surgical interventions might be necessary in rare cases.
Safety and Monitoring
When using antipsychotics like chlorpromazine, close clinical observation, cardiorespiratory monitoring, pulse oximetry, and/or an electrocardiogram are essential to monitor for potential cardiac adverse effects, such as QTc prolongation 1.
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. If symptoms persist for 2-3 days after trial with oral therapy, give 25 to 50 mg (1-2 mL) IM. Should symptoms persist, use slow IV infusion with patient flat in bed: 25 to 50 mg (1-2 mL) in 500 to 1000 mL of saline.
Treatment of Intractable Hiccups: The recommended dosage for intractable hiccups is 25 mg to 50 mg of chlorpromazine orally three to four times a day. If symptoms persist for 2 to 3 days, parenteral therapy with 25 to 50 mg of chlorpromazine intramuscularly (IM) is indicated. If symptoms still persist, a slow IV infusion with the patient in a flat position can be used, with 25 to 50 mg of chlorpromazine in 500 to 1000 mL of saline 2, 3.
From the Research
Treatment Options for Hiccups
- Various pharmacologic treatments have been proposed for intractable and persistent hiccups, including chlorpromazine, amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 4
- First-line therapy for persistent hiccups should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation, especially if the cause involves GERD 5
- Gabapentin has been found to be effective in the treatment of persistent or intractable hiccups, with positive therapeutic outcomes in all cases, and is well tolerated with only minor adverse effects 6
- Vagus nerve stimulation (VNS) is a novel surgical option for the treatment of intractable hiccups, with some cases showing significant improvement in symptoms 7
- Oral application of lidocaine has also been found to be successful in treating intractable hiccups in some patients, particularly those with cancer 8
Pharmacologic Agents
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 4
- Baclofen, gabapentin, and metoclopramide have been studied in prospective manner and randomized controlled trials for the treatment of hiccups 4
- Other pharmacologic agents, such as amitriptyline, haloperidol, and valproic acid, have been found to be successful in treating hiccups in some cases 4