Baclofen Dosing for Hiccups
Start baclofen at 5-10 mg three times daily (total 15-30 mg/day), with gradual weekly titration up to a maximum of 30-60 mg/day as needed for hiccup control. 1, 2
Initial Dosing Strategy
- Begin with 5-10 mg orally three times daily, which represents the standard starting dose for hiccup management 1
- The most commonly prescribed regimen in clinical practice is 10 mg three times daily (30 mg total daily dose) 3
- For elderly patients or those with increased sensitivity concerns, start lower at 5 mg twice daily and titrate more cautiously 1, 2
Titration Protocol
- Increase the dose by 10 mg/day weekly if hiccups persist, up to a maximum of 30 mg/day initially 1, 2
- The typical effective total daily dose range is 30-60 mg/day, with most patients responding within this range 1, 2
- Continue titration beyond 30 mg/day only if partial response is observed and side effects are tolerable 1
Duration-Based Considerations
Baclofen appears more effective for chronic hiccups (>48 hours duration) compared to acute hiccups. 3 In a large 2024 multisite study of 301 patients, baclofen showed better efficacy in chronic hiccup cases (OR 0.51,95% CI: 0.29-0.91, p=0.02) 3. However, this same study found only 35% overall palliation rate, falling short of the 75% threshold for true clinical benefit 3.
Despite this recent negative study, older case series from 1995 showed 76% of patients (28/37) achieved complete resolution or considerable decrease in chronic hiccups with baclofen 4, suggesting it remains a reasonable first-line option, particularly for chronic cases.
Special Population Adjustments
- Patients with hepatic encephalopathy: Use with extreme caution or avoid entirely, as baclofen may worsen mental status 5, 1
- Renal impairment: Dose reduction required since baclofen is primarily renally excreted 5, 2
- Elderly patients: Start at 5 mg twice daily with slower titration (increase by 5 mg every 5-7 days) to minimize sedation and cognitive effects 1, 2
Monitoring and Side Effects
- Primary side effects include sedation, drowsiness, dizziness, and muscle weakness 2
- In the 2024 study, adverse events occurred in 15 patients with drowsiness being most common 3
- Monitor for cognitive impairment, muscle weakness, and urinary dysfunction, especially in older adults 1, 2
- Never discontinue abruptly—taper gradually to avoid CNS irritability and withdrawal symptoms 1, 2
Mechanism and Clinical Context
Baclofen works as a GABA-B receptor agonist and muscle relaxant, theoretically blocking the hiccup reflex arc by activating inhibitory neurotransmitters 1, 6
Alternative Considerations
If baclofen fails after adequate trial (4-6 weeks at therapeutic doses), consider gabapentin as an alternative, which has shown rapid efficacy (within 24 hours) at low doses (100 mg twice daily) with fewer CNS side effects in case reports 7. Combination therapy with olanzapine has also been reported successful in refractory cases 6.