What medications can be used to treat synchronous diaphragmatic contractions (hiccups)?

From the Guidelines

Chlorpromazine is the most effective medication for treating intractable hiccups, as evidenced by its use in clinical settings 1. When considering treatment options for hiccups, it's essential to evaluate the potential benefits and risks of each medication.

• Chlorpromazine, a phenothiazine, has been used to treat nausea/vomiting and intractable hiccups, making it a viable option for patients experiencing persistent hiccups 1.
• Other medications, such as antipsychotics and benzodiazepines, may have additive effects when used together, but their use should be carefully considered due to potential cardiac adverse effects, such as QTc prolongation 1.
• The choice of medication should be based on the individual patient's needs and medical history, taking into account potential side effects and interactions with other medications.
• It's crucial to monitor patients receiving antipsychotics closely, including cardiorespiratory monitoring, pulse oximetry, and/or an electrocardiogram, to minimize the risk of adverse effects 1.
• In clinical practice, the goal is to prioritize medications with the most significant benefit and minimal risk, making chlorpromazine a reasonable choice for treating intractable hiccups, as supported by the available evidence 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.

• Chlorpromazine can be used to try to treat hiccups, with a dosage of 25 mg to 50 mg taken three or four times a day. 2

From the Research

Medications for Treating Hiccups

• Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 3
• Metoclopramide is another widely employed agent for treating hiccups 4, 3
• Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include:
  • Amitriptyline 3
  • Baclofen 3, 5, 6, 7
  • Gabapentin 3
  • Haloperidol 3
  • Midazolam 3
  • Nifedipine 3
  • Nimodipine 3
  • Orphenadrine 3
  • Valproic acid 3
  • Lansoprazole, clonazepam, and dimenhydrinate have also been used in combination to treat intractable hiccups 5
  • Olanzapine has been used in combination with baclofen to treat intractable hiccups 7
  • Piracetam has been reported to have favourable experiences in treating hiccups 6

Mechanism of Action

• The exact mechanism of action for some of these medications is not fully understood, but it is thought that they may work by:
  • Stimulating the uvula or pharynx or disrupting diaphragmatic rhythm 4
  • Activating inhibitory neurotransmitters, such as GABA 7
  • Augmenting phrenic motoneuronal activity on the reflex arcs involved in the generation of hiccups 7
  • Antagonizing dopamine D₂-receptors 7