What is the treatment for hiccups (synchronous diaphragmatic contractions)?

From the Guidelines

For hiccups, chlorpromazine is a viable treatment option, as it has been used to treat intractable hiccups, according to a study published in Pediatrics 1. When considering treatment for hiccups, it's essential to evaluate the potential benefits and risks of each option.

• 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 eating a teaspoon of granulated sugar may be effective in interrupting the hiccup reflex or stimulating the vagus nerve.
• Over-the-counter medications like simethicone (Gas-X) may also be considered for persistent hiccups.
• However, for severe cases, prescription options such as chlorpromazine (25-50 mg) may be necessary, as it has been used to treat intractable hiccups, as mentioned in the study published in Pediatrics 1. It's crucial to note that most hiccup episodes are brief and resolve on their own within minutes, but if hiccups persist for more than 48 hours, seeking medical attention is recommended, as this could indicate an underlying medical condition.
• Avoiding triggers like carbonated beverages, alcohol, and eating too quickly may help prevent hiccups from occurring.
• The study published in Pediatrics 1 highlights the importance of monitoring patients who receive antipsychotics, including chlorpromazine, due to potential cardiac adverse effects, such as QTc prolongation.

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. For intractable hiccups, the recommended dosage is 25 mg to 50 mg of chlorpromazine, taken three to four times a day. If symptoms persist for 2 to 3 days, parenteral therapy may be necessary 2.

From the Research

Treatment Options for Hiccups

• Pharmacological treatments:
  • Chlorpromazine 3, 4, 5
  • Gabapentin 3, 4, 5
  • Baclofen 3, 4, 5
  • Metoclopramide 4, 5
  • Amitriptyline, haloperidol, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 4
  • Lansoprazole, clonazepam, and dimenhydrinate 6
• Non-pharmacological approaches:
  • Nerve blockade 3
  • Pacing 3
  • Acupuncture 3
  • Measures to hold breathing 3
  • Physical maneuvers 7, 5
• Lifestyle changes:
  • Treatment of underlying conditions such as gastroesophageal reflux and gastritis 7
  • Avoiding overdistension of the stomach 7

Considerations for Treatment

• The treatment of hiccups should be directed at the underlying cause whenever possible 7, 5
• Persistent or intractable hiccups can be a harbinger of serious medical pathology 7
• There are no formal guidelines for the treatment of hiccups, and most methods are based on case reports and anecdotal evidence 7