Can Xanax Cause Hiccups the Next Morning?
No, alprazolam (Xanax) is not a recognized cause of hiccups, and there is no established mechanism linking benzodiazepines taken at bedtime to next-morning hiccups.
Evidence Review
While benzodiazepines have been mentioned in the literature as potentially associated with hiccups, the evidence is extremely weak and does not support a causal relationship, particularly for next-morning symptoms after bedtime dosing.
Benzodiazepine-Hiccup Association
A 1997 systematic review concluded that despite benzodiazepines being mentioned frequently in case reports, there is insufficient evidence for any drug to be considered causative in the etiology of hiccups 1
Three case reports from 2005 described hiccups occurring in healthy subjects during clinical trials of lormetazepam and lorazepam, but these occurred during active drug effect (within 3-4 hours of administration), not the following morning 2
The hiccups in these cases resolved spontaneously within 10-45 minutes and occurred while the drug was at peak plasma levels 2
Timing Inconsistency
The temporal relationship in your question doesn't align with known pharmacology:
Alprazolam has a half-life of 11-16 hours, meaning morning levels would be lower than nighttime levels 1
All documented benzodiazepine-associated hiccups occurred during peak drug effect, not during elimination phase the next morning 2
If alprazolam were causing hiccups, they would be expected shortly after taking the medication at bedtime, not emerging 8+ hours later 2
Other Medications More Strongly Associated
Aripiprazole (an antipsychotic) has multiple case reports of causing hiccups, including next-morning hiccups when combined with methylphenidate 3, 4
Eszopiclone (a non-benzodiazepine hypnotic) has been documented to cause intermittent hiccups during sleep 5
Corticosteroids have been mentioned more frequently than benzodiazepines in hiccup case reports 1
Alternative Explanations to Consider
Gastroesophageal reflux: Lying flat after taking medication can trigger reflux-induced hiccups in the morning
Other medications: Review all medications, particularly antipsychotics, corticosteroids, or other hypnotics 3, 4, 1
Unrelated causes: Idiopathic hiccups, gastric distension, or other organic causes are far more common than drug-induced hiccups 4
Clinical Recommendation
The hiccups are almost certainly unrelated to the Xanax taken the night before. If hiccups persist or recur, evaluate for:
- Gastroesophageal reflux disease (GERD) 4
- Other medications taken concurrently 3, 1
- Organic causes (gastric distension, diaphragmatic irritation) 4
There is no need to discontinue alprazolam based on this temporal association, as the evidence does not support causation 1, 2.