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 in 2016 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 can be effective in interrupting the hiccup reflex or stimulating the vagus nerve.
- Medications like chlorpromazine (25-50 mg) can be used to treat persistent hiccups, as mentioned in the study 1.
- It's crucial to note that chlorpromazine, a phenothiazine, may have anticholinergic properties, which can worsen certain conditions, such as anticholinergic delirium, but its use in treating hiccups is supported by the available evidence 1.
- If hiccups persist for more than 48 hours, it's essential to seek medical attention, as they may indicate an underlying condition.
- Preventive measures, such as avoiding carbonated beverages, alcohol, and large meals, can help reduce the occurrence of hiccups in prone individuals.
- Staying hydrated and remaining calm can also help alleviate hiccup episodes, as stress can sometimes trigger or worsen them.
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
- 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 3
- The adjuvant use of lansoprazole, clonazepam, and dimenhydrinate has been reported to be successful in treating intractable hiccups in a patient with gastritis and reflux esophagitis complicated with myocardial infarction 4
- Treatment of hiccups should be directed at the underlying cause whenever possible, and may include lifestyle changes, physical maneuvers, pharmacotherapy, and surgical intervention 5
- First-line therapy for persistent hiccups may involve a proton pump inhibitor (PPI) and appropriate gastrointestinal consultation, with other etiologies such as central causes explored if symptoms persist 6
- Baclofen and gabapentin may be considered as first-line therapy for persistent and intractable hiccups, with metoclopramide and chlorpromazine in reserve, based on limited efficacy and safety data 7
Pharmacologic Agents for Hiccups
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 3
- Baclofen, gabapentin, and metoclopramide have been studied in prospective manner, with baclofen and metoclopramide also studied in randomized controlled trials 3
- Lansoprazole, clonazepam, and dimenhydrinate have been reported to be effective in treating intractable hiccups in a case report 4
- Gabapentin and chlorpromazine are also effective in treating hiccups, based on observational data 7
Underlying Causes of Hiccups
- Overdistension of the stomach is the most commonly identifiable cause of acute hiccups, followed by gastroesophageal reflux and gastritis 5
- Persistent or intractable hiccups can be a harbinger of serious medical pathology, including underlying gastrointestinal, neurological, cardiovascular, pulmonary, infectious, and psychogenic disorders 5
- The most common cause of persistent hiccups involves GERD, and first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation 6