From the Guidelines
For hiccups lasting 2 days, chlorpromazine (25-50mg orally or 25mg intramuscularly) is a recommended treatment option, as it has been used to treat intractable hiccups, according to the study published in Pediatrics in 2016 1.
Treatment Options
- Simple remedies: drink a glass of cold water quickly, hold your breath for 10-20 seconds, breathe into a paper bag for a few minutes, or eat a teaspoon of granulated sugar
- Over-the-counter medications: simethicone (Gas-X, 125mg) or baclofen (5-10mg three times daily with physician guidance)
- Prescription options: metoclopramide (10mg three times daily), or gabapentin (300mg three times daily)
Mechanism of Action
Hiccups occur when your diaphragm involuntarily contracts while your vocal cords simultaneously close, causing the characteristic "hic" sound. Most remedies work by interrupting this reflex pathway or relaxing the diaphragm.
Important Considerations
If hiccups persist beyond 48 hours despite these interventions, seek medical attention as they could indicate an underlying condition requiring professional evaluation and treatment. Additionally, when using antipsychotics like chlorpromazine, monitoring patients for potential cardiac adverse effects, such as QTc prolongation, is crucial 1.
Alternative Treatments
Other studies, such as the one published in the Journal of the National Comprehensive Cancer Network in 2016, suggest alternative treatments for nausea and vomiting, which may also be applicable to hiccups, including the use of dopamine receptor antagonists, 5-HT3 antagonists, and corticosteroids 1. However, these treatments may not be directly applicable to hiccups and should be used with caution and under medical guidance.
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.
The management of hiccups that have lasted for 2 days involves administering 25 mg to 50 mg of chlorpromazine t.i.d. or q.i.d. If the symptoms persist, parenteral therapy is indicated 2.
From the Research
Managing Hiccups
To manage hiccups that have lasted for 2 days, several pharmacologic interventions can be considered.
- The US Food and Drug Administration has approved chlorpromazine for the treatment of hiccups 3.
- Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 3.
- Baclofen, gabapentin, and metoclopramide have been studied in a prospective manner, with baclofen and metoclopramide being studied in randomized controlled trials 3.
- The use of baclofen and metoclopramide is supported by small randomized, placebo-controlled trials, while observational data suggest that gabapentin and chlorpromazine are also effective 4.
- Baclofen and gabapentin may be considered as first-line therapy for persistent and intractable hiccups, with metoclopramide and chlorpromazine in reserve 4.
Treatment Considerations
- Management of hiccups is most effective when directed at the underlying condition 4.
- An empirical trial of anti-reflux therapy may be appropriate if the underlying cause is not known or not treatable 4.
- Therapy selection should be specific to individual patients, their underlying comorbidities, etiology of hiccups, and take into account the individual properties of the drugs 3.
- The infrequent occurrence of intractable hiccups makes it difficult to perform large, well-controlled clinical trials, resulting in limited evidence to support the use of one agent over another 3, 5.