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 best treatment for hiccups is chlorpromazine (PO) with a dosage of 25 mg to 50 mg taken three to four times a day. If symptoms persist for 2 to 3 days, parenteral therapy is indicated 1.
From the Research
The best treatment for hiccups is to try simple physical maneuvers first, such as holding your breath for 10-20 seconds, drinking a glass of cold water quickly, gargling with ice water, or pulling gently on your tongue, as these techniques can help interrupt the hiccup reflex by stimulating the vagus nerve or distracting the diaphragm 2.
Treatment Options
For persistent hiccups, breathing into a paper bag for a few minutes may help by increasing carbon dioxide levels in your blood, which can relax the diaphragm. If hiccups last longer than 48 hours, medical treatment may be necessary.
- Medications that can be effective include: + Baclofen (5-10 mg three times daily) + Chlorpromazine (25-50 mg) + Metoclopramide (10 mg) These medications work by either reducing nerve impulses to the diaphragm or relaxing the muscles involved in hiccupping 3, 2.
Underlying Conditions
Most hiccups are benign and self-limiting, caused by irritation of the phrenic or vagus nerves that control the diaphragm, but persistent hiccups may indicate an underlying medical condition that requires evaluation 4, 5.
Recent Studies
A recent study published in 2014 found that metoclopramide was effective in treating intractable hiccups, with a total efficacy higher than placebo and mild adverse events 2. Another study published in 2022 aimed to evaluate the effectiveness and safety of metoclopramide in treating intractable hiccup, but the results are not yet available 6.
Recommendations
Based on the available evidence, metoclopramide (10 mg) appears to be a promising candidate for the treatment of patients with intractable hiccups, with mild adverse events 2. However, further clinical trials are required to confirm these results. It is essential to prioritize the patient's quality of life and consider the potential underlying conditions that may be causing the hiccups.