What’s up with hiccups? – Harvard Health

Drug Remedy of Hiccups

Full replace March 2017
Hiccups, the involuntary contraction of the diaphragm, are widespread.1 Hiccups are brought on by something that stimulates the hiccup reflex arc. Acute hiccup assaults final lower than 48 hours, whereas persistent hiccups last more. Intractable hiccups are outlined as an assault lasting a couple of month.1,2 Though the incidence and prevalence aren’t recognized, one retrospective chart overview discovered that of 100,000 consecutive affected person visits to a hospital, 55 have been for hiccups.3 Persistent hiccups could also be an indication of an underlying downside. Earlier than initiating drugs to deal with hiccups, correctable causes for hiccups ought to be investigated. Examples of underlying causes of hiccups embrace CNS abnormalities (e.g., meningitis, intracranial tumors, and so forth), gastrointestinal points (e.g., peptic ulcer, gastroesophageal reflux illness, belly abscess, and so forth), thoracic ailments (e.g., pneumonia, bronchial asthma, and so forth), abnormalities of the ears-nose-throat (e.g., rhinitis, otitis media, and so forth), poisonous exposures or metabolic derangements (e.g., alcohol, electrolyte abnormalities, and so forth), psychogenic causes (e.g., stress, worry, pleasure, and so forth), post-surgical causes (e.g., anesthetic brokers, pharyngeal intubation, and so forth), and drugs (e.g., corticosteroids, opioids, benzodiazepines, and so forth).1,2,4 Pharmacological remedy ought to solely be used if persistent hiccups are inflicting misery. Though house cures similar to breath holding, swallowing a spoonful of sugar, or ingesting pickle juice are typically tried, the proof to assist these strategies is scant. The desk under summarizes medicine which have been used within the remedy of hiccups. A lot of the remedies can be utilized for seven to 10 days however might be discontinued one or two days after hiccups stop.4 If hiccups proceed regardless of remedy, it’s cheap to contemplate a distinct treatment.4 Of be aware, two completely different latest systematic opinions of the literature discovered no prime quality knowledge on which to base remedy suggestions.1,5

Abbreviations: GERD=gastroesophageal reflux illness; IM=intramuscular; IV=intravenous; PO=by mouth

*A lot of the medicine under are used off-label for the remedy of hiccups. Dosing regimens will fluctuate relying on the supply*

Drug

Instance Routine(s)1,2,4

Feedback
Antidopaminergic brokers

Chlorpromazine

25 mg to 50 mg PO three to 4 instances a day4,13

If signs persist after two to a few days: 25 mg to 50 mg IM x113

If IM dose fails, attempt 25 mg to 50 mg IV administered as a gradual IV infusion (max 1 mg/min) with the drug diluted in 500 to 1000 mL saline.13

Chlorpromazine is the one treatment accepted by the FDA for the remedy of intractable hiccups (it’s not accepted for this indication by Well being Canada), however there are solely observational knowledge to assist the use.1,6

Could reverse the irregular depolarization within the hiccup reflex arc.2

Concern about QTc prolongation, hypotension (particularly with IV doses), others.4

Concern about motion issues with extended use.12

Monitor blood stress with IV administration.13

Haloperidol

2 mg to five mg IM,13,14 then
1 mg to 4 mg PO 3 times daily14

Could also be a safer various to IV chlorpromazine (much less hypotension).13

Restricted data (case stories, case collection) to assist use.10

Concern about QTc prolongation.4

Concern about motion issues with extended use.12

Metoclopramide

10 mg PO or 5 mg to 10 mg IV/IM three to 4 instances day by day

Decrease high quality, small, randomized, managed trials and case collection accessible to assist the use.1,4

Could scale back the depth of esophageal contractions.2

Concern about QTc prolongation.9

Concern about motion issues with extended use.1

Theoretically, domperidone (Canada solely) ought to be efficient, however there aren’t any research supporting its use.1

GABA analogs

Baclofen

5 mg to 10 mg PO 3 times a day

Some specialists take into account baclofen a first-line remedy as a result of throughout long-term remedy it’s much less more likely to trigger hostile results in contrast with antidopaminergic brokers.1,2

Decrease high quality, small, randomized, managed trials accessible to assist the use.1

Could reverse the irregular depolarization within the hiccup reflex arc or have an effect on GABA transmission.2

Could trigger drowsiness and dizziness.4

Gabapentin

900 mg to 1200 mg/day; in divided doses

Some specialists take into account gabapentin a first-line remedy as a result of throughout long-term remedy it’s much less more likely to trigger hostile results in contrast with antidopaminergic brokers.1

Solely case collection and case stories accessible to assist the use.1

Could improve GABA transmission centrally.1

Could trigger drowsiness and dizziness.4

Antiepileptic brokers

Carbamazepine

100 mg to 300 mg PO as much as 4 instances a day

Solely case collection and case stories accessible to assist the use.1

Could inhibit excitatory sodium channels on central neurons.1

Could trigger dizziness, nausea, vomiting.12

Phenytoin

100 mg PO 3 times day by day

Use primarily based on skilled opinion; restricted proof to assist the use.1

Could inhibit excitatory sodium channels on central neurons.1

Could trigger dizziness, drowsiness.12

Valproate

Dose titration as much as 20 mg/kg/day

Solely case collection and case stories accessible to assist the use.1

Could improve GABA transmission centrally.1,2

Could trigger dizziness, drowsiness, nausea, vomiting.12

Miscellaneous Agents2

Nifedipine

20 mg to 60 mg/day PO

Solely case collection and case stories accessible to assist the use.1

Could reverse the irregular depolarization within the hiccup reflex arc.2

Amitriptyline

25 mg to 100 mg/day PO

Use primarily based on skilled opinion; restricted proof to assist the use.1

Proton pump inhibitors (omeprazole, others)

GERD remedy doses11

One giant case collection of proton pump inhibitors confirmed profit in sufferers with hiccups associated to gastroesophageal reflux illness. Nonetheless, there was no management group and it’s not recognized if the hiccups have been because of GERD or if hiccups have been the reason for GERD.1

Different drugs which have been tried for hiccups embrace midazolam, clonazepam, pramipexole, olanzapine, amantadine, sertraline, risperidone, methylphenidate, viscous lidocaine and methylcellulose.7,8

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