Hiccups: Information for clinicians

Intractable hiccups can be painful, disturb sleep and affect quality of life. It is important to  treat reversible causes where possible.

Common causes
  • Gastric distension is the usual cause eg partial obstruction/ascites/severe constipation
  • Irritation of the diaphragm eg pleural disease/lung cancer
  • CNS disorders eg raised intracranial pressure
  • Metabolic disorders (check U&Es and calcium)
An initial approach to treatment

Consider reversible causes (see above) and advise patients and carers about recommended techniques

Pharmacological Treatment

Top tip- often a trial of metoclopramide 10mgs t.d.s plus baclofen 5mg b.d will cure persistent hiccups.

Once hiccups have stopped taper the relevant drugs over 48 hours and then stop.

Treatment Mechanism

Drug type

Drug name

Dose

Reduction of gastric distension ±  reflux

Antiflatulent

Simeticone

10ml q.d.s

 

Prokinetic

Metoclopramide

10mg t.d.s

 

PPI

Lansoprazole

30mgs o.d

 Muscle relaxants

GABA agonist

Baclofen

Start with 5mg once daily and increase to bd slowly - can be sedative

Central suppression of hiccup reflex

Anti-epileptic

Gabapentin

100-300mg t.d.s. for 3 days. Titrate slowly

 

Corticosteroid (suppression of irritation from cerebral tumour)

 

Dexamethasone 

initially 4-8mg o.d

 

Recommended Resources

PANG Guidelines Physical Symptoms and Signs - Hiccups

Published 16th October 2016

NICE CKS - Management of hiccups

Published 1st February 2022

Share

Related Services

Community Palliative Care Team - based at Meadow House Hospice
Close

Community Palliative Care Team - based at Meadow House Hospice

T. 020 8967 5179

W. http://meadowhouse.lnwh.nhs.uk/our-services/community-team/

The Community Specialist Palliative Care Nurse Team provides advice and visiting to palliative care patients in Ealing and Hounslow. The team are based at Meadow House Hospice.

The team will visit patients with progressive life limiting illness in their own homes. They provide specialist advice around pain and symptom control and support for patients, their families, and carers during the last stages of illness. They also support patients wishing to die at home through coordination with GPs and hospital teams.

The team is comprised of medical consultants, specialist nurses, physiotherapists, occupational therapists, social workers, a bereavement support officer and a patient and carer advocacy worker

The team can be contacted for referrals Monday to Friday 9.00am to 5.00pm.

Between Monday to Friday 5.00pm and 8.30am, the Out of Hours Telephone Advice line 020 8102 5000 takes calls. Weekends and Bank Holidays 5.00pm to 9.00am.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)

Related Articles

15th February 2023

Hiccups: Information for patients and carers

Feedback