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 e.g. partial obstruction/ascites/severe constipation
- Irritation of the diaphragm e.g. pleural disease/lung cancer
- CNS disorders e.g. 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 10 mg TDS plus Baclofen 5 mg BD 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 |
10 ml QDS |
|
|
Prokinetic |
Metoclopramide |
10 mg TDS |
|
|
PPI |
Lansoprazole |
30 mg once daily |
|
Muscle relaxants |
GABA agonist |
Baclofen |
Start with 5 mg once daily and increase to BD slowly - can be sedative |
|
Central suppression of hiccup reflex |
Anti-epileptic |
Gabapentin |
100mg to 300 mg TDS for 3 days. Titrate slowly |
|
|
Corticosteroid (suppression of irritation from cerebral tumour)
|
Dexamethasone |
initially 4 mg to 8 mg once daily |