05/04/2026
Persistent hiccups: lasting > 48 hours
Intractable hiccups: lasting > 1 month
Treatment
1) Gold Standard (Exam Answer)
Chlorpromazine (TOC)
• Only FDA-approved drug for hiccups
• Dose: 25–50 mg PO (or IM/IV if severe)
• Highly effective but limited by sedation, hypotension, anticholinergic effects
2) Preferred First-Line (Modern Clinical Practice)
Baclofen
• 5–10 mg TID
• Often first choice in persistent/intractable hiccups
• Better tolerated than antipsychotics
Gabapentin
• Effective in idiopathic or central causes
• Increasingly used as first-line
3) Alternatives (when first-line or chlorpromazine cannot be used)
Metoclopramide
• 10 mg PO/IV
• Particularly useful if associated with GERD or gastric distention
4) Other Options (2nd / 3rd line)
• Gabapentin (if not already used)
• Haloperidol
• Pregabalin
• Nifedipine (limited evidence)
• Valproate (limited evidence)
5) Treat Underlying Cause (MOST IMPORTANT)
Always evaluate for:
• GERD (most common cause)
• CNS lesions (stroke, tumor, infection)
• Diaphragmatic irritation (pneumonia, subphrenic abscess, hepatomegaly)
• Post-operative state
• Metabolic causes:
• Uremia
• Hyponatremia
• Hypocalcemia
Simple bedside measures for acute hiccups
• Breath holding / Valsalva maneuver
• Drinking cold water
• Stimulating nasopharynx (e.g., swallowing sugar)
• Avoid large meals, alcohol, sudden temperature changes
