Hiccups: Information for clinicians

This information is sourced from NICE and PANG:

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

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Hiccups: Information for patients and carers

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