Remedies for Intractable Hiccups
Lynn was telling me about a case she saw this year – if I recall, it was a young man who developed uncontrollable hiccuping after an inguinal hernia repair. I don’t know what happened to the guy, but I saw my first hiccuping patient shortly thereafter. As I surf the web, I keep coming across remedies for this unusual but vexing complaint:
- Methylcellulose (to expand the stomach)
- NG Tube (to decompress the stomach)
- An implantable vagal nerve stimulator
- Pressing on the ears while drinking through a straw
- Digital rectal massage (also reported in Annals of EM)
- Chlorpromazine 25-50mg IV (the only FDA-approved agent for intractable hiccups)
Our anesthesia colleagues have looked at this issue, as hiccuping in the OR is a pressing concern. Unfortunately, a systematic review (Kranke, Eur J Anaesthesiol 2003 Mar;20(3):239-44) turned up lots of anecdotes, but only one (inconclusive) RCT:
A large variety of interventions have been proposed for the treatment of hiccup during anaesthesia and sedation. However, perioperative treatment is still based on empirical findings and no treatment is ‘evidence-based’. Thus, no valid recommendations for the treatment of hiccup can be derived. Uncontrolled observations are inadequate to establish treatment efficacy.
More drug suggestions below, along with some background on hiccups…
