Materiały źródłowe

• #1 Hiccups – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/symptoms-of-digestive-disorders/hiccups

  Hiccups are repeated involuntary spasms of the diaphragm, followed by quick, noisy closings of the glottis. […] Brief episodes of hiccups often have no obvious cause but sometimes are triggered by a bloated stomach, alcohol consumption, or swallowing hot or irritating substances. […] Persistent episodes of hiccups sometimes have more serious causes. […] The best way to treat hiccups is to treat the underlying disorder. […] Nearly all hiccups go away with or without treatment. Many home remedies have been used to treat brief hiccups. […] For persistent hiccups, treatment is needed, particularly when the cause cannot be easily corrected. Several medications have been used with varying success. […] If medications do not work, doctors may block one of the phrenic nerves, which control the contractions of the diaphragm. […] A doctor’s evaluation typically does not reveal a cause but should be done for hiccups that are persistent. […] Numerous remedies exist, but none is superior to or more effective than the other ones.

• #1 Hiccup: Mystery, Nature and Treatment

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2012.18.2.123

  Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. […] An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. […] The effective hiccup treatment is exactly established upon a correct diagnosis of lesion responsible for the serious event. For example, after effective measures were undertaken to CNS lesions such as vascular ischemia and tumors, hiccup episodes subsided. Similarly, some peripheral lesions related hiccups responded well after these lesions were ablated. In addition, many available therapies are not evidence-based; moreover, alternative medicines and remedies have been tested with unbelievable effectiveness.

• #1 Hiccups and cancer | Coping with cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/hiccups-and-cancer

  People with cancer can get hiccups for lots of reasons. It is not a common problem but hiccups can be tiring and difficult to cope with. […] Hiccups usually go away on their own but there are some things you can try. If hiccups carry on for a couple of days they can be difficult to cope with. Tell your doctor as you might need treatment. […] Hiccups normally go away on their own. But if your hiccups are troublesome and last more than a few days, it is important you talk to the team caring for you about them. They will want to find out if there is reason for them so that they can try to help you. […] Some hiccups can last for more than a couple of days. If they last this long you may need medical treatment. […] Your doctor will try to find out what is causing your hiccups. They will treat the cause if they find it. For example, the hiccups may go away if your doctor changes one of the drugs you take.

• #1 Managing hiccups

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3114667/

  Hiccups are a common experience, and warrant treatment only when they become persistent and bothersome. […] Treatment of hiccups should be directed toward the specific cause, if one can be identified. […] If they are persistent and bothersome, consider the addition of a medication to treat the hiccups, recognizing that adding medications might result in drug interactions and side effects. […] Chlorpromazine is the only medication approved for hiccups by the US Food and Drug Administration, and for many years it was the drug of choice. […] Baclofen in dosages of 5 mg twice daily to 20 mg 3 times daily has been shown to be effective in alleviating hiccups in several small trials and case series since 1992. […] Reducing the frequency of recurrent or persistent hiccups is important, as it will improve overall quality of life. […] Many treatments of hiccups are described, and some common nonmedical treatments might be effective. […] While the use of medications remains somewhat empirical, defoaming and propulsive agents, followed by baclofen if needed, are good initial choices.

• #1 Hiccups: Causes, treatments, and complications

  https://www.medicalnewstoday.com/articles/181573

  Hiccups are medically known as synchronous diaphragmatic flutter or singultus. […] Most cases resolve without treatment, but prolonged hiccups can lead to complications such as insomnia and depression. […] If hiccups last for longer than 48 hours, the person should contact a doctor, who may prescribe muscle relaxants. […] If a person has an underlying condition, managing it will probably resolve the hiccups. […] Chlorpromazine is the first-line treatment, as it is the only medication with Food and Drug Administration (FDA) approval to treat hiccups. […] A doctor may recommend the following medications for hiccups if there appears to be no underlying condition: metoclopramide (Reglan), which is an antinausea medication that may help some people with hiccups; baclofen (Lioresal), which is a muscle relaxant (off-label use); gabapentin, which is an antiseizure medication that doctors commonly prescribe for neuropathic pain and that can help alleviate the symptoms of hiccups (off-label use). […] In severe cases that do not respond to other treatments, a surgeon may inject medication into the phrenic nerve to temporarily block the nerves action or sever the phrenic nerve in the neck.

• #1 Hiccups, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17672-hiccups

  Hiccups usually go away on their own without any treatment. However, some people have hiccups that go on much longer than normal. You should call a healthcare provider if your hiccups last longer than two days. This could be a sign of a more serious condition that needs medical attention. […] Hiccups that last longer than two days are more than just a nuisance. They can interfere with your quality of life and lead to trouble with basic needs like eating or sleeping. Possible medications a healthcare provider may prescribe for you include: Chlorpromazine, Proton pump inhibitor (medicines that reduce stomach acid), Metoclopramide, Baclofen, Gabapentin. […] If another medication you’re taking is causing your hiccups, your provider may tell you to stop taking it and take another instead. Never stop taking a medication unless your provider tells you to. […] Other treatments your provider may suggest include nerve blocks or hypnosis. There’s currently limited data to support the use of acupuncture in treating hiccups.

• #1 Hiccups Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/775746-treatment

  Generations of physicians have failed to discover a definitive cure for hiccups. The following statement from the Mayo Clinic, though made in 1932, still describes the situation perfectly: „The amount of knowledge on any subject such as this can be considered as being in inverse proportion to the number of different treatments suggested and tried for it.” […] Supportive care is administered as indicated by the causative pathology (eg, oxygen for the patient whose hiccups may be secondary to pneumonia). Therapy is directed first toward at the cause of the hiccups (if identified) and then toward the hiccups themselves (if necessary). […] Treatment may be pharmacologic or nonpharmacologic. Chlorpromazine remains the only agent approved by the US Food and Drug Administration (FDA) for the treatment of intractable hiccups.

• #1 Remedies for Prolonged Hiccups | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0501/p1684.html

  Of any malady in medicine, hiccups probably have some of the most interesting home remedies. Perhaps the most well-known home remedy is breathing into a paper bag. This method (at least partly) relies on the observation that hiccups decreases as Pco2 rises. Many of the home remedies either stimulate the nasopharynx or interrupt the normal respiratory cycle: holding one’s breath, being frightened (gasping), swallowing sugar and sipping ice water. […] When you are seeing a patient with severe hiccups or (more commonly) when you or someone you know needs relief from hiccups, there are many (mostly anecdotal) effective methods you can try.

• #1 Hiccups: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.hiccups-care-instructions.abk7514

  Hiccups occur when a spasm contracts the diaphragm. This is a large sheet of muscle that separates the chest cavity from the abdominal cavity. The spasm causes an intake of breath that is suddenly stopped by the closing of the vocal cords. This closure causes the „hiccup” sound. […] Most hiccups go away on their own within a few minutes to a few hours and don’t require any treatment. […] Hiccups that last longer than 48 hours are called persistent hiccups. Hiccups that last longer than a month are called intractable hiccups. Both kinds of hiccups may be a sign of a more serious health problem. Tests may be needed to help find the cause. […] Try these safe and easy home remedies if your hiccups are making you uncomfortable. Eat a teaspoon of sugar. Hold your breath and count slowly to 10. Quickly drink a glass of cold water. […] If your doctor prescribed medicine, take it as directed. Call your doctor if you think you are having a problem with your medicine. […] Call your doctor now or seek immediate medical care if: You have hiccups for more than 2 days. […] Hiccups occur often and get in the way of your activities.

• #1 Hiccups: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003068.htm

  Hiccups often start for no apparent reason. They most often disappear after a few minutes. In rare cases, hiccups can last for days, weeks, or months. […] There is no sure way to stop hiccups, but there are a number of common suggestions that can be tried: […] Contact your health care provider if hiccups go on for more than a few days. […] If you need to see your provider for hiccups, you will have a physical exam and be asked questions about the problem. […] To treat hiccups that do not go away, the provider may perform gastric lavage or massage of the carotid sinus in the neck. DO NOT try carotid massage by yourself. This must be done by a provider. […] If hiccups continue, medicines may help. Tube insertion into the stomach (nasogastric intubation) may also help. […] In very rare cases, if medicines or other methods do not work, treatment such as phrenic nerve block may be tried. The phrenic nerve controls the diaphragm.

• #1 Hiccups: a common problem with some unusual causes and cures | British Journal of General Practice

  https://bjgp.org/content/66/652/584

  Hiccups is a reflex consisting of a sudden spasmodic contraction of the diaphragm causing shaking of the inspiratory muscles of the chest and abdomen, followed by the sudden closure of the glottis, which generates a characteristic noise of air being violently expelled from the lungs. […] This article describes an unusual cause of persistent hiccups and considers some of the remedies that can be used for the condition. […] The recommendations for treatment of transient hiccups are nasopharyngeal stimulation (drinking a glass of water, or inserting a tube through the nose as far as the back wall of the pharynx for 20 seconds), vagal stimulation (carotid sinus massage, cold compress to face, or induced vomiting), and respiratory manoeuvres (holding the breath, cough, Valsalva manoeuvre, or breathing into a paper bag). These manoeuvres are, in general, effective only in shortening an attack of acute hiccups and not in the treatment of persistent or recurrent hiccups.

• #1 Discover 5 Natural and Effective Solutions for Hiccups | Netmeds

  https://www.netmeds.com/health-library/post/5-effective-natural-remedies-for-hiccups?srsltid=AfmBOopC0taRe2CMYy8ftuMOS1eFUu738sw5xGBu6RT-Nv_5kAbYEfRm

  When hiccupping uncontrollably, gently pat your back, from behind your neck along your spine. This helps release the tension in the diaphragm muscles and stops hiccups. […] Slowly sip on a glass of warm water. This helps stimulate the activity of the vagus nerve, that travels from the brain down to the stomach and thus reduces hiccups. […] Take about half a teaspoon of sugar and keep it at the far end of the back of the tongue. Hold this for two minutes and then swallow the sugar. Applying pressure along with the tongue aids in eliminating the tightness in diaphragm muscles. […] The pleasant aroma combined with the tangy flavour of lemons naturally invigorates the nasopharynx muscles. This, in turn, relaxes the knots in the diaphragm muscles and decreases hiccups. […] Holding the breath for a few seconds effectively retains some carbon dioxide in the body. This functions to eliminate the spasms in the diaphragm, thereby preventing hiccups.

• #1 How to Get Rid of Hiccups: Remedies That Can Actually Help

  https://www.healthline.com/health/how-to-get-rid-of-hiccups

  Eating certain things or changing the way you drink may also help to stimulate your vagus or phrenic nerves. […] A few other remedies you can try include gargling with water or sniffing smelling salts. […] If you regularly get hiccups or have hiccups that last for more than 2 days, talk with your doctor. Your hiccups could be a sign of an underlying condition, such as: […] In addition, some cases of hiccups are more stubborn than others. When this happens, your doctor might prescribe medication to help them stop. Common medications for chronic hiccups include: […] Common cases of hiccups that are triggered by lifestyle factors can usually be prevented by making some changes to your habits. If you notice certain behaviors are causing your hiccups, here are some things to try:

• #1 Hiccups: Why You Get Hiccups ..and How To Make Them Stop

  https://www.webmd.com/digestive-disorders/why-do-i-hiccup

  Hiccups can happen for a lot of reasons — some of them are physical and some emotional. […] If your hiccups don’t stop after a few minutes, some experts believe holding your breath or breathing into a paper bag will help. […] If all else fails, and your hiccups continue for several days or more, your doctor may try different medications to see if they can put an end to those uncomfortable hiccups. […] Drinking cold water to get rid of your hiccups is thought to work by overstimulating the vagus nerve. […] If your baby’s hiccups are minor and not caused by something like reflux (stomach acids flowing back into the esophagus), here are some ways to try to get rid of them: […] See your doctor if your hiccups last longer than 2 days or if they begin to interfere with your sleep, eating, or breathing. […] If your hiccups come and go frequently and impact your quality of life, you should have them checked out. […] If they last longer than 48 hours, contact your doctor.

• #1 Discover 5 Natural and Effective Solutions for Hiccups | Netmeds

  https://www.netmeds.com/health-library/post/5-effective-natural-remedies-for-hiccups?srsltid=AfmBOopC0taRe2CMYy8ftuMOS1eFUu738sw5xGBu6RT-Nv_5kAbYEfRm

  Applying pressure on certain areas of your body that are particularly sensitive to pressure points may help to ease hiccups by relaxing the diaphragm or stimulating vagus or phrenic nerves. […] Pulling on your tongue triggers the nerves and muscles in the throat. Hold the tip of your tongue and mildly pull or forward once or twice. […] With your hand, apply pressure to the region just below the end of the sternum to get respite from hiccups. […] With your thumb apply pressure to the palm of your other hand.

• #1 How To Get Rid of Hiccups: Remedies and More

  https://www.health.com/condition/digestive-health/how-to-get-rid-of-hiccups

  Hiccups happen to almost everyone. Still, they’re annoying. And if hiccups don’t go away fast, they can become uncomfortable, even embarrassing. A hiccup occurs when there is an involuntary spasm of the diaphragm, the largest muscle responsible for breathing. While you can’t readily control these involuntary movements, you may at least be able to use simple remedies to get rid of them. Here’s what causes hiccups, how to get rid of them, and how to prevent them plus which treatment options are available for hiccups that just won’t go away. […] How long do hiccups last? Most of the time, they will go away within several minutes. Sometimes your best strategy for getting rid of them may be to ignore them and wait. After a few minutes, they’ll likely stop on their own. However, let’s say you have a Zoom presentation in five minutes, and you’d rather not hiccup between every sentence in front of your colleagues. What can you do to nip hiccups in the bud? Try these home remedies: Bite into a lemon. Blow up a balloon. Breathe into a paper bag. Drink water or ice water. Gargle. Hold your breath for 5 to 10 seconds. Let someone or something scare you. Pull on your tongue. Put a cold compress on your face. Sit down and pull your knees to your chest for one minute. Swallow dry bread, granulated sugar, or crushed ice. Take deep, slow breaths.

• #1 Hiccup – Wikipedia

  https://en.wikipedia.org/wiki/Hiccup

  Acupressure, either through actual function or placebo effect, may cure hiccups in some people. […] A simple treatment involves increasing the partial pressure of CO2 and inhibiting diaphragm activity by holding one’s breath or rebreathing into a paper bag. […] Other potential remedies suggested by NHS Choices include pulling the knees up to the chest and leaning forward, sipping ice-cold water and swallowing some granulated sugar. […] A breathing exercise called supra-supramaximal inspiration (SSMI) has been shown to stop persistent hiccups. […] Drinking through a straw with the ears plugged is a folk remedy that can be successful. […] In 2021 a scientific tool with a similar basis was tested on 249 hiccups subjects; the results were published in the Journal of the American Medical Association (JAMA). This device is named FISST (Forced Inspiratory Suction and Swallow Tool) and branded as „HiccAway”. This study supports the use of FISST as an option to stop transient hiccups, with more than 90% of participants reporting better results than home remedies. HiccAway stops hiccups by forceful suction that is being generated by diaphragm contraction (phrenic nerve activity), followed by swallowing the water, which requires epiglottis closure.

• #1 How To Get Rid of Hiccups: Remedies and More

  https://www.health.com/condition/digestive-health/how-to-get-rid-of-hiccups

  You might also try the Valsalva maneuver. To do it, pinch your nose and hold your breath, then force yourself to exhale and bear down as if you’re going to poop. Hold for about 10 seconds. Some of these remedies work by relying on similar mechanisms. Deep breathing and breathing into a bag can increase the amount of carbon dioxide in your blood enough to stop hiccups. Swallowing dry bread, granulated sugar, or crushed ice and pulling on your tongue can also stop hiccups by stimulating the vagus nerve responsible for breathing. […] Unfortunately, none of these „cures” are proven treatments. They may work for some people, but not all. Still, they might get rid of your hiccups, and most are safe to try. However, not everyone should try them. If you often have shortness of breath, for example, it might not be a good idea to try and hold your breath for a long time. If you’re unsure if a remedy is safe for you, consult your healthcare provider first.

• #1 Hiccups Medication: Antiemetic Agents, Anticonvulsants/Antiarrhythmics, Anesthetics, Muscle Relaxants, Analgesics, Antipsychotic Agents, Sedative/Hypnotics, Antidepressants, Tricyclic Antidepressants, Stimulants

  https://emedicine.medscape.com/article/775746-medication

  Various agents have been reported to cure hiccups. Chlorpromazine appears to be the drug of choice. Haloperidol and metoclopramide have been used successfully. Several anticonvulsant agents (eg, phenytoin, valproic acid, and carbamazepine) have effectively treated intractable hiccups in typical anticonvulsant doses. Gabapentin has been effective in patients with central nervous system (CNS) lesions and in some other groups. […] Of the anesthetic agents, ketamine has been the most successful. Baclofen is particularly useful in patients for whom other agents are contraindicated. Lidocaine has cured patients after other agents were unsuccessful. Other reportedly beneficial agents include muscle relaxants, sedatives, analgesics, stimulants, and various miscellaneous agents (eg, edrophonium, dexamethasone, amantadine, and nifedipine). Benzodiazepines should be avoided.

• #1 :: Journal of Neurocritical Care

  https://www.e-jnc.org/m/journal/view.php?doi=10.18700/jnc.200018

  Chlorpromazine, a dimethylamine derivative of phenothiazine, is a centrally acting dopamine antagonist which acts at the hypothalamus. […] The suggested dose has been 10-25 mg orally or intravenously; if no response then up to 25-50 mg three times a day can be used. […] Haloperidol alleviates hiccups by its dopamine antagonism in the hypothalamus. […] The major side effect is extrapyramidal symptoms. […] Baclofen, a GABA-B agonist, inhibits transient relaxations of the lower esophageal sphincter and diaphragm with its peripherally and centrally mediated effect on vagal nerves. […] Anti-convulsant medications are used as a second line treatment of persistent hiccups. […] Gabapentin modulates diaphragmatic excitability by increasing the endogenous GABA-mediated inhibition of inspiratory muscles and reducing calcium influx through inhibitory effects on voltage-operated calcium channels in the presynaptic terminals of respiratory muscles.

• #1 Hiccups treatment & management | PPT

  https://www.slideshare.net/slideshow/hiccupstreatment-amp-management/71244821

  Chlorpromazine is the most thoroughly studied medication and appears to be the drug of choice in many reports. Regimens in the range of 25-50 mg intravenously (IV) or intramuscularly (IM) are effective in 80% of cases. To prevent or minimize hypotension caused by this agent, preloading the patient with 500-1000 mL of IV fluid is advised. […] Another major tranquilizer, haloperidol, is effective in doses of 2-5 mg. […] Metoclopramide has been used successfully in a dosage of 10 mg every 8 hours. Indeed, a double-blind, randomized, controlled pilot study by Wang and Wang provided evidence of the usefulness of metoclopramide against intractable hiccups. […] Several anticonvulsant agents have been used to treat intractable hiccups. Phenytoin, valproic acid, and carbamazepine have all been effective when used in typical anticonvulsant doses. Gabapentin has been shown to be effective in patients with central nervous system (CNS) lesions and in some other etiologic groups.

• #1 Hiccups Medication: Antiemetic Agents, Anticonvulsants/Antiarrhythmics, Anesthetics, Muscle Relaxants, Analgesics, Antipsychotic Agents, Sedative/Hypnotics, Antidepressants, Tricyclic Antidepressants, Stimulants

  https://emedicine.medscape.com/article/775746-medication

  Antiemetic agents are effective in treating hiccups. […] Chlorpromazine is the drug of choice in this setting. […] Metoclopramide blocks dopamine receptors in the chemoreceptor trigger zone of the CNS. […] Anticonvulsants are used for severe muscle spasms. […] Ketamine acts on the cortex and limbic system, decreasing muscle spasms. […] Baclofen may induce the hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at the spinal level. It is useful in patients for whom other agents are contraindicated (eg, those with renal impairment). […] Sedative agents with effects in spastic muscles have shown effectiveness. […] Haloperidol is useful in treatment of irregular spasmodic movements of muscles. […] Tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. […] The mechanisms by which stimulants act in the treatment of hiccups are not well understood.

• #1 TREATMENT APPROACHES FOR PERSISTENT AND INTRACTABLE HICCUPS: A SYSTEMATIC REVIEW AND RECOMMENDATIONS | Journal of Population Therapeutics and Clinical Pharmacology

  https://jptcp.com/index.php/jptcp/article/view/5192

  A treatment algorithm is proposed based on available evidence, with baclofen as first-line therapy for persistent and intractable hiccups. Gabapentin may offer a safe and effective alternative, particularly for patients with central nervous system (CNS) involvement. However, long-term use of phenothiazines, including metoclopramide, is discouraged due to potential neurological and other adverse effects.

• #1 FF #81 Management of Hiccups | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/management-of-hiccups/

  In most clinical scenarios, it is best to start with non-pharmacologic therapy and resort to pharmacologic options for refractory cases. There are many time-honored home remedies — gargling with water, biting a lemon, swallowing sugar, or producing a fright response — which are low risk even if they are lacking in evidence. Other non-pharmacologic options include: […] Once hiccups have lasted beyond a time-limited annoyance, deciding on therapeutic intervention should be based on a thorough clinical assessment and, if possible, treatment directed at the underlying cause. […] Anti-Psychotics: Chlorpromazine – the only FDA approved drug for hiccups. […] Baclofen – the only drug studied in a double blind randomized controlled study for treatment of hiccups. […] Interventions: Acupuncture, diaphragmatic pacing electrodes, or surgical ablation of the reflex arc can be considered when other treatments fail.

• #1 Hiccups Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/775746-treatment

  Surgical phrenic nerve ablation has been advocated for intractable cases that are unresponsive to other treatment. This drastic approach may be associated with considerable morbidity and is not universally successful. […] A Cochrane review concluded that the available evidence was insufficient to guide treatment of persistent or intractable hiccups by either pharmacologic or nonpharmacologic means. […] Various agents have been reported to cure hiccups. Gabapentin, baclofen, and metoclopramide appear to show promise for persistent hiccups alone, in combination with other drugs, including proton-pump inhibitors, or as conjoined therapy. […] However, on the basis of the limited data available, the investigators indicated that owing to their lower risk of adverse effects over long-term therapy as compared with traditional neuroleptic agents, baclofen and gabapentin may be considered first-line therapy for persistent/intractable hiccups, with metoclopramide and chlorpromazine in reserve.

• #1 Hiccup: Mystery, Nature and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3325297/

  Apart from the well-known chlorpromazine approved to treat hiccups, many other drugs have been tested and recommended. For example, anticonvulsants in various preparations are indicated to treat intractable hiccups. Gabapentin, an alpha-2-delta ligand with structural similarity to GABA and the ability to block voltage-operated calcium channels to reduce release of several neurotransmitters including glutamate and substance P and finally to modulate the diaphragmatic activity, was promising and safe to treat intractable hiccups. […] Non-pharmacological Measures to Treat Hiccups include phrenic nerve blockades such as ultrasound guided blocking of efferent limbs, trans-esophageal diaphragmatic pacing and nerve stimulator to confirm the effective blocking were successfully used to treat persistent post-operative and lung cancer related hiccups.

• #1 :: Journal of Neurocritical Care

  https://www.e-jnc.org/m/journal/view.php?doi=10.18700/jnc.200018

  Gabapentin either alone or in combination with other medications has been recommended especially in patients with hiccups secondary to brain tumors. […] Combination therapy for IH has also been proposed in certain case reports. […] Considering the present literature on hiccup pharmacotherapy, baclofen may be considered as a first line therapy followed by gabapentin.

• #1 What are pharmacotherapeutic options for treating hiccups in patients without oral access?

  https://inpharmd.com/inquiries/64e0d3a837b13d9cd9ebd3ba4446537154410e1bc91117c1703b88624bfab37c

  The use of baclofen and metoclopramide are supported by small randomized, placebo-controlled trials. Both drugs showed significant benefit in terms of the cessation of hiccups compared to placebo. […] Based on the quality of available evidence, the authors of this review recommend baclofen (5 to 20 mg TID) as first-line therapy for persistent and intractable hiccups. Gabapentin (300 to 600 mg TID) or pregabalin (75 to 150 mg BID) are also recommended as first-line options due to safety. […] Clinical experience also supports the use of chlorpromazine (25 to 50 mg QID) and other neuroleptics for acute, but longterm management may result in neurological adverse events. […] According to a review from the College of Family Physicians of Canada, there are no large randomized controlled trials, nor any consensus statements, on how to treat hiccups.

• #1 Hiccups Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/775746-treatment

  Chlorpromazine is the most thoroughly studied medication, is FDA-approved for intractable hiccups, and appears to be the drug of choice in many reports. […] Several anticonvulsant agents have been used to treat intractable hiccups. Phenytoin, valproic acid, and carbamazepine have all been effective when used in typical anticonvulsant doses. […] The centrally acting muscle relaxant baclofen, in a dosage of 10 mg orally every 6 hours, is particularly useful in patients for whom other agents are contraindicated (eg, those with renal impairment). […] The final and most drastic treatment for hiccups is phrenic nerve ablation. […] Microvascular decompression of the vagus nerve has been reported to be successful in case reports.

• #1 Hiccups and cancer | Coping with cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/hiccups-and-cancer

  Your doctor may treat the hiccups directly. Drugs they might use include: the anti sickness drug metoclopramide (Maxolon), a mild sedative, such as haloperidol or chlorpromazine, a drug to relax your muscles such as baclofen, a proton pump inhibitor such as omeprazole. […] Doctors will try one drug for a short time to see if it is helpful and stops the hiccups. If the hiccups start again they may use a different drug or a combination of drugs until they stop completely.

• #1 Hiccups treatment & management | PPT

  https://www.slideshare.net/slideshow/hiccupstreatment-amp-management/71244821

  Benzodiazepines exacerbate or precipitate hiccups and should be avoided. […] Gastroesophageal reflux is associated closely with hiccups but may be either a cause or an effect. Acid perfusion studies should be done to confirm the inducibility of hiccups before antireflux surgery is performed to cure hiccups. […] Surgical phrenic nerve ablation has been advocated for intractable cases that are unresponsive to other treatment. This drastic approach may be associated with considerable morbidity and is not universally successful. […] A Cochrane review concluded that the available evidence was insufficient to guide treatment of persistent or intractable hiccups by either pharmacologic or nonpharmacologic means. […] Chlorpromazine appears to be the drug of choice. Haloperidol and metoclopramide have been used successfully. Several anticonvulsant agents (eg, phenytoin, valproic acid, and carbamazepine) have effectively treated intractable hiccups in typical anticonvulsant doses. Gabapentin has been effective in patients with central nervous system (CNS) lesions and in some other groups.

• #1 Diagnostics: Intractable Hiccups — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/intractable-hiccups

  Empiric Therapy: Proton Pump Inhibitors for treatment of presumed GERD. […] First Line for Refractory Hiccups: Metoclopramide 10 mg PO or IV, Gabapentin 300 mg PO TID, Baclofen 5 mg PO TID. […] Second Line: Chlorpromazine 25mg PO or IV. […] If workup has yielded identifiable or suspected secondary cause, or the patient is experiencing sleep deprivation/exhaustion secondary to hiccups consult appropriate service as indicated for possible admission and further workup.

• #1 Treatment for hiccups

  https://www.mymed.com/symptoms/hiccups/how-to-get-rid-of-hiccups-hiccup-treatment

  If a doctor is unable to find the cause of hiccups, then the first-line of treatment is often physical manoeuvres coupled with empirical therapy. […] Should the aforementioned physical manoeuvres fail, there are a number of different classes of drugs that can be prescribed in the treatment of chronic hiccups. […] Chlorpromazine should be the first line of treatment as this has been a commonly used drug in the treatment of the condition and generally regarded as a well-tolerated drug that offers successful results. […] Should chronic hiccups subside as a result of treatment, then the drugs can usually be stopped a day or so after cessation is achieved. […] Should chronic hiccups persist and not respond to physical manoeuvres or drug therapy, then CAM treatment options may be attempted, such as acupuncture, which has been to improve chronic hiccups in a number of observational studies.

• #1 Hiccups – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiccups/diagnosis-treatment/drc-20352618

  Most cases of hiccups go away on their own without medical treatment. If an underlying medical condition is causing your hiccups, treating that condition may stop the hiccups. […] If your hiccups last longer than two days, medicines or certain procedures may be needed. […] Drugs used to treat long-term hiccups include baclofen, chlorpromazine and metoclopramide. […] If less invasive treatments aren’t effective, your health care provider may recommend an injection of an anesthetic to block your phrenic nerve to stop hiccups. […] Another option is to surgically implant a battery-operated device to deliver mild electrical stimulation to your vagus nerve. This procedure is most commonly used to treat epilepsy, but it also has helped control long-term hiccups. […] When long-term hiccups don’t respond to other remedies, alternative treatments, such as hypnosis and acupuncture, may help.

• #1

  https://journals.lww.com/md-journal/fulltext/2018/11300/treatment_of_persistent_postoperative_hiccups_with.50.aspx

  Although persistent postoperative hiccups can cause various problems (such as sleep disorders, depression, fatigue) for the patient, there has been little research on this topic. The purpose of this study is to determine the effectiveness of treating persistent postoperative hiccups with a stellate ganglion block (SGB), an injection of local anesthetic in the sympathetic nerve tissue of the neck. […] The 3 patients were treated with an SGB. After the procedure, the frequency and intensity of hiccups decreased and then the hiccups stopped completely. […] An SGB is an effective method that can be considered in conjunction with other treatments for persistent hiccups. Clinicians should be mindful of the negative effects that persistent hiccups can exert on patients. […] Treatment of persistent hiccups is nonspecific. Nonpharmacological treatments involve stimulation and suppression of the vagus nerve, with tongue lifting, ingestion of highly concentrated sugar water, stimulation of the pharynx, compression over the eyeball or carotid artery, a valsalva maneuver, and rebreathing. Pharmacological treatments include anticonvulsants (i.e., phenytoin, carbamazepine, and valproic acid), gamma-aminobutyric acid analogues (i.e., baclofen and gabapentin), and dopamine receptor antagonists (i.e., haloperidol, metoclopramide, and chlorpromazine). If these fail, nerve blocking procedures and surgical treatments can be performed.

• #1 Persistent Postoperative Hiccups – Greater Philadelphia Anesthesia Services

  https://philadelphiaanesthesiaservices.com/persistent-postoperative-hiccups/

  Other options include vagus nerve stimulators, implantable breathing pacemakers, or acupuncture, though the evidence for these treatments consists mainly of case reports due to lack of research. […] Treatment will depend on severity and duration of hiccups. […] For more serious types of hiccups, there are a wide range of treatment options, though they lack systematic study.

• #1 Treatment of Lung Cancer-Related Intractable Hiccups Using Pulsed Radiofrequency: Clinical Experience

  https://www.e-jhpc.org/journal/view.html?doi=10.14475/kjhpc.2018.21.3.104

  While most benign hiccups can be controlled with empirical therapy, intractable hiccups lasting longer than one month tend to have significant adverse effects with obscure etiology. Treatment strategies for intractable hiccups have not been established. […] Here, we describe the first case of an intractable hiccup in a patient with a lung cancer in the right lower lobe just above the diaphragm that was successfully treated by ultrasound (US) guided pulsed radiofrequency treatment (PRFT) of right phrenic nerve. […] Treatments for hiccup include non-pharmacological therapy, pharmacological therapy, and nerve block. Non-pharmacological therapy is used to inhibit afferent pathway of vagus nerve, such as holding a breath, drinking cold water, and carotid sinus massage. If non-pharmacological therapy is ineffective, variable drugs, including metoclopramide, chlorpromazine, amitriptyline, phenytoin, and valproic acid can be used.

• #1 Treatment of Lung Cancer-Related Intractable Hiccups Using Pulsed Radiofrequency: Clinical Experience

  https://www.e-jhpc.org/journal/view.html?doi=10.14475/kjhpc.2018.21.3.104

  If the etiology of the intractable hiccup is highly suspected to be associated with lung cancer near the diaphragm, a phrenic nerve PRFT guided by ultrasonography can be an alternative procedure to treat the intractable hiccup. The procedure can be performed simply and unilaterally that might provide effect and safe management for the hiccup.

• #1 Hiccups | Canadian Cancer Society

  https://cancer.ca/en/treatments/side-effects/hiccups

  Persistent and intractable hiccups can be difficult to treat. Your healthcare team may suggest the following ways to treat these hiccups. Your doctor may prescribe medicines, such as: […] Acupuncture may be effective for treating persistent or intractable hiccups. […] To treat intractable hiccups, doctors may block or disrupt the signals in the nerves that control the diaphragm (called the phrenic nerves). There are several ways to do this: […] Sometimes doctors may stimulate the nerves by using electrical signals. They may stimulate the vagus nerve, which helps control the diaphragm, and maybe the phrenic nerves too. […] If other treatments fail, the doctor may cut the phrenic nerves (called a phrenicotomy) to permanently stop the nerve signals to the diaphragm, but even this does not cure all cases of intractable hiccups.

• #1 Treatment for hiccups

  https://www.mymed.com/symptoms/hiccups/how-to-get-rid-of-hiccups-hiccup-treatment

  Hypnosis is another form of treatment that has shown some success in the treatment of intractable hiccups in some case studies. […] There are some surgical approaches to treating stubborn cases of hiccups that do not respond to other treatments. […] Phrenic nerve surgery entails the surgical crushing or blocking of this nerve through the use of a local anaesthetic. […] This treatment option is regarded as the last resort in attempting to terminate chronic hiccups.

• #1 Hiccups: Causes, Serious Signs, Treatment, Home Remedies and More

  https://www.medicinenet.com/hiccups/article.htm

  Hiccups can be prevented by avoiding overeating, eating too quickly, or drinking too much. […] Most hiccups will stop on their own. Home remedies are generally sufficient to resolve hiccups. […] Treatment varies for persistent hiccups (lasting more than three hours), and you may need to contact your doctor. […] A health care professional may prescribe medications for severe, chronic hiccups. Chlorpromazine (Thorazine) is usually the first-line medication prescribed for hiccups. Other medications used to treat hiccups include baclofen (Lioresal, Gablofen), haloperidol (Haldol), and metoclopramide (Reglan). […] Phrenic nerve surgery (the nerve that controls the diaphragm) is a treatment of last resort. This treatment is rarely performed, and phrenic nerve surgery is used only in individuals with long-term hiccups who do not respond to other treatments.

• #1 Is there effective ways to treat hiccups in patients with cancer?

  https://www.oncoplus.co.in/treatment-of-hiccups-in-patients-with-cancer/

  Hiccups are an unexpectedly common symptom seen in patients having cancer, whether during cancer treatment or in the palliative care setting. […] However, some patients may experience continuing periods of greater than 24-48 hours, these are persistent/chronic/intractable hiccups that last more than 2 months, and up to 10% of the patients having advanced cancer deal with it. […] Prolonged or persistent may have undesirable effects. […] There are no medical treatments for treating hiccups as these are temporary and get away easily without treatment. […] Other treatments include Chlorpromazine, Chlorpromazine is a dimethylamine derivative of phenothiazine. […] Baclofen is also an effective drug for people suffering from persistent hiccups and has initiation of baclofen resulted in the proper resolution of hiccups in 6 out of 10 patients and showed remarkable improvement in 2 patients.

• #1 Hiccups treatment & management | PPT

  https://www.slideshare.net/slideshow/hiccupstreatment-amp-management/71244821

  Various causes of protracted hiccups have been identified including metabolic abnormalities, central nervous system pathology, malignancy, medications, and disorders attributed to cardiac, pulmonary and gastrointestinal etiologies. […] Diagnosis and management of hiccups in the patient with advanced cancer. Benign, self-limited hiccups are more of a nuisance, but persistent and intractable hiccups lasting more than 48 hours and 1 month, respectively, are a source of significant morbidity in the patient with advanced malignancy. […] The hiccup reflex is complex, but stimulation of vagal afferents followed by activation of efferent phrenic and intercostal nerve pathways results in contraction of the diaphragm and intercostal muscles, respectively. […] Prolonged hiccups can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes.

• #1 Is there effective ways to treat hiccups in patients with cancer?

  https://www.oncoplus.co.in/treatment-of-hiccups-in-patients-with-cancer/

  Gabapentin is also a medication that has shown significant improvement and the hiccups were relieved by oral gabapentin. […] Medications that are effective in treating long-term hiccups are the following: Baclofen, Metoclopramide, Chlorpromazine. […] Hiccups are one of the side effects of chemotherapy. […] Yes, hiccups can be a sign of serious illness. […] Hiccups can happen if a person nears death if they have an underlying health condition or taking a specific medication.

• #1 Hiccups Management

  https://enclarapharmacia.com/palliative-pearls/hiccups-management

  VL’s physician ordered chlorpromazine 25mg for every 8 hours as needed for hiccups, hoping it would also relieve some nausea as well. […] Hiccups persisting for greater than 48 hours may warrant treatment. […] Hiccups related to reflux, dyspepsia or stomach distension: Antacids (Mylanta, Tums), Anti-flatulent therapy (simethicone), Prokinetic agent (metoclopramide). […] Hiccups NOT related to reflux, dyspepsia or stomach distension: Anticonvulsants (carbamazepine, gabapentin, valproic acid), Antipsychotics (haloperidol, chlorpromazine), Muscle relaxers (baclofen). […] In patients with abdominal malignancies, especially those with other accompanying epigastric symptoms such as bloating, belching, nausea, reflux, hiccups are typically a direct result of significant gastric distension. […] Recommendations to reduce gastric distension and resulting hiccups: Initiate metoclopramide 5mg three times daily for hiccups. Monitor and assess response.

• #1 Hiccups treatment & management | PPT

  https://www.slideshare.net/slideshow/hiccupstreatment-amp-management/71244821

  Evaluation should be symptom-directed, focusing mainly upon the CNS and thoracoabdominal cavities as well as assessment of medications and serum chemistries. […] Most patients with ongoing hiccups require pharmacotherapy, with chlorpromazine being the only US Food and Drug Administration-approved agent. […] However, numerous other medications have been reported to be efficacious for treating intractable hiccups. […] Gabapentin has recently been shown to terminate hiccups effectively in cancer patients and may emerge as a therapy of choice in the palliative setting due to favorable tolerability, pain-modulating effects, minimal adverse events, and lack of drug interactions. […] false

• #1 Interventions for treating persistent and intractable hiccups in adults. | Cochrane

  https://www.cochrane.org/CD008768/SYMPT_interventions-treating-persistent-and-intractable-hiccups-adults

  Hiccups involve repeated, involuntary contractions of the muscles used for breathing. They usually stop of their own accord; rarely, however, they may last for more than 48 hours. When they do persist, hiccups can cause a patient considerable upset, interfere with sleeping and eating, and can lead to other complications. Many different drugs and non-drug measures have been suggested to stop long-lasting hiccups. This review aimed to find out whether there is good evidence that any of these work. Our conclusion is that there is insufficient evidence to recommend a particular treatment for hiccups. There is a need for randomised controlled studies to identify which treatments might be effective or harmful in treating persistent hiccups. […] There is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non-pharmacological interventions.

• #1 Interventions for treating persistent and intractable hiccups in adults. | Cochrane

  https://www.cochrane.org/CD008768/SYMPT_interventions-treating-persistent-and-intractable-hiccups-adults

  The paucity of high quality studies indicate a need for randomised placebo-controlled trials of both pharmacological and non-pharmacological treatments. […] A wide range of pharmacological and non-pharmacological interventions have been used for the treatment of persistent and intractable hiccups. However, there is little evidence as to which interventions are effective or harmful. […] The objective of this review was to evaluate the effectiveness of pharmacological and non-pharmacological interventions used in the treatment of persistent and intractable hiccups of any aetiology in adults. […] A total of four studies (305 participants) met the inclusion criteria. All of these studies sought to determine the effectiveness of different acupuncture techniques in the treatment of persistent and intractable hiccups. […] No studies investigating pharmacological interventions for persistent and intractable hiccups met the inclusion criteria.

• #1 :: Journal of Neurocritical Care

  https://www.e-jnc.org/m/journal/view.php?doi=10.18700/jnc.200018

  In majority of the cases, no cause is found and the treatment is mainly empirical to ameliorate the symptoms. […] Physical maneuvers such as interrupting normal respiratory function (e.g., breath holding, Valsalva maneuver), stimulating nasopharynx or uvula (e.g., sipping cold water, gargling with water, swallowing a teaspoon of dry sugar), increasing vagal stimulation (e.g., pressing on the eyeballs), and countering irritation of the diaphragm (e.g., pulling knees to chest, leaning forward to compress the chest) are first-line treatments for hiccups. […] Drug therapy should be reserved for treatment of hiccups when physical maneuvers have failed. […] There is inadequate data to formulate treatment guidelines for persistent hiccups. […] The pharmacological treatment is summarized in Table 3.

• #1 Hiccups in patients with cancer: a multi-site, single-institution study of etiology, severity, complications, interventions, and outcomes | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-022-09760-5

  This study underscores the challenges of demonstrating the therapeutic efficacy of hiccup interventions. […] Admittedly, in most patients, the hiccups eventually resolve on their own with no or little intervention; this study confirms the same. […] Yet, the data presented here — including the complications of sleep disturbance, emergency department visits and hospitalizations, musculoskeletal pain, and others suggest the need to develop novel study designs for hiccup palliation and to thereby enable healthcare providers to have access to a broader and more effective armamentarium of interventions for managing hiccups.

• #1 FF #81 Management of Hiccups | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/management-of-hiccups/

  Hiccups (singultus) are an involuntary reflex involving the respiratory muscles of the chest and diaphragm, mediated by the phrenic and vagus nerves and a central (brainstem) reflex center. A single episode can last for a few seconds to as long as several days. When they last longer than 48 hours, hiccups are termed persistent; longer than one month, intractable. Persistent and intractable hiccups can be very distressing to patients and families and diminish quality of life. Etiologies range in seriousness from stress/excitement, gastric or esophageal distention, corticosteroids, idiopathic, post-surgical, chemotherapy, cancer, myocardial infarction, liver disease, uremia, and CNS lesions. Irritation of the vagus nerve or diaphragm is a common pathophysiologic mechanism. […] Once hiccups have lasted beyond a time-limited annoyance, deciding on therapeutic intervention should be based on a thorough clinical assessment and, if possible, treatment directed at the underlying cause. A thorough history, review of medications, focused review of systems, and physical exam may help guide initial choice of treatment. Many drug and non-drug treatments have been used, but there is little evidence of any one superior approach to management. The patient’s prognosis, current level of function, and potential adverse effects from any proposed treatment should be considered.

• #2 Hiccup: Mystery, Nature and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3325297/

  Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. […] An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. […] The effective hiccup treatment is exactly established upon a correct diagnosis of lesion responsible for the serious event. For example, after effective measures were undertaken to CNS lesions such as vascular ischemia and tumors, hiccup episodes subsided. Similarly, some peripheral lesions related hiccups responded well after these lesions were ablated. In addition, many available therapies are not evidence-based; moreover, alternative medicines and remedies have been tested with unbelievable effectiveness.

• #2 :: Journal of Neurocritical Care

  https://www.e-jnc.org/m/journal/view.php?doi=10.18700/jnc.200018

  Hiccups are usually self-limiting and benign but can be distressing when they become persistent or intractable and produce significant morbidity. […] Several pharmacological and nonpharmacological strategies have been devised for the treatment of persistent and intractable hiccups. […] In this review, we have presented the pathophysiology and workup, and a stepwise management protocol for intractable hiccups. […] Unfortunately, there are no clear guidelines applicable to the management of persistent or IH. […] Recently U.S. Food and Drug Administration (FDA) revoked the approval of chlorpromazine, citing its serious side effects in treating hiccups. […] The treatment approach of persistent hiccups is mostly based on observational reports and case series, and clear-cut guidelines are lacking. The treatment is mainly directed at treating the underlying cause when the illness causing hiccups has been identified.

• #2 What Causes Hiccups: How to Make Them Stop and More

  https://www.healthline.com/health/hiccups

  Hiccups are caused by the diaphragm involuntarily contracting. […] There are numerous options for treating hiccups. […] Not all of these have been proven to stop hiccups, but you can try the following potential treatments for hiccups at home: […] Treating any underlying causes of your hiccups will usually make them go away. […] If your hiccups last for a while and have no obvious cause, a doctor may recommend several anti-hiccup medications. […] A doctor may perform a carotid sinus massage to help stop long lasting hiccups. […] There are also more invasive options, which can be used to end extreme cases of hiccups. […] Hiccups that last longer than 48 hours are considered persistent. […] If the cause of your hiccups is unclear, a doctor may recommend tests. […] A long-term episode of hiccups can be uncomfortable and even harmful to your health. […] Theres no proven method for preventing hiccups. […] A number of possible treatments are also available. […] If your hiccups last longer than 48 hours, dont respond to treatment, or you arent sure whats causing them, see a doctor for a diagnosis.

• #2 Hiccups Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/775746-treatment

  Generations of physicians have failed to discover a definitive cure for hiccups. The following statement from the Mayo Clinic, though made in 1932, still describes the situation perfectly: „The amount of knowledge on any subject such as this can be considered as being in inverse proportion to the number of different treatments suggested and tried for it.” […] Supportive care is administered as indicated by the causative pathology (eg, oxygen for the patient whose hiccups may be secondary to pneumonia). Therapy is directed first toward at the cause of the hiccups (if identified) and then toward the hiccups themselves (if necessary). […] Treatment may be pharmacologic or nonpharmacologic. Chlorpromazine remains the only agent approved by the US Food and Drug Administration (FDA) for the treatment of intractable hiccups.

• #2 Hiccups Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/775746-treatment

  Surgical phrenic nerve ablation has been advocated for intractable cases that are unresponsive to other treatment. This drastic approach may be associated with considerable morbidity and is not universally successful. […] A Cochrane review concluded that the available evidence was insufficient to guide treatment of persistent or intractable hiccups by either pharmacologic or nonpharmacologic means. […] Various agents have been reported to cure hiccups. Gabapentin, baclofen, and metoclopramide appear to show promise for persistent hiccups alone, in combination with other drugs, including proton-pump inhibitors, or as conjoined therapy. […] However, on the basis of the limited data available, the investigators indicated that owing to their lower risk of adverse effects over long-term therapy as compared with traditional neuroleptic agents, baclofen and gabapentin may be considered first-line therapy for persistent/intractable hiccups, with metoclopramide and chlorpromazine in reserve.

• #2

  https://jhoponline.com/issue-archive/2014-issues/december-vol-4-no-4/16296-hiccups

  Hiccups are an underreported respiratory complication that can significantly impair an individuals quality of life. Responsible for at least 4000 hospital admissions annually, they often are not considered significant in the need to care for a patients other pressing comorbidities such as malignancy. […] Self-limited hiccups do not require intervention as they will generally resolve without causing significant distress. Although there is little scientific evidence to support their use, it is common for people to try a variety of nonpharmacologic interventions to resolve their hiccups. Common interventions include the pressure or stimulation of different body areas, sudden frightening experiences, ingestion of sugar or a glass of liquid, black pepperinduced sneezes, or breathing into a paper bag.

• #2 Hiccups: a common problem with some unusual causes and cures | British Journal of General Practice

  https://bjgp.org/content/66/652/584

  Hiccups is a reflex consisting of a sudden spasmodic contraction of the diaphragm causing shaking of the inspiratory muscles of the chest and abdomen, followed by the sudden closure of the glottis, which generates a characteristic noise of air being violently expelled from the lungs. […] This article describes an unusual cause of persistent hiccups and considers some of the remedies that can be used for the condition. […] The recommendations for treatment of transient hiccups are nasopharyngeal stimulation (drinking a glass of water, or inserting a tube through the nose as far as the back wall of the pharynx for 20 seconds), vagal stimulation (carotid sinus massage, cold compress to face, or induced vomiting), and respiratory manoeuvres (holding the breath, cough, Valsalva manoeuvre, or breathing into a paper bag). These manoeuvres are, in general, effective only in shortening an attack of acute hiccups and not in the treatment of persistent or recurrent hiccups.

• #2 Hiccups: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.hiccups-care-instructions.abk7514

  Hiccups occur when a spasm contracts the diaphragm. This is a large sheet of muscle that separates the chest cavity from the abdominal cavity. The spasm causes an intake of breath that is suddenly stopped by the closing of the vocal cords. This closure causes the „hiccup” sound. […] Most hiccups go away on their own within a few minutes to a few hours and don’t require any treatment. […] Hiccups that last longer than 48 hours are called persistent hiccups. Hiccups that last longer than a month are called intractable hiccups. Both kinds of hiccups may be a sign of a more serious health problem. Tests may be needed to help find the cause. […] Try these safe and easy home remedies if your hiccups are making you uncomfortable. Eat a teaspoon of sugar. Hold your breath and count slowly to 10. Quickly drink a glass of cold water. […] If your doctor prescribed medicine, take it as directed. Call your doctor if you think you are having a problem with your medicine. […] Call your doctor now or seek immediate medical care if: You have hiccups for more than 2 days. […] Hiccups occur often and get in the way of your activities.

• #2 Discover 5 Natural and Effective Solutions for Hiccups | Netmeds

  https://www.netmeds.com/health-library/post/5-effective-natural-remedies-for-hiccups?srsltid=AfmBOopC0taRe2CMYy8ftuMOS1eFUu738sw5xGBu6RT-Nv_5kAbYEfRm

  Applying pressure on certain areas of your body that are particularly sensitive to pressure points may help to ease hiccups by relaxing the diaphragm or stimulating vagus or phrenic nerves. […] Pulling on your tongue triggers the nerves and muscles in the throat. Hold the tip of your tongue and mildly pull or forward once or twice. […] With your hand, apply pressure to the region just below the end of the sternum to get respite from hiccups. […] With your thumb apply pressure to the palm of your other hand.

• #2 Hiccups

  https://www2.hse.ie/conditions/hiccups/

  Hiccups usually go away on their own. But there are things you can try to stop or prevent hiccups. These things may not work for everyone. […] Your GP can check if a health condition or medicine causes your hiccups. […] If they find a cause, they may recommend: treatment for the condition, changing your medicine. […] Your GP may prescribe a medicine called chlorpromazine if: your hiccups last longer than 2 days, there is no obvious cause. […] In rare cases, they may prescribe baclofen.

• #2 Hiccups: Causes, treatments, and complications

  https://www.medicalnewstoday.com/articles/181573

  Hiccups are medically known as synchronous diaphragmatic flutter or singultus. […] Most cases resolve without treatment, but prolonged hiccups can lead to complications such as insomnia and depression. […] If hiccups last for longer than 48 hours, the person should contact a doctor, who may prescribe muscle relaxants. […] If a person has an underlying condition, managing it will probably resolve the hiccups. […] Chlorpromazine is the first-line treatment, as it is the only medication with Food and Drug Administration (FDA) approval to treat hiccups. […] A doctor may recommend the following medications for hiccups if there appears to be no underlying condition: metoclopramide (Reglan), which is an antinausea medication that may help some people with hiccups; baclofen (Lioresal), which is a muscle relaxant (off-label use); gabapentin, which is an antiseizure medication that doctors commonly prescribe for neuropathic pain and that can help alleviate the symptoms of hiccups (off-label use). […] In severe cases that do not respond to other treatments, a surgeon may inject medication into the phrenic nerve to temporarily block the nerves action or sever the phrenic nerve in the neck.

• #2 :: Journal of Neurocritical Care

  https://www.e-jnc.org/m/journal/view.php?doi=10.18700/jnc.200018

  In majority of the cases, no cause is found and the treatment is mainly empirical to ameliorate the symptoms. […] Physical maneuvers such as interrupting normal respiratory function (e.g., breath holding, Valsalva maneuver), stimulating nasopharynx or uvula (e.g., sipping cold water, gargling with water, swallowing a teaspoon of dry sugar), increasing vagal stimulation (e.g., pressing on the eyeballs), and countering irritation of the diaphragm (e.g., pulling knees to chest, leaning forward to compress the chest) are first-line treatments for hiccups. […] Drug therapy should be reserved for treatment of hiccups when physical maneuvers have failed. […] There is inadequate data to formulate treatment guidelines for persistent hiccups. […] The pharmacological treatment is summarized in Table 3.

• #2 Managing hiccups

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3114667/

  Hiccups are a common experience, and warrant treatment only when they become persistent and bothersome. […] Treatment of hiccups should be directed toward the specific cause, if one can be identified. […] If they are persistent and bothersome, consider the addition of a medication to treat the hiccups, recognizing that adding medications might result in drug interactions and side effects. […] Chlorpromazine is the only medication approved for hiccups by the US Food and Drug Administration, and for many years it was the drug of choice. […] Baclofen in dosages of 5 mg twice daily to 20 mg 3 times daily has been shown to be effective in alleviating hiccups in several small trials and case series since 1992. […] Reducing the frequency of recurrent or persistent hiccups is important, as it will improve overall quality of life. […] Many treatments of hiccups are described, and some common nonmedical treatments might be effective. […] While the use of medications remains somewhat empirical, defoaming and propulsive agents, followed by baclofen if needed, are good initial choices.

• #2 Hiccups treatment & management | PPT

  https://www.slideshare.net/slideshow/hiccupstreatment-amp-management/71244821

  Chlorpromazine is the most thoroughly studied medication and appears to be the drug of choice in many reports. Regimens in the range of 25-50 mg intravenously (IV) or intramuscularly (IM) are effective in 80% of cases. To prevent or minimize hypotension caused by this agent, preloading the patient with 500-1000 mL of IV fluid is advised. […] Another major tranquilizer, haloperidol, is effective in doses of 2-5 mg. […] Metoclopramide has been used successfully in a dosage of 10 mg every 8 hours. Indeed, a double-blind, randomized, controlled pilot study by Wang and Wang provided evidence of the usefulness of metoclopramide against intractable hiccups. […] Several anticonvulsant agents have been used to treat intractable hiccups. Phenytoin, valproic acid, and carbamazepine have all been effective when used in typical anticonvulsant doses. Gabapentin has been shown to be effective in patients with central nervous system (CNS) lesions and in some other etiologic groups.

• #2 Hiccups: a common problem with some unusual causes and cures | British Journal of General Practice

  https://bjgp.org/content/66/652/584

  In the case of persistent hiccups, the following drugs are used: haloperidol 25 mg/24 hr, metoclopramide 10 mg, baclofen 5 mg/8 hr, phenytoin, valproic acid, carbamazepine, gabapentin, amitriptyline, and amantadine. Chlorpromazine 2550 mg intramuscularly or intravenously is effective in up to 80% of cases. […] When hiccups fail to respond to the above therapies, other treatment options can be tried, including surgery, hypnosis, acupuncture, rectal massage, sexual stimulation, ejaculation, and even smoking marijuana.

• #2 :: Journal of Neurocritical Care

  https://www.e-jnc.org/m/journal/view.php?doi=10.18700/jnc.200018

  Chlorpromazine, a dimethylamine derivative of phenothiazine, is a centrally acting dopamine antagonist which acts at the hypothalamus. […] The suggested dose has been 10-25 mg orally or intravenously; if no response then up to 25-50 mg three times a day can be used. […] Haloperidol alleviates hiccups by its dopamine antagonism in the hypothalamus. […] The major side effect is extrapyramidal symptoms. […] Baclofen, a GABA-B agonist, inhibits transient relaxations of the lower esophageal sphincter and diaphragm with its peripherally and centrally mediated effect on vagal nerves. […] Anti-convulsant medications are used as a second line treatment of persistent hiccups. […] Gabapentin modulates diaphragmatic excitability by increasing the endogenous GABA-mediated inhibition of inspiratory muscles and reducing calcium influx through inhibitory effects on voltage-operated calcium channels in the presynaptic terminals of respiratory muscles.

• #2 Hiccups Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/775746-treatment

  Chlorpromazine is the most thoroughly studied medication, is FDA-approved for intractable hiccups, and appears to be the drug of choice in many reports. […] Several anticonvulsant agents have been used to treat intractable hiccups. Phenytoin, valproic acid, and carbamazepine have all been effective when used in typical anticonvulsant doses. […] The centrally acting muscle relaxant baclofen, in a dosage of 10 mg orally every 6 hours, is particularly useful in patients for whom other agents are contraindicated (eg, those with renal impairment). […] The final and most drastic treatment for hiccups is phrenic nerve ablation. […] Microvascular decompression of the vagus nerve has been reported to be successful in case reports.

• #2 What are pharmacotherapeutic options for treating hiccups in patients without oral access?

  https://inpharmd.com/inquiries/64e0d3a837b13d9cd9ebd3ba4446537154410e1bc91117c1703b88624bfab37c

  The use of baclofen and metoclopramide are supported by small randomized, placebo-controlled trials. Both drugs showed significant benefit in terms of the cessation of hiccups compared to placebo. […] Based on the quality of available evidence, the authors of this review recommend baclofen (5 to 20 mg TID) as first-line therapy for persistent and intractable hiccups. Gabapentin (300 to 600 mg TID) or pregabalin (75 to 150 mg BID) are also recommended as first-line options due to safety. […] Clinical experience also supports the use of chlorpromazine (25 to 50 mg QID) and other neuroleptics for acute, but longterm management may result in neurological adverse events. […] According to a review from the College of Family Physicians of Canada, there are no large randomized controlled trials, nor any consensus statements, on how to treat hiccups.

• #2 :: Journal of Neurocritical Care

  https://www.e-jnc.org/m/journal/view.php?doi=10.18700/jnc.200018

  Gabapentin either alone or in combination with other medications has been recommended especially in patients with hiccups secondary to brain tumors. […] Combination therapy for IH has also been proposed in certain case reports. […] Considering the present literature on hiccup pharmacotherapy, baclofen may be considered as a first line therapy followed by gabapentin.

• #2 Hiccups Medication: Antiemetic Agents, Anticonvulsants/Antiarrhythmics, Anesthetics, Muscle Relaxants, Analgesics, Antipsychotic Agents, Sedative/Hypnotics, Antidepressants, Tricyclic Antidepressants, Stimulants

  https://emedicine.medscape.com/article/775746-medication

  Antiemetic agents are effective in treating hiccups. […] Chlorpromazine is the drug of choice in this setting. […] Metoclopramide blocks dopamine receptors in the chemoreceptor trigger zone of the CNS. […] Anticonvulsants are used for severe muscle spasms. […] Ketamine acts on the cortex and limbic system, decreasing muscle spasms. […] Baclofen may induce the hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at the spinal level. It is useful in patients for whom other agents are contraindicated (eg, those with renal impairment). […] Sedative agents with effects in spastic muscles have shown effectiveness. […] Haloperidol is useful in treatment of irregular spasmodic movements of muscles. […] Tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. […] The mechanisms by which stimulants act in the treatment of hiccups are not well understood.

• #2

• #2 Persistent Postoperative Hiccups – Greater Philadelphia Anesthesia Services

  https://philadelphiaanesthesiaservices.com/persistent-postoperative-hiccups/

  FISST stopped hiccups in 92% of cases and was demonstrated to be more efficacious than traditional home remedies, making it a promising new tool for hiccup treatment. […] For persistent and intractable hiccups, workup should include looking for underlying causes, such as a structural issue or medication side effect. […] If physical maneuvers do not work for eliminating hiccups, pharmacotherapy is the next step to consider. […] Treatment includes medications such as baclofen or metoclopramide depending on the etiology of the hiccups. […] If the hiccups are refractory to medication, more invasive treatments such as nerve blocks can be performed. […] Lee et al. reported success in treating 3 patients who developed postoperative hiccups with a stellate ganglion block. […] Similarly, phrenic nerve blocks stop hiccups in refractory cases.

• #2 Hiccup – Wikipedia

  https://en.wikipedia.org/wiki/Hiccup

  Hiccups are normally waited out, as fits will usually pass quickly. Folk cures for hiccups are common and varied. Hiccups are treated medically only in severe and persistent (termed „intractable”) cases. […] Numerous medical remedies exist but no particular treatment is known to be especially effective, generally because of a lack of high-quality evidence. […] A vagus nerve stimulator has been used with an intractable case of hiccups. „It sends rhythmic bursts of electricity to the brain by way of the vagus nerve, which passes through the neck. The Food and Drug Administration approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy.” […] In one person, persistent digital rectal massage coincided with terminating intractable hiccups. […] There are many folk remedies for hiccups, including headstanding, drinking a glass of water upside-down, being frightened by someone, breathing into a bag, eating a large spoonful of peanut butter and placing sugar on or under the tongue.

• #2 Treatment of Lung Cancer-Related Intractable Hiccups Using Pulsed Radiofrequency: Clinical Experience

  https://www.e-jhpc.org/journal/view.html?doi=10.14475/kjhpc.2018.21.3.104

  If the etiology of the intractable hiccup is highly suspected to be associated with lung cancer near the diaphragm, a phrenic nerve PRFT guided by ultrasonography can be an alternative procedure to treat the intractable hiccup. The procedure can be performed simply and unilaterally that might provide effect and safe management for the hiccup.

• #2 Treating 'Never-Ending’ Hiccups | Psychology Today

  https://www.psychologytoday.com/us/blog/the-red-light-district/202005/treating-never-ending-hiccups

  Limited evidence has shown that it may also help with intractable hiccups. […] Various manipulations to the phrenic nerve have been floated to cure intractable hiccups, including injection with a local anesthetic, electrical stimulation, and even crushing and avulsion (ie, tearing the nerve). […] Vagal blockade may work for shortening an attack of acute hiccups. […] Alternative or complementary medicine strategies including acupuncture and hypnosis have been used to treat intractable hiccups. […] For many with intractable hiccups, no magic bullet exists. Treatments may take hours to days to work, with hiccups gradually remitting.

• #2 Hiccups | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hiccups

  Hiccups are usually harmless and resolve by themselves after a few minutes. […] Prolonged hiccups should be medically investigated. Treatment options may include: […] Anti-spasmodic drugs to calm the diaphragm. […] Hiccups that last for days, weeks or even years may be symptomatic of underlying disease. […] Certain lung or brain disorders can sometimes interfere with the functioning of the diaphragm and make the person prone to hiccups. […] Treatment for the underlying disorder. […] Changes to current drug dosages. […] Switching to another form of nicotine therapy. […] A nerve block. […] Surgery, to sever some of the nerves servicing the diaphragm.

• #2 ALL YOU NEED TO KNOW ABOUT HICCUPS: CAUSES, PREVENTION AND TREATMENT | Mya Care

  https://myacare.com/blog/all-you-need-to-know-about-hiccups-causes-prevention-and-treatment

  Hiccups are an amusing and often annoying reflex that appear spontaneously when we least expect them. […] A few home remedies may be effective solely on the principle of belief, with some advocating vinegar or peanut butter to get rid of hiccups. […] The following article explores the causes and triggers of hiccups, how remedies work best for prevention, and when to get medical help for intractable hiccups. […] For hiccups that last more than 48 hours or that cause severe symptoms, you should seek out a doctors appointment as soon as possible. […] Common causes of persistent hiccups include digestive disorders, such as GERD, brainstem or nerve damage, stroke or heart attack, infections, tumors, allergies, heart problems, respiratory conditions, and medications such as cisplatin and dexamethasone.

• #2 Hiccups Management

  https://enclarapharmacia.com/palliative-pearls/hiccups-management

  VL’s physician ordered chlorpromazine 25mg for every 8 hours as needed for hiccups, hoping it would also relieve some nausea as well. […] Hiccups persisting for greater than 48 hours may warrant treatment. […] Hiccups related to reflux, dyspepsia or stomach distension: Antacids (Mylanta, Tums), Anti-flatulent therapy (simethicone), Prokinetic agent (metoclopramide). […] Hiccups NOT related to reflux, dyspepsia or stomach distension: Anticonvulsants (carbamazepine, gabapentin, valproic acid), Antipsychotics (haloperidol, chlorpromazine), Muscle relaxers (baclofen). […] In patients with abdominal malignancies, especially those with other accompanying epigastric symptoms such as bloating, belching, nausea, reflux, hiccups are typically a direct result of significant gastric distension. […] Recommendations to reduce gastric distension and resulting hiccups: Initiate metoclopramide 5mg three times daily for hiccups. Monitor and assess response.

• #2 Hiccups in patients with cancer: a multi-site, single-institution study of etiology, severity, complications, interventions, and outcomes | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-022-09760-5

  Hiccups appear to be highly problematic in a small subset of patients with cancer with no well-defined palliative approaches. […] Therapeutically, the Food and Drug Administration (FDA) has previously approved only one drug, chlorpromazine, for hiccup palliation, but the reports cited above point to other interventions, such as baclofen or gabapentin, that might also provide palliation. […] Most patients 239 (75%) managed hiccups on their own with no medical intervention. […] However, when medical interventions were resorted to, the most frequent consisted of prescription medications with baclofen the most prescribed single agent. […] In 234 patients (73%), the medical record documented evidence of hiccup cessation, but it was often not clear whether the intervention was the true cause of hiccup cessation.

• #2 Interventions for treating persistent and intractable hiccups in adults. | Cochrane

  https://www.cochrane.org/CD008768/SYMPT_interventions-treating-persistent-and-intractable-hiccups-adults

  The paucity of high quality studies indicate a need for randomised placebo-controlled trials of both pharmacological and non-pharmacological treatments. […] A wide range of pharmacological and non-pharmacological interventions have been used for the treatment of persistent and intractable hiccups. However, there is little evidence as to which interventions are effective or harmful. […] The objective of this review was to evaluate the effectiveness of pharmacological and non-pharmacological interventions used in the treatment of persistent and intractable hiccups of any aetiology in adults. […] A total of four studies (305 participants) met the inclusion criteria. All of these studies sought to determine the effectiveness of different acupuncture techniques in the treatment of persistent and intractable hiccups. […] No studies investigating pharmacological interventions for persistent and intractable hiccups met the inclusion criteria.

• #2 Persistent Postoperative Hiccups – Greater Philadelphia Anesthesia Services

  https://philadelphiaanesthesiaservices.com/persistent-postoperative-hiccups/

  Other options include vagus nerve stimulators, implantable breathing pacemakers, or acupuncture, though the evidence for these treatments consists mainly of case reports due to lack of research. […] Treatment will depend on severity and duration of hiccups. […] For more serious types of hiccups, there are a wide range of treatment options, though they lack systematic study.

• #3 Hiccups: a common problem with some unusual causes and cures | British Journal of General Practice

  https://bjgp.org/content/66/652/584

  Hiccups is a reflex consisting of a sudden spasmodic contraction of the diaphragm causing shaking of the inspiratory muscles of the chest and abdomen, followed by the sudden closure of the glottis, which generates a characteristic noise of air being violently expelled from the lungs. […] This article describes an unusual cause of persistent hiccups and considers some of the remedies that can be used for the condition. […] The recommendations for treatment of transient hiccups are nasopharyngeal stimulation (drinking a glass of water, or inserting a tube through the nose as far as the back wall of the pharynx for 20 seconds), vagal stimulation (carotid sinus massage, cold compress to face, or induced vomiting), and respiratory manoeuvres (holding the breath, cough, Valsalva manoeuvre, or breathing into a paper bag). These manoeuvres are, in general, effective only in shortening an attack of acute hiccups and not in the treatment of persistent or recurrent hiccups.

• #3 Hiccups Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nonpharmacologic Therapy

  https://emedicine.medscape.com/article/775746-treatment

  Surgical phrenic nerve ablation has been advocated for intractable cases that are unresponsive to other treatment. This drastic approach may be associated with considerable morbidity and is not universally successful. […] A Cochrane review concluded that the available evidence was insufficient to guide treatment of persistent or intractable hiccups by either pharmacologic or nonpharmacologic means. […] Various agents have been reported to cure hiccups. Gabapentin, baclofen, and metoclopramide appear to show promise for persistent hiccups alone, in combination with other drugs, including proton-pump inhibitors, or as conjoined therapy. […] However, on the basis of the limited data available, the investigators indicated that owing to their lower risk of adverse effects over long-term therapy as compared with traditional neuroleptic agents, baclofen and gabapentin may be considered first-line therapy for persistent/intractable hiccups, with metoclopramide and chlorpromazine in reserve.

• #3

  https://jhoponline.com/issue-archive/2014-issues/december-vol-4-no-4/16296-hiccups

  Patients with persistent or intractable hiccups often require pharmacologic intervention to alleviate the condition or complications. The only US Food and Drug Administrationapproved hiccup remedy is chlorpromazine, which may not be useful in many patients because of its associated side effects. […] There are no randomized, adequately powered clinical trials to determine the efficacy of pharmaceuticals for the treatment of hiccups. Many agents have been tried, with anecdotal success, and are hypothesized to work via a variety of neural mechanisms to decrease the activity of irritated nerves via sodium, calcium, or gamma-aminobutyric acid (GABA)-enervated pathways. […] Older anticonvulsants such as phenytoin, valproic acid, and carbamazepine were previously used, but have largely been replaced with dopamine antagonists (eg, chlorpromazine, haloperidol, metoclopramide), GABA enhancers (baclofen, gabapentin), or calcium channel blockers (nifedipine, nimodipine). In severe cases, intravenous lidocaine, which blocks sodium channels, has been used to resolve postoperative hiccups, although this practice is limited because of the risk for cardiac side effects.

• #3 TREATMENT APPROACHES FOR PERSISTENT AND INTRACTABLE HICCUPS: A SYSTEMATIC REVIEW AND RECOMMENDATIONS | Journal of Population Therapeutics and Clinical Pharmacology

  https://jptcp.com/index.php/jptcp/article/view/5192

  A treatment algorithm is proposed based on available evidence, with baclofen as first-line therapy for persistent and intractable hiccups. Gabapentin may offer a safe and effective alternative, particularly for patients with central nervous system (CNS) involvement. However, long-term use of phenothiazines, including metoclopramide, is discouraged due to potential neurological and other adverse effects.

• #3 Interventions for treating persistent and intractable hiccups in adults. | Cochrane

  https://www.cochrane.org/CD008768/SYMPT_interventions-treating-persistent-and-intractable-hiccups-adults

  The paucity of high quality studies indicate a need for randomised placebo-controlled trials of both pharmacological and non-pharmacological treatments. […] A wide range of pharmacological and non-pharmacological interventions have been used for the treatment of persistent and intractable hiccups. However, there is little evidence as to which interventions are effective or harmful. […] The objective of this review was to evaluate the effectiveness of pharmacological and non-pharmacological interventions used in the treatment of persistent and intractable hiccups of any aetiology in adults. […] A total of four studies (305 participants) met the inclusion criteria. All of these studies sought to determine the effectiveness of different acupuncture techniques in the treatment of persistent and intractable hiccups. […] No studies investigating pharmacological interventions for persistent and intractable hiccups met the inclusion criteria.

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