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Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective. Many pharmacologic and nonpharmacologic remedies have been used to try to abort hiccups. (Reglan), 1 baclofen (Lioresal) 1, 5 and gabapentin (Neurontin) The recommended dosing of gabapentin for persistent or intractable hiccups is 100 mg three to four times daily, titrated until improvement up to a maximum total daily dose of 1200 mg. Gabapentin has a similar body of evidence as other pharmacotherapeutic agents used to treat hiccups. Gabapentin is well tolerated and should be considered as a second-line agent in selected patients. Gabapentin, a newer antiepileptic drug commonly used in cancer and palliative medicine for neuropathic pain management, produces a blockade of neural calcium channels and increases release of GABA, which might modulate diaphragmatic excitability. Gabapentin has no known serious drug interactions and is not hepatically metabolized. Gabapentin has a similar body of evidence as other pharmacotherapeutic agents used to treat hiccups. Gabapentin is well tolerated and should be considered as a second-line agent in selected patients. Amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid were found in the literature to be successful in treating hiccups. Conclusion: Baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner, while only baclofen and Gabapentin, a newer antiepileptic drug commonly used in cancer and palliative medicine for neuropathic pain management, produces a blockade of neural calcium channels and increases release of GABA, which might modulate diaphragmatic excitability. A separate review of gabapentin included additional reports and found improvement or cessation of hiccups in 81/83 patients with the longest treatment duration needed being 6 months and a wide range of dosages used (200–1200 mg daily) . This systematic review revealed no high quality data on which to base treatment recommendations. Based on limited efficacy and safety data, baclofen and gabapentin may be considered as first line therapy for persistent and intractable hiccups, with metoclopramide and chlorpromazine in reserve. The hiccups were dramatically relieved by oral Gabapentin, highlighting the recent reports that mention this molecule as being useful for hiccups. Gabapentin is a simple tool that may be utilized by palliative care physicians to relieve hiccups in advanced malignancies. For people with hiccups any duration: Advise them to avoid any identified trigger factors (where possible). Suggest the use of self-help remedies during a bout of hiccups, such as: Breath holding. The Valsalva manoeuvre (a forced expiration against a closed glottis). Breathing into a paper bag. Pulling on the tongue. Sneezing. Drugs used in the treatment of hiccups have included chlorpromazine, metoclopramide, sodium valproate, haloperidol, amitriptyline, carbamazepine, magnesium sulphate, baclofen, gabapentin, peppermint water, simeticone, benzodiazepines and nifedipine. Baclofen, gabapentin, and metoclopramide were the only drugs found in a systematic review of the literature to have positive results in studies that were prospective in nature and are good options to use when initially treating persistent and intractable hiccups, especially if the hiccups are believed to be related to ischemic stroke or cancer. Patients with severe chronic hiccups were treated with gabapentin (300 mg t.i.d.). Doses of gabapentin were titrated based on the response to treatment. Gabapentin-related adverse effects were recorded. Introduction1,2 Hiccups are involuntary, intermittent contractions of the diaphragm and intercostal muscles. The medical term for hiccups is singultus, which derives from the Latin “singult” meaning ‘to catch one’s breath while sobbing’. These contractions are often caused by irritation of the phrenic or vagus nerves, disturbances to the central nervous system (e.g., encephalitis Baclofen, gabapentin, and metoclopramide were the only drugs found in a systematic review of the literature to have positive results in studies that were prospective in nature and are good options to use when initially treating persistent and intractable hiccups, especially if the hiccups are believed to be related to ischemic stroke or cancer. Based on his medical history and a probable neurogenic etiology, gabapentin was recommended for his hiccups. Symptoms improved within several hours, with complete resolution after a dose titration to 200 mg twice daily on the second day of gabapentin treatment. While brief bouts of hiccups lasting less than 48 hours are common, little is known about the overall incidence and prevalence of prolonged hiccups in the general population. However, among patients with advanced cancer, a systematic review found that 1 to 9 percent had persistent or intractable hiccups [ 1 ]. We report a patient with a history of Guillain-Barré syndrome and metastatic gastric neoplasm who presented with intractable hiccup that successfully responded to treatment with gabapentin plus baclofen.
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