Intractable hiccups (singultus) abolished by risperidone, but not by haloperidol

Area of Science:

• Neurology
• Pharmacology

Background:

• Hiccups (singultus) are involuntary diaphragmatic contractions linked to neurological dysfunction.
• Dopamine is implicated in hiccup pathophysiology, with antipsychotics like chlorpromazine sometimes used for treatment.
• Existing treatments for intractable hiccups often have limited efficacy.

Observation:

• An 18-year-old experienced recurrent, intractable hiccups triggered by stress.
• Initial treatment with haloperidol showed no significant effect on the hiccups.
• Administration of risperidone, a dopamine-serotonin antagonist, completely resolved the hiccups within 6 hours.

Findings:

• This case report details a differential response to two antipsychotics in managing intractable hiccups.
• Risperidone's efficacy suggests a role for the serotonergic system in hiccup pathophysiology, beyond the dopaminergic system.
• The study highlights the distinct effects of different antipsychotic mechanisms on hiccup control.

Implications:

• Findings suggest that antipsychotics with combined dopamine and serotonin antagonism, like risperidone, may be effective for intractable hiccups.
• This case broadens the understanding of neurotransmitter involvement in hiccup generation.
• Further research into serotonin-acting agents for hiccup treatment is warranted.