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Pharmacologic Interventions for Intractable and Persistent Hiccups: A Systematic Review.
Nick B Polito1, Shawn E Fellows1
1Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York.
The Journal of Emergency Medicine
|October 29, 2017
Summary
This review found 10 pharmacologic treatments for persistent hiccups, but limited evidence exists for specific recommendations. Treatment choice should be individualized based on patient factors and drug properties.
Area of Science:
- Pharmacology
- Neurology
- Gastroenterology
Background:
- Chlorpromazine is the sole FDA-approved drug for hiccups, despite numerous proposed treatments for intractable and persistent cases.
- Limited evidence currently supports the superiority of any single pharmacologic agent over others for hiccup treatment.
Purpose of the Study:
- To systematically review pharmacologic treatments for intractable and persistent hiccups.
- To evaluate identified therapies based on evidence level, mechanism, efficacy, dosing, onset, and adverse effects.
Main Methods:
- Systematic literature search of major databases (PubMed, Embase, Cochrane Library, NYAM) from 1966-2016.
- Inclusion of articles detailing pharmacologic treatment for intractable or persistent hiccups.
- Assessment of evidence levels using the GRADE method.
Main Results:
- Twenty-six articles identified 10 pharmacologic options for hiccup treatment.
- Amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid showed success in literature.
Conclusions:
- Baclofen, gabapentin, and metoclopramide were prospectively studied; only baclofen and metoclopramide underwent randomized controlled trials.
- Current evidence is insufficient to recommend specific treatments for intractable and persistent hiccups.
- Treatment selection requires individualized patient assessment, considering comorbidities, etiology, and drug-specific properties.