Main Article Content

Dr. Muhammad Ammar Bhatti
Amira Shahid Sheikh
Dr. Masooda Fatima
Sajawal Khan
Dr. Coenrad Adolph Groenewald
Dr. Elma Sibonghanoy Groenewald




Hiccups, involuntary contractions of the diaphragm, are commonly benign but can become distressing when persistent or intractable. While acute hiccups are self-limiting, lasting only a few minutes, persistent cases lasting days or months pose challenges in management.


To evaluate existing treatment modalities for persistent and intractable hiccups and propose evidence-based recommendations.


A systematic review was conducted to assess the efficacy of various treatments for persistent and intractable hiccups. Studies were included if they reported on interventions targeting hiccups and provided measurable outcomes. The search encompassed randomized controlled trials, observational studies, and case reports.


Treatment of 341 patients with persistent or intractable hiccups was reported in 15 published studies. Management was most effective when directed at the underlying condition. An empirical trial of anti-reflux therapy may be appropriate. If the underlying cause is not known or not treatable, then a range of pharmacological agents may provide benefit; however, a systematic review revealed no adequately powered, well-designed trials of treatment. Small randomized, placebo-controlled trials support the use of baclofen and metoclopramide. The review identified a scarcity of adequately powered, well-designed trials on hiccup management. Empirical treatment targeting underlying causes, such as gastroesophageal reflux disease (GERD), was recommended if evident. Pharmacological interventions targeting dopaminergic and GABAergic receptors, such as baclofen and metoclopramide, showed promise in small randomized, placebo-controlled trials. Observational studies also suggested efficacy for Gabapentin and chlorpromazine, although associated side effects warrant caution.


A treatment algorithm (Figure 3) 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. Clinical decisions should align with recommendations from regulatory bodies and consider individual patient factors.

Abstract 253 | PDF Downloads 72


1. Adam, E. (2020). "A systematic review of the effectiveness of oral baclofen in the management of hiccups in adult palliative care patients." Journal of Pain & Palliative Care Pharmacotherapy 34(1): 43-54.
2. Al-hajri, A., et al. (2021). "A case report of chronic dysphagia, intractable hiccups, vomiting, and sever gastroesophageal reflux as symptoms of a posterior cranial fossa hemangioblastoma." Available at SSRN 3947410.
3. Amundson, C. J., et al. (2022). "Mitigating the Risk of Adverse Effects Related to Augmentation Therapy for Resistant Major Depressive Disorder: A Case Report." Medicina 58(3): 438.
4. Chen, J. and P. Brady (2019). "Gastroesophageal reflux disease: Pathophysiology, diagnosis, and treatment." Gastroenterology Nursing 42(1): 20-28.
5. Desanti-Siska, L., et al. (2021). "Constitutional Symptoms." Palliative and Serious Illness Patient Management for Physician Assistants: 125.
6. Devi, N. B. "Hiccup as a Challenge in My Father’s Life: An Observation from Medication and Psychological Relaxation: A Case Study Report."
7. Ehret, C. J., et al. (2022). "Olanzapine for cisplatin-induced hiccups: observations from a 338-patient study." Annals of Palliative Medicine 11(7): 2314-2318.
8. García, M., et al. (2021). "Tramadol-induced hiccups: a case–noncase study in the European pharmacovigilance database." Therapeutic Advances in Drug Safety 12: 20420986211021230.
9. Ikitimur, H., et al. (2021). "Case report: two cases of persistent hiccups complicating COVID-19." The American Journal of Tropical Medicine and Hygiene 104(5): 1713.
10. Katzka, D. A. and P. J. Kahrilas (2020). "Advances in the diagnosis and management of gastroesophageal reflux disease." bmj 371.
11. Kim, E., et al. (2021). "Microsupercapacitor with a 500 nm gap between MXene/CNT electrodes." Nano Energy 81: 105616.
12. Kim, J. E., et al. (2018). "Continuous cervical epidural block: treatment for intractable hiccups." Medicine 97(6).
13. Krysko, K. M., et al. (2020). "Association between breastfeeding and postpartum multiple sclerosis relapses: a systematic review and meta-analysis." JAMA neurology 77(3): 327-338
14. Marcolino, M. S., et al. (2018). "The impact of mHealth interventions: systematic review of systematic reviews." JMIR mHealth and uHealth 6(1): e8873.
15. Sardana, K. and S. Sachdeva (2022). "Update on pharmacology, actions, dosimetry & regimens of Glucocorticoids in dermatology." Journal of Cosmetic Dermatology.
16. Shankar, T., et al. (2022). "Intractable hiccups as the harbinger of a diffuse pontine glioma." BMJ Case Reports CP 15(3): e247830.
17. Tariq, K., et al. (2021). "A case report of Vagus nerve stimulation for intractable hiccups." International Journal of Surgery Case Reports 78: 219-222.
18. Weledji, E. P. (2020). "Perspectives on paralytic ileus." Acute Medicine & Surgery 7(1): e57
19. Zhang, Y., et al. (2021). "Efficacy of acupuncture for persistent and intractable hiccups: A protocol for systematic review and meta-analysis of randomized controlled trials." Medicine 100(8).

Most read articles by the same author(s)

1 2 > >>