Hiccups Side Effect

Hiccups (synchronous diaphragmatic flutter) is caused by a combination of involuntary diaphragmatic contraction and glottic closure. Each contraction is followed by a sudden closure of the vocal cords, which produces the distinctive sound.

The onset of drug-induced hiccups may range from minutes to a few days following medication intake.

Medications that have been reported to induce hiccup are corticosteroids, benzodiazepines, antidepressant, dopaminergic antiparkinsonians, digitalis compounds, opioids, and NSAIDs3, 4.

Drug Incidence
Aloxi® < 1%
Amphotericin (AmBisome®) 2% to 10%
Aprepitant (Emend®) 10.8%
Aripiprazole (Abilify®)1 < 1%
Azithromycin (Zithromax®)2
Busulfex® 18%
Carisoprodol (Soma®)
Celecoxib (Celexa®) Rare
CellCept® 3% to < 20%
Cevimelin (Evoxac®) 1% to 3%
Cyclosporine (Gengraf®, Neoral®) 2% or less
Dexamethasone (Decadron®, Maxidex®)
Divalproex sodium (Depakote®) > 1%
Doxil® < 1%
Eloxatin® 2% to 5%
Esomeprazole (Nexium®) < 1%
Ethyol®
Fentanyl (Actiq®, Duragesic®) < 1%
Lamotrigine (Lamictal®) Rare
Lansoprazole (Prevacid®) < 1%
Lupron® < 5%
Methohexital (Brevital Sodium®)
Moduretic® < 1%
Morphine (Avinza®, Oramorph®, MS-Contin®, Kadian®)5 < 5%
Norvir® < 2%
Ofloxacin (Floxin®)
Olanzapine (Zyprexa®) Rare
Ondansetron (Zofran®)
Oxcarbazepine (Trileptal®)
Oxycodone (OxyContin®) 1% and 5%
Pantoprazole (Protonix®) < 1%
Parcopa®
Paroxetine (Paxil®) Rare
Pergolide Mesylate (Permax®) 1.1%
Photofrin® 6%
Prevpac® < 1%
Propofol (Diprivan®)6 < 1%
Prozac® Infrequent
Quetiapine (Seroquel®) Rare
Rabeprazole (Aciphex®)
Reminyl® Infrequent
Requip® Infrequent
Rescriptor®
Reyataz® < 3%
Rilutek® Infrequent
Rizatriptan (Maxalt®) Rare
Rocuronium (Zemuron®) < 1%
Romazicon® < 1%
Salagen® < 1%
Sandimmune® < 2%
Sertraline (Zoloft®) Rare
Stalevo®
Sumatriptan (Imitrex®) Rare
Symbyax® Infrequent
Tiagabine (Gabitril®) Infrequent
Tolcapone (Tasmar®) Infrequent
Vicoprofen® < 3%
Zaleplon (Sonata®) Rare
Zolpidem (Ambien®) 1% to 10%
Zomig® Infrequent
Zosyn® 1% to 2.6%

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Risk factors

Factors that may increase risk of hiccups

  • Excessive food or alcohol intake
  • Carbonated beverages ingestion
  • Sudden temperature changes
  • Emotional stress
  • Irritation of diaphragmatic nerve
  • Aerophagia (excessive swallowing of air)

Medications for hiccup

Persistent or intractable hiccups may require treatment with medication.

List of medications that can suppress hiccups7:

  • Chlorpromazine (Thorazine®) - currently is the only medication approved for hiccups by the US FDA
  • Haloperidol (Haldol®)
  • Metoclopramide (Reglan®)
  • Baclofen (Lioresal®)
  • Gabapentin (Neurontin®)
  • Valproic acid
  • Nifedipine
  • Phenytoin
  • Peppermint oil helps - to relax the lower esophageal sphincter.

References

  • 1. Silverman MA, Leung JG, Schak KM. Aripiprazole-associated hiccups: a case and closer look at the association between hiccups and antipsychotics. J Pharm Pract. 2014 Dec;27(6):587-90. PubMed
  • 2. Jover F, Cuadrado JM, Merino J. Possible azithromycin-associated hiccups. J Clin Pharm Ther. 2005 Aug;30(4):413-6. PubMed
  • 3. Bagheri H, Cismondo S, Montastruc JL. Drug-induced hiccup: a review of the France pharmacologic vigilance database. Therapie. 1999 Jan-Feb;54(1):35-9. PubMed
  • 4. Thompson DF, Landry JP. Drug-induced hiccups. Ann Pharmacother. 1997 Mar;31(3):367-9. PubMed
  • 5. Wilcox SK. Persistent hiccups after slow-release morphine. Palliat Med. 2005 Oct;19(7):568-9.
  • 6. Landers C, Turner D, Makin C, Zaglul H, Brown R. Propofol associated hiccups and treatment with lidocaine. Anesth Analg. 2008 Nov;107(5):1757-8.
  • 7. Woelk CJ; Managing hiccups Can Fam Physician. 2011 Jun; 57(6): 672–675.

Published: August 15, 2016
Last updated: December 14, 2017

Interesting facts
  • Cases of hiccups may last for more than 48 hours (called persistent hiccups).
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