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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