Intractable hiccups

Haloperidol is indicated for schizophrenia, severe anxiety, motor tics and intractable hiccup. It is not indicated in the treatment of parkinsonism, which may be aggravated through its use, as haloperidol tends to cause extra pyramidal symptoms. 

Mechanism of Action A phenothiazine that blocks dopamine neurotransmission at postsynaptic dopamine receptor sites. Possesses strong anticholinergic, sedative, and antiemetic effects moderate extrapyramidal effects and slight antihistamine action. Therapeutic Effect Relieves nausea and vomiting improves psychotic conditions controls intractable hiccups and porphyria. 

A 59-year-old man had intractable hiccups during treatment with dexamethasone for multiple myeloma... 

Low-dose metoclopramide can be effective and may allow a patient to continue beneficial therapy without the discomfort and exhaustion that can accompany intractable hiccups. 

Lim BS, Choi WY, Choi JW. A case of steroid-induced intractable hiccup. Tuberc Respir Dis 1991 38 304-7. 

Hiccup (due to diaphragmatic spasm). Where this is intractable and exhausting, chlorpromazine (or other phenothiazine) or metoclopramide may help also baclofen, nifedipine or sodium valproate. 

Baclofen is a chlorophenyl derivative of gamma-aminobutyric acid (GABA), a naturally occurring inhibitory neurotransmitter in the brain and spinal cord. It is of proven therapeutic value in reducing the severity of flexor or extensor spasms resulting from spinal cord injury or disease. The recommended oral dose is 5 mg tds, which can be carefully increased however, the total daily dose should not exceed 80 mg (20 mg qds). It is also used for the treatment of intractable hiccups, especially in patients with uremia. 

Cefotetan-induced hiccup recurred after each cefotetan infusion and disappeared immediately after withdrawal it did not recur after administration of another antibiotic (8). Intractable hiccups in a boy were attributed to ceftriaxone-induced pseudolithiasis (9). 

Despite the recent reports of neurotoxicity of star fruit in uremic patients, the first one on star fruit toxicity was described by Muir and Lam [27] in 1980. They related toxic effects of star fruit extract after its intraperitoneal administration in mice. This extract induced seizures and death. In 1993, Martin LC et al. reported the outcome of intractable hiccups in uremic patients associated to star fruit consume [3]. However, the first report of neurotoxicity in human beings was performed by Moyses-Neto M et al (4). Subsequently, many similar case reports were described, but only in 2002 an etiological agent was proposed oxalic acid would be the star fruit neurotoxin [28]. 

Relief of intractable hiccups, acute PR 1-2 hours PR 3 hours hours PR ... 

Perphenazine, a phenothiazine (4 to 8 mg t.i.d.), is indicated in the management of psychotic disorders, in the control of nausea and vomiting in adults, and in the relief of intractable hiccups. 

Psychotic disorders, nausea, vomiting, intractable hiccups... 

Oral baclofen, in daily divided doses of 15 to 80 mg, has been found to be effective in treating neiu-opathic pain it has been used alone and as an adjuvant for the treatment of trigeminal neuralgia. Oral baclofen, in similar doses, has been used to treat intractable hiccups. In addition, though not a conventional analgesic itself, it may potentiate opioid analgesia. Continuous intrathecal baclofen infusion of 1 to 2 mg daily for the management of tetanus has been reported. 

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