Hiccup, treatment

Hemostatic mechanisms and drugs influencing them Hiccup treatment of Hirsutism treatment of... 

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. 

Phenothiazines have a diverse use in medicine. They are primarily used as antipsy-chotics. Despite the fact that they do not cure the disease, they reduce psychotic symptoms to a point where the patient is provided with a better sense of reality. Phenothiazines are sometimes used for relieving severe anxiety, especially in panic attacks caused by dependence on amphetamines or lycergic acid diethylamide (LSD). Phenothiazines are used for alleviating behavioral problems in children that do not respond to treatment of other agents. Phenothiazines are sometimes used during the preoperational period because they relieve anxiety, control nausea, hiccups, diarrhea, and also cause muscle relaxation. 

Unlabeled Uses Prevention of aspiration pneumonia treatment of drug-related postoperative nausea and vomiting, persistent hiccups, slow gastric emptying, vascular headaches... 

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

A 38-year-old man had an intra-articular injection of betamethasone dipropionate (dose not stated) into his right ankle, and the day after had hiccups that lasted for 24 hours and then resolved without treatment. Some months later, because of persistent arthritis, he received a further injection of betamethasone dipropionate into his right ankle. Once again, he had hiccups the following day. On this occasion, the hiccups resolved after 2 weeks, following treatment with levo-mepromazine. 

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. 

In 2000 Chang JM et al [5] reported 19 patients with renal failure under dialysis and one also with renal failure but in supportive treatment who after star fruit ingestion developed signs and symptoms of intoxication such as hiccups, mental confusion, paresis, muscular weakness and convulsions. Eight of those patients died (including the patient in supportive treatment)... 

In one of the first observations, Martin LC et al [3] reported that hemodialysis eliminated all symptoms, although all of them presented clinical pictures of mild intoxication (hiccups and vomiting). None of those patients had mental confusion or seizures. In another report 6 patients who were described by Neto et al [4], one patient died and PD was offered as the only treatment. The other five received conventional hemodialysis and improved without sequelae (mild and moderate levels of intoxication, and in one case the patient had severe mental confusion without seizures or hemodynamic instability). Unfortunately there is no neurological... 

Seven patients who were in supportive treatment (without need for dialysis) at the time of star fruit ingestion had rruld intoxication presenting hiccups or diarrhea. Six patients improved without dialysis. Time to improve was up to 24 hours in 4 patients, 5 days in another one, and there is no information in one patient. One patient improved after IPD (intermittent peritoneal dialysis) [13,14]. Peritoneal dialysis was not an efficient method of treatment although 1 patient with signs and symptoms of moderate intoxication and 2 with mild intoxication changed from CAPD to IPD (intermittent peritoneal dialysis) and improved [13]. Two patients that remained in CAPD also improved [7, 12]. In one case [13] patient presented diplopia that continued for 6 weeks after improvement of the acute intoxication episode. Patients with severe intoxication did not benefit from peritoneal dialysis treatment [13]. 

All observations in our reports and reports from ofhers show fhaf sfar fruif intoxication may be harmful and even life fhreatening in patients with renal failure on supportive or dialytic treatment. Hiccups and vomiting, which are common symptoms, could be used as an indication of sfar fruit intoxication in renal patients presenting with neurological and consciousness disturbances that have no apparent cause. 

Phenothiazines are used to treat psychosis including schizophrenia violent, agitated, disturbed behavior and manic phase of bipolar disorder. Other uses include treatment of pain, headache, hiccups, acute severe anxiety, idiopathic dystonia, withdrawal, taste disorders, leishmaniasis, alleviation of nausea and vomiting, and acute intermittent porphyria. Phenothiazines permit smoother induction of anesthesia, potentiate anesthetic agents, and allow treatment of behavioral symptoms secondary to Alzheimer s disease and senile dementia. Some phenothiazines exert an antipruritic effect and are useful for the treatment of neurodermatitis and pruriginous eczema, and may relieve psychogenic itching. 

Biochemical Connections A frequently recommended treatment for hiccups is to hold one s breath. The resulting condition, hypoventilation, causes buildup of carbon dioxide in the lungs. Predict the effect on the pH of blood. 

The antipsychotics are represented by chlorpromazine (and other pheno-thiazines), haloperidol (and other butyrophenones) and thioxanthenes, and the atypical, or newer, antipsychotic drugs, such as clozapine and risperidone. Their major use is in the treatment of psychoses such as schizophrenia and mania. These are listed in Table 20.1 , (below). Some of the antipsychotics are also used as antiemetics, and for motor tics and 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. 

The results of various clinical trials indicated that the incidence of adverse events was similar in the aprepitant group compared with the group which received only standard regimen of ondansetron and dexamethasone. The most commonly observed side effects with aprepitant treatment were asthenia, hiccups, diarrhea, gastritis, elevation in fiver function tests, and dizziness. There are also reports of thrombocytopenia and dehydration. 

Landers C, Turner D, Makin C, Zaglul H, Brown R. Propofol associated hiccups and treatment with lidocaine. Anesth Analg 2008 107(5) 1757-8. 

Hiccups have been associated with administration of glucocorticoids into the epidural space [29, 3(y ]. Their cause is not understood. They are usually transient and self-limiting, and reassurance is often the only treatment needed. 

An 81-year-old man with probable Parkinson s disease was given increasing doses of levodopa combined with benserazide. When the dose reached a total of 500 mg/day of levodopa he developed hiccups, which lasted for 3 days. He took no further levodopa and the hiccups stopped. On restarting at a dose of 100 mg the hiccups returned, though only for 1 hour. However, this was enough for the patient to refuse all follow-up and treatment. 

Seker MM, Aksoy S, Ozdemir NY, Uncu D, Civelek B, Akinci MB, et al. Successful treatment of chronic hiccup with baclofen in cancer patients. Med Oncol 2012 29 1369-70. 

Lee GW, Oh SY, Kang MH, Kang JH, Park SH, Hwang IG, et al. Treatment of dexamethasone-induced hiccup in chemotherapy patients by methylprednisolone rotation. Oncologist 2013 18(ll) 1229-34. 

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