Management of Intractable Hiccups in Clinical Settings
Summary
Intractable hiccups represent a significant clinical challenge when episodes persist beyond 48 hours or fail to respond to initial measures. Although transient singultus is common and self-limited, persistent or intractable hiccups can lead to sleep disturbance, malnutrition and psychological distress. Management strategies span pharmacological agents, neuromodulatory interventions and targeted therapies based on underlying aetiology. First-line pharmacotherapies often include dopamine-receptor antagonists, while GABA-B receptor agonists such as baclofen and anticonvulsants offer alternative mechanisms for stabilising diaphragmatic spasms. Non-pharmacological measures range from vagal manoeuvres and nerve blocks to complementary methods like acupuncture. Emerging diagnostic frameworks leverage adverse-event databases and mechanistic models to predict drug-induced hiccups, guiding prophylactic and therapeutic decisions. Multidisciplinary approaches emphasise identification of reversible triggers, particularly in oncology and neuropsychiatric settings, and the refinement of treatment algorithms to balance efficacy, tolerability and quality of life.
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Management of Intractable Hiccups in Clinical Settings publication trend
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Technical terms
Intractable hiccups: Hiccups persisting beyond 48 hours or refractory to standard therapies.
Singultus: Medical term for the involuntary spasmodic contraction of the diaphragm and intercostal muscles.
Baclofen: A GABA-B receptor agonist used to reduce diaphragmatic excitability in persistent hiccups.
Molecular initiating event: The first interaction at the molecular level triggering an adverse outcome pathway, used in predictive models of drug-induced hiccups.
References
- Persistent hiccups due to aripiprazole: a case report and review of the literature. Frontiers in Pharmacology (2024).
- The Association between Molecular Initiating Events and Drug-Induced Hiccups. Pharmaceuticals (2024).
- Baclofen for stroke patients with persistent hiccups: a randomized, double-blind, placebo-controlled trial. Trials (2014).
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