Gabapentin for Intractable Hiccups in Palliative Care

Abstract

Intractable hiccups are not common in the general population or in the palliative care population but can adversely impact quality of life and cause other complications such as weight loss and sleep disturbance. Many treatments have been proposed for intractable hiccups, but there is little consensus regarding treatment in the medical literature. This is partly because hiccups are relatively uncommon and many of the proposed treatments are unproven or have long-term side effects. Pharmacologic treatments rather than home remedies or surgical treatments are more appropriate for the palliative care patient. Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective.

Hiccup: Mystery, Nature and Treatment

“…For example, anticonvulsants in various preparations are indicated to treat intractable hiccups. Gabapentin, an alpha-2-delta ligand with structural similarity to GABA and the ability to block voltage-operated calcium channels to reduce release of several neurotransmitters including glutamate and substance P and finally to modulate the diaphragmatic activity, was promising and safe to treat intractable hiccups 25,41,60. Overall, the response rates of gabapentin ranged from 66.7% to 88.4%.…”

Gabapentin in the treatment of persistent hiccups in advanced malignancy

“…Literature describes the role of Gabapentin in the management of this symptom in advanced malignancy in the form of observational studies. [134] Our case report highlights the application of this drug in the management of advanced hiccups in the Indian palliative care setting. This has implications in the management of patients who may not be able to access palliative care services or advanced interventions because of geographical, socio-economic, or personal barriers.…”

Post operative hiccups

“…1 Baclofen (gamma-amino-butyric-acid receptor type B agonist), gabapentin and pregabalin (alpha-2-delta ligand) seem to be promising drugs in perioperative and intractable hiccups. 2,3,4 The vagus nerve, phrenic nerve, glossopharyngeal nerve and sympathetic fibers irritation with subsequent hiccups may be caused by different disorders of the chest (injury, surgery), the heart e.g. myocardial ischemia, the abdomen and digestive tract, and ear, nose and throat area.…”