Treatment of Dexamethasone-Induced Hiccup in Chemotherapy Patients by Methylprednisolone Rotation

Abstract

Background. Dexamethasone-induced hiccup (DIH) is an underrecognized symptom in patients with cancer, and little information is available about its treatment. The aims of this study were to investigate the feasibility of methylprednisolone rotation as treatment and to confirm the male predominance among those with cancer who experienced DIH during chemotherapy. Methods. Persons with cancer who experienced hiccups during chemotherapy treatment and who were receiving treatment with dexamethasone were presumed to have DIH. The following algorithmic practice was implemented for antiemetic corticosteroid use: rotation from dexamethasone to methylprednisolone in the next cycle and dexamethasone re-administration in the second cycle of chemotherapy after recognition of hiccups to confirm DIH. All other antiemetics except corticosteroid remained unchanged. Patients (n ϭ 40) were recruited from eight cancer centers in Korea from September 2012 to April 2013. Data were collected retrospectively.Results. Hiccup intensity (numeric rating scale [NRS]: 5.38 vs. 0.53) and duration (68.44 minutes vs. 1.79 minutes) were significantly decreased after rotation to methylprednisolone, while intensity of emesis was not increased (NRS: 2.63 vs. 2.08). Median dose of dexamethasone and methylprednisolone were 10 mg and 50 mg, respectively. Thirty-four (85%) of 40 patients showed complete resolution of hiccups after methylprednisolone rotation in the next cycle. Of these 34 patients, 25 (73.5%) had recurrence of hiccups after dexamethasone re-administration. Compared with baseline values, hiccup intensity (NRS: 5.24 vs. 2.44) and duration (66.43 minutes vs. 22.00 minutes) were significantly attenuated after dexamethasone re-administration. Of the 40 eligible patients, 38 (95%) were male. Conclusion. DIH during chemotherapy could be controlled without losing antiemetic potential by replacing dexamethasone with methylprednisolone. We also identified a male predominance of DIH. Further prospective studies are warranted. The Oncologist 2013;18:1229 -1234 Implications for Practice: Dexamethasone, an essential antiemetic for chemotherapy, may cause hiccups, and dexamethasoneinduced hiccup (DIH) happens frequently. Discontinuance of dexamethasone can relieve DIH; however, abrupt suspension of dexamethasone in patients on emetogenic chemotherapy increases the risk for emesis in return. In this study, we introduce a new treatment strategy, dexamethasone rotation into methylprednisolone, that may offer a solution to this dilemma. Our data show that a majority of patients experienced a reduction in hiccup without aggravating emesis by switching to methylprednisolone. This treatment strategy has not been previously reported except in a case series by our team. The treatment maneuver described in this study has the potential to improve quality of life in cancer patients undergoing chemotherapy.

Hiccups during Chemotherapy: What Should We Do?

“…Under this assumption, we found that hiccups during chemotherapy could be controlled without losing antiemetic potential by replacing dexamethasone with methylprednisolone. 2,4 We also observed that the severity of hiccups was attenuated by readministration of dexamethasone. 4 The authors wrote in the case presentation that ''hiccups continued constantly for seven days with only a few hours of daily relief'' in the first cycle and lessened by about eight hours in the second cycle.…”

“…2,4 We also observed that the severity of hiccups was attenuated by readministration of dexamethasone. 4 The authors wrote in the case presentation that ''hiccups continued constantly for seven days with only a few hours of daily relief'' in the first cycle and lessened by about eight hours in the second cycle. Based on our previous finding, it is possible that hiccup tolerance contributed to mitigation of the symptom over time.…”

“…3 Male gender also increases the risk of dexamethasone-induced hiccups. 4 Since the main purpose of dexamethasone in chemotherapy is preventing emesis, it might be possible to change dexamethasone for another corticosteroid. Under this assumption, we found that hiccups during chemotherapy could be controlled without losing antiemetic potential by replacing dexamethasone with methylprednisolone.…”

Risk Factors for Cancer Chemotherapy-Induced Hiccups (CIH)

“…Lee GW et al succeeded in decreasing the induction of hiccups by changing patient medication from the antiemetic drug dexamethasone to methylprednisolone [11]. Their study suggested that hiccups occurring due to chemotherapy [16].…”

“…In addition, it was found that antiemetic drugs including steroid drugs when combined with anti-cancer drugs may increase the risk of hiccups. Lee GW et al succeeded in decreasing the induction of hiccups by changing patient medication from the antiemetic drug dexamethasone to methylprednisolone in a patient who developed hiccups as a result of a dexamethasone-containing chemotherapy regime [11]. They concluded that dexamethasone-induced hiccups may be controlled via steroid rotation.…”