16.11 Hiccup in palliative care

Hiccups lasting more than 48 hours are not uncommon in patients with advanced disease and can be very distressing.

Management

• Treat reversible factors such as gastric irritation and stasis
• Hiccups often stop spontaneously
• Treatment is only required if hiccups are persistent
• Try some physical manoeuvres initially, particularly those that have worked previously

For gastric irritation try starting or increasing dose of PPI, (See section 1.3 Antisecretory drugs and mucosal protectants)

For gastric stasis try regular metoclopramide, see section 4.6 Drugs used in nausea and vertigo

Sometimes immediate release nifedipine capsules 10mg gel capsules can be helpful; prick capsule with a needle and release into mouth (off-label use). This helps with oesophageal spasm.

Seek specialist advice for further pharmacological management.

 

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