{ "schema_version": 1, "kind": "condition", "id": "hiccups-persistent", "name": "Persistent Hiccups (Singultus)", "category": "chronic", "sources": "American College of Gastroenterology Guideline on Singultus 2017 for the indication, with the dose from Maxolon 10mg Tablets (metoclopramide hydrochloride) SmPC section 4.2 (eMC product 6213): \"The recommended single dose is 10 mg, repeated up to three times daily. The maximum recommended daily dose is 30 mg or 0.5mg/kg body weight.\" and \"The maximum recommended treatment duration is 5 days.\" The SmPC's indications are nausea and vomiting rather than hiccup, so use here is off-label. · American College of Gastroenterology Guideline on Singultus 2017 · Chlorpromazine 25 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 3477) · Famotidine US label, section 2.1 Symptomatic Nonerosive GERD (DailyMed SetID 04aaf296-f136-29d7-e063-6294a90affe1) · Omeprazole delayed-release capsules US label, section 2.1 Symptomatic GERD (DailyMed SetID 0fb314cb-6291-422c-98ff-24d8449992f6)", "review_status": "reviewed", "verified_against": "American College of Gastroenterology Guideline on Singultus 2017 for the indication, with the dose from Maxolon 10mg Tablets (metoclopramide hydrochloride) SmPC section 4.2 (eMC product 6213): \"The recommended single dose is 10 mg, repeated up to three times daily. The maximum recommended daily dose is 30 mg or 0.5mg/kg body weight.\" and \"The maximum recommended treatment duration is 5 days.\" The SmPC's indications are nausea and vomiting rather than hiccup, so use here is off-label. · Chlorpromazine 25 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 3477) · American College of Gastroenterology Guideline on Singultus 2017", "verified_date": "2026-08", "treatments": [ { "id": 941, "generic": "Chlorpromazine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 25.0, "adult_dose": "25 mg 3 times daily, adjusted according to response", "adult_duration": "3-7 days until hiccups terminate", "dose_source": "Chlorpromazine 25 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 3477)", "rationale": "Dopamine-receptor antagonist that is the only orally approved agent specifically for intractable hiccups, acting centrally to interrupt the hiccup reflex arc; used once an underlying cause has been considered.", "cautions": [ "Side effects include sedation, postural hypotension, and extrapyramidal symptoms.", "Investigate underlying cause (GERD, Uremia, CNS lesions, diaphragm irritation) if persistent >48 hrs.", "It photosensitises. In this sun that is not a footnote - cover up, stay out of direct sunlight.", "It also breaks thermoregulation both ways. A Cairo summer or a cold snap both raise the risk, and the elderly are where that shows up first.", "Elderly: start at a third to a half of the adult dose and climb more slowly.", "Anyone handling phenothiazine tablets or solution repeatedly should avoid getting it on their skin.", "Chlorpromazine is the only FDA-approved oral agent for intractable hiccups." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist paediatric neurologist supervision required", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "PROMACID 25 MG 50 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 2.6, "pack_count": 50, "unit_price": 0.05, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NEURAZINE 25 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 20.0, "pack_count": 20, "unit_price": 1.0, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hiccups-persistent" }, { "id": 943, "generic": "Famotidine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "20 mg twice a day", "adult_duration": "A trial of a few weeks, then review whether the hiccups stopped", "dose_source": "Famotidine US label, section 2.1 Symptomatic Nonerosive GERD (DailyMed SetID 04aaf296-f136-29d7-e063-6294a90affe1) - verbatim: \"Symptomatic Nonerosive GERD 20 mg twice daily\"", "rationale": "The same reflux trial for the patient who cannot take a proton pump inhibitor - clopidogrel, an interaction, a previous reaction - or who cannot afford one. Fewer drug interactions than omeprazole and available as a syrup.", "cautions": [ "If the trial of acid suppression changes nothing, stop it and look for another cause.", "Reduce the dose in moderate or severe renal impairment - it accumulates and causes confusion and QT prolongation, which matters most in the older patients who get persistent hiccups.", "Do not use it in anyone who has had a serious reaction to famotidine or another H2 blocker." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Persistent hiccups needing drug treatment is an adult problem. A child with persistent hiccups needs a cause looked for rather than a trial of acid suppression.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FAMOTAK 20MG 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 28.0, "pack_count": 20, "unit_price": 1.4, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GASTRODOMINA 20MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > ALMIRALL PRODES-SPAIN", "price_egp": 28.0, "pack_count": 20, "unit_price": 1.4, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANTODINE 20 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 60.0, "pack_count": 30, "unit_price": 2.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FAMOTIN 20MG 20TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 40.0, "pack_count": 20, "unit_price": 2.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RANI-F 20MG 6 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 42.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hiccups-persistent" }, { "id": 944, "generic": "Omeprazole", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "20 mg once a day before breakfast", "adult_duration": "Up to 4 weeks, then review whether the hiccups stopped", "dose_source": "Omeprazole delayed-release capsules US label, section 2.1 Symptomatic GERD (DailyMed SetID 0fb314cb-6291-422c-98ff-24d8449992f6) - verbatim: \"Symptomatic GERD 20 mg once daily for up to 4 weeks\"", "rationale": "Most persistent hiccups turn out to be reflux, and a four-week proton pump inhibitor trial is a safe, cheap test of that before committing anyone to chlorpromazine or metoclopramide. Also check the drug list first - steroids and benzodiazepines cause hiccups.", "cautions": [ "If four weeks of acid suppression changes nothing, stop it and look for another cause rather than adding a second drug on top.", "Do not use it in anyone who has reacted to omeprazole or another benzimidazole proton pump inhibitor, and not at all with rilpivirine.", "Long courses are associated with low magnesium, low B12 and Clostridioides difficile diarrhoea - this is a time-limited trial, not open-ended treatment." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Persistent hiccups needing drug treatment is an adult problem. A child with persistent hiccups needs a cause looked for rather than a trial of acid suppression.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "OMEGASTAZOLE 20MG 14 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RIVA PHARMA S.A.E.", "price_egp": 18.0, "pack_count": 14, "unit_price": 1.29, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OMEPRAL 20MG 14 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 32.0, "pack_count": 14, "unit_price": 2.29, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RISEK 20 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 75.0, "pack_count": 28, "unit_price": 2.68, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OMISEC 20MG 14CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "THE UNITED PHARMACEUTICALS CO LTD-JORDAN > MODERN PHARMA", "price_egp": 42.0, "pack_count": 14, "unit_price": 3.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPIRAZOLE 20MG 14CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 44.0, "pack_count": 14, "unit_price": 3.14, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OMEPAK 20 MG 14 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 50.0, "pack_count": 14, "unit_price": 3.57, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RISEK 20 MG 14 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 57.0, "pack_count": 14, "unit_price": 4.07, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPIZOLE 20MG 14 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 62.0, "pack_count": 14, "unit_price": 4.43, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hiccups-persistent" }, { "id": 942, "generic": "Metoclopramide", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg 3 times daily 30 minutes before meals", "adult_duration": "max 5 days", "dose_source": "American College of Gastroenterology Guideline on Singultus 2017 for the indication, with the dose from Maxolon 10mg Tablets (metoclopramide hydrochloride) SmPC section 4.2 (eMC product 6213): \"The recommended single dose is 10 mg, repeated up to three times daily. The maximum recommended daily dose is 30 mg or 0.5mg/kg body weight.\" and \"The maximum recommended treatment duration is 5 days.\" The SmPC's indications are nausea and vomiting rather than hiccup, so use here is off-label.", "rationale": "Dopamine antagonist and prokinetic that accelerates gastric emptying and reduces gastric distension, a plausible trigger for the hiccup reflex; used as an alternative when chlorpromazine is unsuitable, for a short course to limit extrapyramidal risk.", "cautions": [ "The maximum duration is 5 days, to reduce the risk of extrapyramidal disorders (tardive dyskinesia).", "Contraindicated in gastrointestinal hemorrhage, obstruction, or perforation.", "Metoclopramide is a dopamine antagonist that accelerates gastric emptying." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Contraindicated in children under 1 year; restricted under 18 years", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CLOPRAM 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 3.0, "pack_count": 20, "unit_price": 0.15, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PLEMAZOL 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 3.2, "pack_count": 20, "unit_price": 0.16, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOMAWAY 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.5, "pack_count": 20, "unit_price": 0.42, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PRIMPERAN 10MG 10 SCORED TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hiccups-persistent" } ] }