# Persistent Hiccups (Singultus) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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 ## Treatment metadata - Chlorpromazine — 25 mg — oral.solid - Famotidine — 20 mg — oral.solid - Omeprazole — 20 mg — oral.solid - Metoclopramide — 10 mg — oral.solid ## Complete treatment card ```text PERSISTENT HICCUPS (SINGULTUS) 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 against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Large meals, emotional stress, or excitement can trigger hiccups [hiccups] - Hiccups can occur alongside reflux, coughing, abdominal pain, or unintended weight loss [abdominal pain · cough · heartburn · hiccups · weight loss] - Hiccups happening during sleep point away from a psychogenic cause and toward a gut, neurologic, or lung problem [hiccups] - A recent operation, a cancer history, or chemotherapy exposure warrants further questioning - Symptoms resolving after a suspect drug is stopped supports that drug as the cause SIGNS - what you find (4) - A head and neck exam may find a foreign body touching the eardrum, a mass, a goitre, tonsillitis, or pharyngitis as the source [foreign body · goitre] - Chest auscultation checks for findings of pneumonia or empyema [empyema] - Abdominal tenderness or a mass can point to obstruction, volvulus, pancreatitis, hepatitis, or an intra-abdominal tumour [abdominal tenderness · volvulus] - A full neurological exam is needed, though hiccups are rarely the only sign of a brain or spinal problem [hiccups] TESTS (7) - Brief hiccups are usually benign and self-limiting and need no workup - Persistent or hard-to-stop hiccups warrant a thorough workup to find a reversible cause - Useful blood tests include electrolytes, calcium, kidney markers, lipase, and liver function - Chest x-ray can reveal pneumonia, empyema, a diaphragmatic hernia, swollen lymph nodes, or aortic disease - Brain CT or MRI is used when persistent hiccups come with neurological symptoms, looking for stroke, MS, a tumour, or an aneurysm - Endoscopy is appropriate when hiccups persist despite antacids or PPIs, to check for an oesophageal lesion such as cancer - Arterial blood gas is essential in ventilated patients who develop hiccups, since it can desynchronise the ventilator and destabilise them IF NOT THIS - what else fits (2) - Hiccups can occasionally be mistaken for coughing or gagging - The differential for persistent hiccups spans ear, nose, throat, brain, heart, and gut causes, plus infectious, chest, metabolic, and psychological ones Source StatPearls "Singultus" - disease-level clinical article Status traced to the source above Rx: Main treatment | H2 blocker version of the same reflux trial | Reflux trial - the first thing to try, before chlorpromazine MAIN TREATMENT - choose one 1. CHLORPROMAZINE [1st line] Adult 25 mg 3 times daily, adjusted according to response x 3-7 days until hiccups terminate Peds Specialist paediatric neurologist supervision required Source Chlorpromazine 25 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 3477) Why 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. Caution 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. Egypt PROMACID 25 MG 50 TAB. CID 2.60 EGP (0.05/unit) NEURAZINE 25 MG 20 TABS. MISR 20.00 EGP (1.00/unit) 2. METOCLOPRAMIDE [2nd line] Adult 10 mg 3 times daily 30 minutes before meals - max 5 days Peds Contraindicated in children under 1 year; restricted under 18 years 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. Why 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. Caution 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. Egypt CLOPRAM 10MG 20 TAB. EL NASR 3.00 EGP (0.15/unit) PLEMAZOL 10MG 20 TAB. CID 3.20 EGP (0.16/unit) VOMAWAY 10MG 20 TAB. MEMPHIS 8.50 EGP (0.42/unit) PRIMPERAN 10MG 10 SCORED TAB. SANOFI 10.50 EGP H2 BLOCKER VERSION OF THE SAME REFLUX TRIAL 3. FAMOTIDINE [1st line] Adult 20 mg twice a day - A trial of a few weeks, then review whether the hiccups stopped Peds 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. 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" Why 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. Caution 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. Egypt FAMOTAK 20MG 20 F.C.TAB. SEDICO 28.00 EGP (1.40/unit) GASTRODOMINA 20MG 20 TAB. MUP > ALMIRAL... 28.00 EGP (1.40/unit) ANTODINE 20 MG 30 F.C.TABS. AMOUN 60.00 EGP (2.00/unit) FAMOTIN 20MG 20TAB. MEMPHIS 40.00 EGP (2.00/unit) RANI-F 20MG 6 SACHETS PHARCO 42.00 EGP REFLUX TRIAL - THE FIRST THING TO TRY, BEFORE CHLORPROMAZINE 4. OMEPRAZOLE [1st line] Adult 20 mg once a day before breakfast - Up to 4 weeks, then review whether the hiccups stopped Peds 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. Choice Most persistent hiccups are reflux, and a four-week proton pump inhibitor trial is a safe, cheap test of that before chlorpromazine or metoclopramide. 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" Why 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. Caution 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. Egypt OMEGASTAZOLE 20MG 14 CAPS. RIVA PHARMA S... 18.00 EGP (1.29/unit) OMEPRAL 20MG 14 CAPS. MEMPHIS 32.00 EGP (2.29/unit) RISEK 20 MG 28 CAPS. JULPHAR 75.00 EGP (2.68/unit) OMISEC 20MG 14CAPS. THE UNITED PH... 42.00 EGP (3.00/unit) EPIRAZOLE 20MG 14CAPS. EIPICO 44.00 EGP (3.14/unit) OMEPAK 20 MG 14 CAPS. SEDICO 50.00 EGP (3.57/unit) RISEK 20 MG 14 CAPS. JULPHAR 57.00 EGP (4.07/unit) NAPIZOLE 20MG 14 CAPS. GLOBAL NAPI P... 62.00 EGP (4.43/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)