Causes of Chemo Hiccups
Chemo hiccups (singultus) can be caused by corticosteroids given for nausea control, such as Decadron (Dexamethosone). Curiously, decadron-induced hiccups mainly affect men, especially older men, and not women. The good news is that people who suffer from chemo hiccups are much less likely to suffer from nausea and vomitting. The bad news is about a third of patients who stop the Decadron to cure the hiccups subsequently suffer from nausea and vomitting.
Cisplatin can also cause hiccups. If the hiccups are caused by the cisplatin, they should stop naturally a few days after the last cisplatin infusion.
Chemo hiccups can also be a sign of reflux (a common side effect of chemotherapy), so it is important to talk to your oncologist first, before trying any home remedies. If it is reflux, some home remedies like drinking water while upside down could actually make things worse.
Also, some types of cancer can cause hiccups, such as prostate cancer, pancreatic cancer, cancer of the esophagus and brainstem tumors. Kidney failure can cause hiccups.
Some of the modern antiemetics (5-HT3 receptor antagonists) can cause hiccups. These include aprepitant (Emend), granisetron (Kytril), ondansetron (Zofran) and ramosetron.
Other drugs that can cause hiccups include Medrol (methylprednisolone) and benzodiazepines, although their use in cancer treatment is much less common than corticosteroids like Decadron. There are a handful of reported cases of hiccups caused by slow drip morphine.
Cures for Chemo Hiccups
In most cases the hiccups will end a few days after the administration of the drug that induced the hiccups. As noted above, stopping the Decadron can sometimes lead to nausea and vomitting. But your oncologist could try reducing the dose (e.g., from 20 mg per day to 10 mg per day) to see if that helps.
If the hiccups are interfering with sleep, your oncologist can prescribe a mild sedative like Ativan to help you sleep.
If the hiccups are related to reflux, adding pillows to raise your head and back, tilting your bed if you have an adjustable bed, or sleeping in a recliner may help. Altering your diet to eliminate foods that are more difficult to digest (e.g., milk and cheese products) and instead using the BRAT diet (bananas, applesauce, rice and toast) may help.
Over-the-counter remedies like Tums and Gas-X (Simethicone) can help. Chamomile tea can help. Your oncologist can also try a prescription-strength antacid like Prilosec (omeprazole) or Prevacid. GERD medications like Carafate (Sucralfate Susp.) can help. Some oncologists will prescribe Reglan/Maxolon (metoclopramide, an antinausea medication), Baclofen (lioresal, an antispasmodic), Thorazine (chlorpromazine), Haldol (Haloperidol, an antispasmodic) or Dilantin (Phenytoin) to help with the hiccups.
Some patients have found that burping can help.
Some oncologists have reported that Neurontin (gabapentin), a drug given for peripheral neuropathy, can help with persistent hiccups.
There are also other drugs that can help for permanent hiccups, such as intravenous or nebulized lidocaine, but in most cases the hiccups are temporary and do not need such extreme measures. Other drugs that have been used to treat chronic hiccups include Piracetam, Mirapex (Pramipexole) and Midazolam, with varying degrees of success. Note that Midazolam is a benzodiazepine and so can cause hiccups in addition to curing them.
Home Remedies
The most common home remedies for hiccups include the following. Most are ineffective for chemo hiccups.
- Holding your breath for as long as possible. In some cases after hyperventilating. Careful controlled breathing can sometimes help.
- Eating a spoonful of sugar or corn syrup.
- Swallowing.
- Drink a glass of water, quickly. Sipping ice water. Lapping water like a dog or cat. Gargling (sometimes with a spoonful of salt or apple cider vinegar in a glass of water).
- Biting on a slice of lemon or lime for 5-10 seconds.
- Standing upside down.
- Eating a spoonful of peanut butter.
- Drinking a carbonated beverage (soda pop), sometimes with a teaspoon of salt added.
- Pulling on your tongue.
- Drinking gatorade or pedialyte.
- Chewing gum.
- Rubbing the back of your neck.
- The valsalva maneuver. Used to equalize air pressure in scuba diving, it involves taking a deep breath, holding your nostrils closed, and using the air to puff out your cheeks.
Slapping yourself in the face, hard, doesn't help, but causes great amusement to the person who suggested it to you. Likewise, scaring the person with hiccups is generally ineffective.
References
- Hung YM, Miller MA and Patel MM, Persistent hiccups associated with intravenous corticosteroid therapy, J Clin Rheumatology 9(5):306-9, October 2003.
- Liaw CC, Wang CH, Chang HK, Liau CT, Yeh KY, Huang JS and Lin YC, Gender discrepancy observed between chemotherapy-induced emesis and hiccups, Support Care Cancer 9(6):435-41, September 2001.
- Liaw CC, Wang CH, Chang HK, Wang HM, Huang JS, Lin YC and Chen JS, Cisplatin-related hiccups: male predominance, induction by dexamethasone, and protection against nausea and vomiting, Journal of Pain Symptom Management 30(4):359-66, October 2005.
- Ross J, Eledrisi M and Casner P, Persistent hiccups induced by dexamethasone, West Journal of Medicine 170(1):51-2, January 1999.
- Yuichi Takiguchi, Reiko Watanabe, Keiichi Nagao and Takayuki Kuriyama, Hiccups as an Adverse Reaction to Cancer Chemotherapy, Journal of the National Cancer Institute 94(10):772, May 15, 2002.
- Garry Wilkes, Hiccups, eMedicine, August 2, 2007.
Copyright © 2005-2018 by Mark Kantrowitz. All rights reserved.
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