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In our case, we successfully treated persistent hiccups of more than four days duration in a patient with acute myeloblastic leukemia with gabapentin. Keywords: palliative care, persistent hiccups, gabapentin, acute myeloid leukemia (aml), anti-epileptics Introduction A search of MEDLINE (1966-March 2013) using the MeSH search terms gabapentin, hiccups, and hiccups/drug therapy was performed. Additional databases searched included Web of Science (1945-March 2013) and International Pharmaceutical Abstracts (1970-March 2013) using the text words gabapentin and hiccups. Bibliographies of relevant articles were reviewed for additional citations. e presence of hiccups was routinely assessed. Patients with severe chronic hiccups were treated with gabapentin (300 mg t.i.d.). Doses of gabapentin were titrated based on the response to treatment. Gabapentin-related adverse effects were recorded. Results: Thirty-seven (3.9%) of 944 in-hospital patients and 6 (4.5%) of 134 patients observed at home presented severe chronic hiccups. We A search of MEDLINE (1966-March 2013) using the MeSH search terms gabapentin, hiccups, and hiccups/drug therapy was performed. Additional databases searched included Web of Science (1945-March 2013) and International Pharmaceutical Abstracts (1970-March 2013) using the text words gabapentin and hiccups. Bibliographies of relevant articles were reviewed for additional citations. Gabapentin was reinitiated by the geriatric medicine team, and the patient's hiccups resolved once again. Conclusion: Randomized, controlled trials evaluating the use of gabapentin in the treatment of hiccups associated with neurogenic etiologies are lacking; however, case reports suggest that this agent may be an effective treatment option. Gabapentin, an anti-epileptic drug has many uses in palliative setting, one of them is to treat hiccups through increasing endogenous GABA-mediated inhibition of inspiratory muscle action,13–15 reducing calcium influx or both of these mechanisms. Gabapentin can be useful alone or as add-on therapy. Reducing the frequency of recurrent or persistent hiccups is important, as it will improve overall quality of life. BOTTOM LINE Hiccups are a common human experience, but can create a great deal of physical and emotional discomfort in end-stage disease. Indeed, gabapentin probably increases the endogenous release of GABA, modulating excitability of the diaphragm and the other inspiratory muscles (4,5). In this patient, the most probable cause for hiccup was the neoplastic infiltration of the diaphragm and thus gabapentin may have been useful for the former reason. Gabapentin is useful in the management of persistent hiccups in malignancy and has the advantage of low dosing, gradual titration of dosage, fewer drug interactions, and systemic effects. Gabapentin: Gabapentin modulates neuronal activity, which can help interrupt the reflex arc responsible for hiccups. Gabapentin can be considered when hiccups are resistant to other treatments or when a neuropathic component is suspected. Baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner, while only baclofen and metoclopramide were studied in randomized controlled trials. No specific recommendations can be made for treating intractable and persistent hiccups with the evidence currently available in the literature. Therapy selection should be specific to individual patients Hiccups, while often seen as a minor inconvenience, can become a significant health issue when they are persistent or intractable. This episode explores the science behind hiccups, their potential medical causes, and treatment options, particularly the use of gabapentin as an off-label solution.• The results of the study allow suggesting gabapentin at least as a promising drug in the treatment of severe chronic hiccups in advanced cancer patients. Hiccups, or Singultus, are a common condition among individuals. Several medications are under research for hiccup management, including Gabapentin, an analog of the neurotransmitter γ-aminobutyric acid (GABA), which has shown effective outcomes in patients with persistent hiccups, highlighting the need for larger clinical studies to evaluate their efficacy and safety. Despite that Gabapentin has a similar body of evidence as other pharmacotherapeutic agents used to treat hiccups. Gabapentin is well tolerated and should be considered as a second-line agent in selected patients. However, there is little evidence as to which interventions are effective or harmful. Drugs used in the treatment of hiccups have included chlorpromazine, metoclopramide, sodium valproate, haloperidol, amitriptyline, carbamazepine, magnesium sulphate, baclofen, gabapentin, peppermint water, simeticone, benzodiazepines and nifedipine. Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective. Conclusion Evidence on the use of gabapentin for persistent or intractable hiccups is limited. This case series expands on the current literature by examining and comparing the current literature to our cases and exploring issues related to dosing, titration, side effects, and adjuncts to gabapentin. Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups; however, many other pharmacologic treatments have been proposed for intractable and persistent hiccups. Currently, there is little evidence to support the use of one agent over another.
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