How to get rid of hiccups from steroids?

According to case reports and studies, certain steroids like dexamethasone are strongly associated with causing hiccups, with one prospective study reporting an incidence as high as 42%. Understanding this link is the first step in learning how to get rid of hiccups from steroids effectively and safely.

Quick Summary

Steroid-induced hiccups can be managed with simple remedies or prescription medications. Management depends on severity and persistence, with options ranging from vagal nerve stimulation techniques to pharmaceutical interventions like metoclopramide or gabapentin. Medical consultation is essential for persistent cases.

Key Points

• Consult a Doctor: If hiccups persist for more than 48 hours or significantly impact daily life, medical consultation is essential.

• Do Not Stop Steroids Abruptly: Never discontinue your prescribed steroid medication without a doctor's supervision, as this can be dangerous.

• Try Simple Remedies First: Techniques like holding your breath, sipping cold water, or breathing into a paper bag can be effective for temporary hiccups.

• Consider Prescription Options for Persistent Hiccups: For intractable cases, doctors may prescribe medications like metoclopramide, gabapentin, or baclofen.

• Understand the Cause: Steroid-induced hiccups are thought to result from the medication's effect on the central nervous system and the hiccup reflex arc.

• Stay Hydrated and Avoid Irritants: Maintaining hydration and avoiding carbonated drinks, alcohol, and spicy foods may help prevent hiccups.

• Adjust Medication with a Doctor: Your healthcare provider might adjust the dose, timing, or even switch to a different steroid to manage the side effect.

Hiccups are a common, albeit annoying, involuntary reflex caused by a spasm of the diaphragm followed by the rapid closing of the vocal cords. While most hiccups are temporary and benign, those triggered by steroids can be persistent and significantly impact a patient's quality of life. This article explores why steroids cause hiccups and outlines practical strategies for managing them, from simple home remedies to prescription medications for intractable cases.

The Cause: Why Steroids Trigger Hiccups

Steroids, particularly corticosteroids such as dexamethasone and prednisone, are known to induce hiccups in some individuals. The exact mechanism is not fully understood, but it's believed to involve the medication’s effect on the central nervous system (CNS) and the nerve pathways controlling the diaphragm.

The Hiccup Reflex Arc

The hiccup reflex arc involves sensory input from various nerves (phrenic, vagus, sympathetic), processing in a hypothesized midbrain 'hiccup center,' and motor signals returning to the diaphragm and intercostal muscles. Corticosteroids may lower the synaptic transmission threshold in the midbrain, making the hiccup center more sensitive. Dexamethasone is particularly noted for causing hiccups, potentially due to its effects in the brainstem.

First-Line Management: Home Remedies and Simple Maneuvers

For temporary hiccups, non-invasive techniques can interrupt the hiccup reflex by stimulating the vagus nerve or increasing carbon dioxide levels. These may provide temporary relief but should not replace medical advice for persistent symptoms.

• Breathing Techniques:
  • Hold your breath for 10-20 seconds.
  • Breathe slowly into a paper bag to increase carbon dioxide.
• Water and Diet:
  • Sip or gargle ice-cold water.
  • Swallow a teaspoon of sugar.
• Physical Maneuvers:
  • Gently pull on your tongue.
  • Perform the Valsalva maneuver by pinching your nose and trying to exhale.

Advanced Management: When to Consider Prescription Medication

If hiccups persist for over 48 hours or interfere with daily life, they are considered persistent and require medical attention. A healthcare provider may consider medication or adjusting the steroid regimen. Never stop taking your steroids without a doctor's guidance.

Pharmacological Options for Persistent Hiccups

Several medications are used for persistent hiccups, based on case reports and small studies. These include Chlorpromazine (the only FDA-approved drug for hiccups), Metoclopramide (effective for dexamethasone-induced hiccups), Gabapentin, and Baclofen. A comparison of these options can be found {Link: DrOracle.AI https://www.droracle.ai/articles/44342/how-to-treat-decadron-induced-hiccups}.

Important Precautions and Lifestyle Changes

Managing steroid-induced hiccups also involves lifestyle adjustments.

• Stay hydrated.
• Avoid carbonated drinks, alcohol, and spicy foods.
• Take oral steroids with food if advised.
• A healthcare provider may recommend adjusting steroid timing or switching to a different type of corticosteroid.

Conclusion

Steroid-induced hiccups can be managed with various strategies. Simple remedies may help short-term hiccups, while persistent cases require medical consultation to consider prescription medications or steroid adjustments. Always consult a healthcare provider before making any changes to your steroid regimen due to the risk of dangerous side effects from sudden discontinuation.

References

• Eze, D. C. A., & Uwaezuoke, S. N. (2021). Steroid-Induced Hiccups in a Patient Managed for Pseudo Foster-Kennedy Syndrome: A Case Report. Cureus, 13(1), e12948. https://pmc.ncbi.nlm.nih.gov/articles/PMC7903257/
• Jabbari, B., & Jankovic, J. (1998). Hiccoughs. Neurology, 50(3), 567-569. https://www.neurology.org/doi/10.1212/WNL.50.3.567
• Hiccups, Causes & Treatment. (2024). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17672-hiccups
• Ko, E., & Bae, G. E. (2012). Corticosteroid Rotation to Alleviate Dexamethasone-Induced Hiccups in Cancer Patients Treated with Chemotherapy: A Case Series. Oncologist, 17(3), 398–402. https://www.sciencedirect.com/science/article/pii/S0885392411003745
• How to get rid of hiccups: Remedies That Can Actually Help. (2024). Healthline. https://www.healthline.com/health/how-to-get-rid-of-hiccups
• Madanagopolan, N. (1988). Metoclopramide for persistent hiccups. Postgraduate medical journal, 64(754), 629–631. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/%28SICI%291097-0142%2819980115%2964%3A754%3C629%3AMFTPH%3E2.0.CO%3B2-O
• Palliative Care Network of Wisconsin. (2019). Management of Hiccups. https://www.mypcnow.org/fast-fact/management-of-hiccups/
• Barton, B. R. (2001). The hiccup reflex arc and persistent hiccups with high-dose dexamethasone: A case report. Pain, 94(2), 177-179. https://pubmed.ncbi.nlm.nih.gov/11290884/

Note: Links are provided for informational purposes only. Consult with a healthcare professional for specific medical advice.

Frequently Asked Questions

Why do steroids cause hiccups?

While the exact mechanism is not fully understood, it is believed that steroids, especially at higher doses, can irritate the nerves that control the diaphragm and affect neurotransmitters in the brainstem, which regulates the hiccup reflex arc.

Can I stop taking my steroids if I get hiccups?

No, you should never stop taking steroids abruptly without first consulting your doctor. A healthcare provider can recommend strategies to manage the side effect or adjust your treatment plan safely.

What is the best home remedy for steroid-induced hiccups?

There is no single 'best' home remedy, as what works varies from person to person. However, techniques that stimulate the vagus nerve or increase carbon dioxide levels are often recommended, such as holding your breath, sipping ice-cold water, or breathing into a paper bag.

Which steroids are most likely to cause hiccups?

Dexamethasone and prednisone are commonly associated with causing hiccups. Higher doses and longer durations of treatment can increase the risk, but they can occur at any dose.

When should I see a doctor for hiccups caused by steroids?

You should contact your healthcare provider if hiccups persist for more than 48 hours, become frequent, or are so severe that they interfere with eating, sleeping, or breathing.

What medications can a doctor prescribe for persistent hiccups?

For persistent or intractable hiccups, a doctor might prescribe medications such as metoclopramide, gabapentin, or baclofen. Chlorpromazine is also an FDA-approved option but is used cautiously due to potential side effects.

Can switching to a different steroid help?

Yes, in some cases, a healthcare provider may switch a patient from one corticosteroid (like dexamethasone) to another (like methylprednisolone) to alleviate hiccups, especially if the side effect is considered to be specific to that agent.