Is Chlorpromazine Good for Hiccups? A Comprehensive Guide

October 11, 2025 •

3 min read

Chlorpromazine is the only medication approved by the U.S. FDA specifically for the treatment of intractable hiccups. However, for most patients, the question remains: is chlorpromazine good for hiccups, and is it a safe choice given its potent side effect profile?

Quick Summary

Chlorpromazine (Thorazine) is an FDA-approved treatment for severe, persistent hiccups but is typically reserved for refractory cases. Due to its potent side effects, including sedation and movement disorders, it is generally considered after safer alternatives have failed.

Key Points

FDA Approval: Chlorpromazine is the only medication specifically FDA-approved for the treatment of intractable hiccups.
Mechanism of Action: It works by blocking dopamine receptors in the central nervous system to interrupt the hiccup reflex arc.
Reserved for Refractory Cases: Due to its significant side-effect profile, chlorpromazine is not a first-line treatment and is reserved for severe cases that haven't responded to other therapies.
Significant Side Effects: Common side effects include sedation and dizziness, while serious risks include orthostatic hypotension, extrapyramidal symptoms, and tardive dyskinesia.
Alternative Medications Preferred: Safer alternatives such as baclofen, gabapentin, and metoclopramide are typically used before resorting to chlorpromazine.
Short-Term Use: Treatment with chlorpromazine for hiccups is generally for a short duration until symptoms resolve, with close medical supervision.

What Are Intractable Hiccups?

Hiccups, or singultus, are an involuntary spasm of the diaphragm followed by the rapid closure of the vocal cords, producing the characteristic 'hic' sound. While most hiccups resolve on their own, persistent hiccups last for more than 48 hours, and intractable hiccups last for more than one month. These prolonged episodes can be debilitating, interfering with eating, sleeping, and overall quality of life. For cases that don't respond to simple maneuvers, medical intervention becomes necessary.

How Chlorpromazine Works for Hiccups

Chlorpromazine, a phenothiazine antipsychotic, is believed to treat intractable hiccups by blocking postsynaptic dopamine receptors in the brain's chemoreceptor trigger zone and hypothalamus. This action on dopamine can help interrupt the reflex arc causing hiccups. It also affects other receptors, including anticholinergic, antiadrenergic, and antihistaminic ones, contributing to its broad effects and side effect profile.

Is Chlorpromazine Effective for Intractable Hiccups?

Chlorpromazine has been used for over 50 years and is the only FDA-approved medication for intractable hiccups. Its approval stems from older reports in the 1950s showing rapid resolution of hiccups with intravenous administration. While effective in severe cases unresponsive to other treatments, there is a lack of recent, high-quality studies specifically on chlorpromazine for hiccups, with most evidence being anecdotal.

Potential Side Effects and Safety Considerations

A major factor limiting chlorpromazine as a first-line treatment is its significant side-effect profile.

Common side effects include:

Drowsiness and sedation
Dizziness
Dry mouth

More serious side effects can be severe and include:

Orthostatic Hypotension (risk of falls)
Extrapyramidal Symptoms (movement disorders like tremors or muscle contractions)
Tardive Dyskinesia (potentially permanent involuntary movements with long-term use)
Neuroleptic Malignant Syndrome (a rare, life-threatening reaction)

These risks mean chlorpromazine should be used cautiously, especially in vulnerable populations or those on interacting medications.

Comparing Chlorpromazine with Other Hiccup Treatments

Other medications are often preferred over chlorpromazine today due to better side effect profiles.


Feature	Chlorpromazine (Thorazine)	Baclofen (Lioresal)	Gabapentin (Neurontin)	Metoclopramide (Reglan)
FDA Approved for Hiccups?	Yes, for intractable hiccups.	No (off-label).	No (off-label).	No (off-label).
Mechanism	Dopamine antagonist.	GABA analog that inhibits reflexes.	Increases GABA release and blocks calcium channels.	Dopamine antagonist and prokinetic.
Typical Use	Reserved for severe, refractory cases.	Often a first-line pharmacologic option.	Useful as a stand-alone or add-on therapy.	Often used early, especially if gastrointestinal issues are a factor.
Key Side Effects	Sedation, hypotension, extrapyramidal effects, tardive dyskinesia.	Sedation, dizziness, ataxia.	Somnolence, dizziness.	Extrapyramidal symptoms, drowsiness.

The Modern Clinical Approach to Hiccup Management

Simple techniques often resolve benign hiccups. For persistent or intractable cases, a stepped approach is used:

First-Line Pharmacologic Options: Medications like baclofen, metoclopramide (especially for suspected GI causes), or gabapentin are typically tried first due to better safety profiles.
Addressing Underlying Causes: Treating any underlying medical condition is crucial.
Last-Resort Therapy: Chlorpromazine is used only for severe, refractory cases that have failed other treatments and requires careful monitoring due to side effects.
Specialist Consultation: May be needed for persistent cases to explore other options or causes.

Conclusion

Chlorpromazine can be effective for persistent and intractable hiccups unresponsive to other treatments, and is the only FDA-approved drug for this use. However, its significant risk of adverse effects, including serious neurological issues, means it is not a first-line treatment. It is typically reserved for the most difficult, refractory cases. Alternative medications like baclofen, metoclopramide, or gabapentin are often preferred today due to more manageable side effects.

For further reading on the management of hiccups, consider this review from the National Institutes of Health: Managing hiccups - PMC.

Disclaimer: This information is for general knowledge and should not be taken as medical advice. Consult with a healthcare professional before starting any new medication or treatment.

Frequently Asked Questions

For intractable hiccups, a healthcare provider will determine the appropriate method of administration. This can include oral forms, intramuscular injection, or slow intravenous infusion depending on the severity and response to treatment.

Chlorpromazine is generally reserved for refractory cases due to its potent and numerous side effects, including significant sedation, orthostatic hypotension, and a risk of developing serious movement disorders like tardive dyskinesia.

Several other medications are often used off-label for hiccups, including baclofen, gabapentin, and metoclopramide. These are frequently preferred as first-line pharmacologic options due to their more manageable side-effect profiles.

No. For short-term, self-resolving hiccups, simpler non-pharmacological remedies are recommended. Chlorpromazine is only used for persistent hiccups that have lasted for an extended period and failed to respond to other treatments.

The most serious side effects include neuroleptic malignant syndrome (NMS), tardive dyskinesia, severe hypotension, and extrapyramidal symptoms. These risks necessitate careful monitoring by a healthcare provider.

The treatment duration is typically short-term, continuing only until the hiccups resolve. It should not be taken for extended periods without close medical supervision due to the risks associated with long-term use.

Chlorpromazine should be used with extreme caution in elderly patients. They may be more sensitive to side effects like dizziness, sedation, and movement disorders, and its use is contraindicated in dementia-related psychosis due to an increased risk of mortality.