Might Medications Be the Culprit When Hiccups Won’t Stop?

Hiccups. Everyone gets them — beginning in the womb. Most of the time, they're little more than an annoyance that quickly goes away. For some people, though, they can become a chronic condition that can make life miserable.

Usually, hiccups are triggered by eating spicy food or drinking alcohol or carbonated beverages, swallowing air, stress or excitement or simply eating too quickly. But hiccuping can be the sign of an underlying medical condition or the side effect of a medication, according to the National Institutes of Health.

​Read more:​ Side Effects of Carbonated Drinks

Hiccups result from involuntary contractions in the diaphragm, the muscle at the base of your lungs that controls breathing. When you hiccup, that muscle spasms and causes the vocal cords to snap shut, resulting in that distinctive "hic" sound, according to the Mayo Clinic.

Hiccups usually disappear by themselves within a few minutes. When they don't — or when hiccupers can't wait — some people resort to such home remedies as holding their breath, breathing into a paper bag, drinking from the opposite side of a cup or trying honey, peanut butter or vinegar.

As silly as these remedies sound, Harvard Health Publishing says certain strategies seem to make sense. Breathing into a paper bag or holding your breath, for example, could raise the level of carbon dioxide in your blood, inhibiting the diaphragm from spasms. Other techniques, like giving yourself a good scare, stimulate the nerves that help coordinate breathing and swallowing.

​Read more:​ Causes of Low Carbon Dioxide in the Blood

When hiccups last longer than a couple of days, doctors worry about underlying causes. These can include damage or irritation to the vagus nerve, which runs from the brain to the stomach and helps control breathing and swallowing.

"Anything that can irritate the nerve, like a tumor or trauma, could lead to persistent hiccuping," says Gregory Levitin MD, an otolaryngologist with the Icahn School of Medicine at Mount Sinai in New York City. "And anything that puts pressure on the diaphragm can cause hiccups, but 95 to 98 percent of cases are self-limited."

Those rare cases of chronic hiccups can be the result of central nervous system disorders such as encephalitis, meningitis, multiple sclerosis or trauma to the brain. In the most serious cases, chronic hiccups may lead to fatigue, malnutrition or even death.

A number of drugs have been linked to chronic hiccups, including drugs used in anesthesia, barbiturates, steroids and tranquilizers, according to Mayo Clinic.

Sometimes, says Dr. Levitin, patients who wake up incompletely from general surgery experience a bout of hiccups. One study published in the ​Journal of Neurogastroenterology and Motility​ in April 2010 found that the use of anesthetic drugs can lead to persistent hiccuping, but it remains unclear whether the hiccups are the direct result of the surgery or of the anesthetic agents.

Persistent hiccuping isn't uncommon among people with cancer undergoing chemotherapy, with the chemotherapy medication cisplatin and the anti-inflammatory drug dexamethasone among the offending agents, according to an article published in August 2018 in the journal ​Pharmacology & Pharmacy​. Steroid therapy has also been linked to hiccuping, though it also has been used as one of the agents to treat the condition, the study authors pointed out.

About 20 percent of Parkinson's disease patients in a study published in the ​European Journal of Clinical Pharmacology​ in September 2017 had frequent hiccups, possibly the result of dopamine treatment. Psychiatric medications like aripiprazole, which is used to treat schizophrenia and bipolar disorder, may trigger hiccups, according to an article in the ​Journal of Pharmacy Practice​ in December 2014.

Chlorpromazine, an antipsychotic drug, can be used to treat chronic hiccups, according to the Mayo Clinic. Doctors can also treat hiccups with a nerve agent to block signals to the diaphragm or pacemakers that cause the diaphragm to contract more rhythmically, it says. Several studies also found that acupuncture may be effective, but there isn't enough evidence to say for sure, according to the British Acupuncture Council.

For reasons that experts don't understand, according to the Mayo Clinic, men are much more likely than women to develop chronic hiccups, as are taller people.