A Systematic Comparative Review of Antipsychotic Efficacy and Safety in the Treatment of Hiccups

Objective: To evaluate and compare the safety and effectiveness of antipsychotic medications for the treatment of hiccups, thereby guiding clinicians toward evidence-based treatment guidelines. Hiccups are often benign and self-limiting; however, they can become persistent and intractable, adversely affecting the quality of life. Antipsychotics have been identified as a therapeutic option for the management of hiccups; however, the available evidence supporting their safety and efficacy has not been synthesized. Methods: This review utilized the revised Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Cochrane Risk of Bias Assessment Tool was modified to evaluate the quality of the selected studies. The search strategy included terms related to or describing hiccups and antipsychotics. Research articles in English published between 1974 and March 2024 were searched in different databases. Duplicates and eligibility criteria were used to screen articles. Results: A search of Medline, Scopus, and Web of Science yielded 1537 articles, of which 1042 were retained after removing duplicates, and 16 met the inclusion criteria. The studies that met the inclusion criteria were all case reports, case series, or retrospective studies, with no randomized trials. A few antipsychotics have been shown to totally or partially alleviate hiccups. Nine studies reported that hiccups were completely resolved in patients treated with 10–25 mg oral and intramuscular chlorpromazine, 1–2 mg oral and intramuscular haloperidol, 2.5–10 mg oral olanzapine, 25–150 mg tetrabenazine, and 3 mg oral risperidone. Adverse events were documented in 7 of the studies. Conclusion: Chlorpromazine and olanzapine are effective antipsychotics for hiccup treatment. However, more evidence-based studies and controlled clinical trials are needed to confirm the efficacy and minimize the side effects. PROSPERO registration: (CRD42024511626).