Correspondence
Nefopam for Severe Hiccups
N Engl J Med 2000; 343:1973-1974December 28, 2000
- Article
To the Editor:
Rapid pharmacologic control of severe hiccups is a difficult problem.1 The preferred drugs for treating hiccups are dopaminergic blockers or antagonists. Nefopam (3,4,5,6-tetrahydro-5-methyl-1-phenyl-1H-2,5-benzoxazocine hydrochloride) is a centrally acting nonopioid analgesic agent with antishivering effects2 that is structurally related to antihistamines and antiparkinsonian drugs.3 We report the use of intravenous nefopam in three patients with incapacitating hiccups.
A 32-year-old woman with lymphoblastic leukemia was hospitalized because she had had intense, nearly continuous hiccups for 48 hours. Vagal maneuvers, chlorpromazine (10 mg intravenously three times a day for 24 hours), and lidocaine (a loading dose of 1 mg per kilogram of body weight, followed by a continuous infusion at a rate of 2 mg per minute for 6 hours) were all ineffective. An infusion of 10 mg of nefopam caused the hiccups to stop within one minute, and they did not recur for four hours. The patient then received 10 mg of nefopam intravenously four times daily for two days plus 200 mg of carbamazepine orally three times a day without a recurrence of the hiccups.
A 25-year-old woman with esophageal candidiasis secondary to an immunodeficiency syndrome presented with continuous hiccups that were resistant to vagal maneuvers. A 10-mg intravenous dose of nefopam stopped the hiccups within one minute, and oral nimodipine (30 mg three times a day) was started.4 No recurrence of hiccups was recorded.
Intense hiccups developed in a 58-year-old man who was undergoing percutaneous embolization of an intracranial arteriovenous malformation. The hiccups were resistant to vagal maneuvers and a bolus infusion of lidocaine (2 mg per kilogram) but stopped one minute after the intravenous administration of a 10-mg dose of nefopam and did not recur. Our experience suggests that patients with severe hiccups that are resistant to vagal maneuvers and to therapy with chlorpromazine, lidocaine, or both, can have a rapid response to intravenous nefopam.
4 ReferencesFederico Bilotta, M.D., Ph.D.
Giovanni Rosa, M.D.
University of Rome La Sapienza, 00196 Rome, Italy1
Kolodzik PW ,Eilers MA . Hiccups (singultus): review and approach to management. Ann Emerg Med 1991;20:565-573
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Rosa G ,Dell'Utri D ,Conti G , et al. Efficacy of nefopam for the prevention and treatment of amphotericin B-induced shivering. Arch Intern Med 1997;157:1589-1592
CrossRef | Web of Science | Medline3
Heel RC ,Brogden RN ,Pakes GE ,Speight TM ,Avery GS . Nefopam: a review of its pharmacological properties and therapeutic efficacy. Drugs 1980;19:249-267
CrossRef | Web of Science | Medline4
Hernandez JL ,Fernandez-Miera MF ,Sampedro I ,Sanroma P . Nimodipine treatment for intractable hiccups. Am J Med 1999;106:600-600
CrossRef | Web of Science | Medline
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