AEGiS-CATIE: Baclofen for hiccups

Baclofen for hiccups

TreatmentUpdate80 - Vol. 8, No. 0; August 1997
Sean Hosein

Background

Cases of persistent hiccups are often linked to conditions that affect the brain/spinal cord, other nerves, the gastro-intestinal tract and the diaphragm (located below the lungs). While persistent hiccups can't kill, they "may interfere with eating and sleep". The following have been used to treat persistent hiccups in the past:

* anti-seizure drugs

* muscle relaxants

* narcotics

* tranquillizers

Baclofen (Atrofen, Lioresal) is used to help block the transmission of certain nerve impulses reducing the intensity and number of spasms, pain and muscle stiffness. In non-HIV-infected people, the drug has been useful in the treatment of persistent hiccups. One team of doctors in New Jersey has stated that persistent hiccups "is a relatively common complaint" among their HIV-infected patients. We have four of their reports about the use of baclofen for the treatment of persistent hiccups.

One

The first person had 608 CD4+ cells and after a bacterial infection of the lungs, developed increasing hiccups over a period of 2 months. Chest x-ray pictures and a physical exam did not reveal any unusual problems. At first doctors prescribed baclofen 5 mg 4 times daily which caused the hiccups to decrease in number. When they doubled the dose of baclofen the hiccups cleared. Every time doctors tried to reduce the dose or withdraw the drug the hiccups returned. Finally, after 4 months, the patient was able to stop taking baclofen without the hiccups reappearing.

Two

Another male with a CD4+ count of 260 cells developed asthma and persistent hiccups. Chest x-ray pictures showed nothing unusual. Despite successful treatment of his asthma he continued to have hiccups. When he began using baclofen 10 mg 4 times daily his hiccups cleared but he needed to continue using the drug for 9 months.

Three

This patient had 11 CD4+ cells and was experiencing complications due to HIV infection of the brain as well as nerve damage in the hands/feet. Over a period of six months his hiccups grew worse despite the use of amitriptyline, chlopromazine, clonazepam and other drugs. Treatment with baclofen 5 mg three times for three months cleared his hiccups. After this he was able to stop using baclofen. "Four months later his hiccups [reappeared but cleared on] treatment with baclofen."

Four

In this case, a PHA with lung and brain tumours developed hiccups which cleared when treated with baclofen 5 mg 4 times daily. The only side effect reported was drowsiness. The doctors state that "baclofen appears to be safe and useful in the treatment of hiccups in HIV-infected patients."

REFERENCE:

1. D'Alessandro DJ and Dever LL. Baclofen for the treatment of persistent hiccups in HIV-infected patients. AIDS 1997;11(8):1063-1064.

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