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Steroid-induced Hiccups — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologySteroid-induced HiccupsSCE Medical Oncology

A 62-year-old woman with metastatic breast cancer develops intractable hiccups after starting dexamethasone for brain metastases. She has tried chlorpromazine without improvement. What is the next pharmacological option?

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Correct answer: C — Reducing dexamethasone dose (if clinically feasible — steroids are a common cause of intractable hiccups)

Corticosteroids (particularly dexamethasone) are one of the most common causes of intractable hiccups in cancer patients. The mechanism involves central stimulation of the hiccup reflex arc. First management step is to consider reducing the steroid dose (if clinically feasible — e.g. switching from dexamethasone to a lower potency steroid). If steroid reduction is not possible, pharmacological options include: baclofen (GABA-B agonist), gabapentin, chlorpromazine, metoclopramide and nifedipine. Baclofen has the strongest evidence after chlorpromazine.

Reference: ESMO 2024 Supportive Care; BNF Dexamethasone; Steger et al J Pain Symptom Manage 2015