Hiccup secondary to dopamine agonists in Parkinson's Disease

Abstract

Hiccup is produced by a sudden contraction of the inspiratory muscles followed by an abrupt closure of the glottis, which produces the typical sound that characterizes this disorder. The causes of hiccup are diverse, 1 including several drugs. 2 Here, we report two cases of patients with Parkinson's Disease (PD) who developed hiccup after using different dopamine agonists (DAs). CLINICAL CASES Case 1This 76-year-old man with a history of arterial hypertension, acute myocardial infarction (AMI) in 1988, and hypercholesterolemia developed progressive resting tremor and bradykinesia, initially involving the left side of his body and later becoming bilateral.He was given a diagnosis of PD 7 years ago and received levodopa/benserazide (500/120 mg/day) and piribedil (150 mg/ day) divided in three doses for the last 8 months. However, because of economic reasons and issues related to his medical insurance, the patient asked if he could change piribedil for another drug. To this end, he started pramipexol (3 mg/day). Two hours after taking the first pramipexol dose, however, he developed hiccups, which persisted for 3 days and stopped after discontinuing pramipexol. He was then switched back to piribedil at a higher dose than his original prescription (200 mg/day) but once again hiccups developed. They stopped after he decreased the dose to 150 mg/day.

The Role of Serotonin in Singultus: A Review

“…inducing hiccups (Miyaoka and Kamijima, 1999;Cheng et al, 2011). • Reports of dopaminergic agonists (amantadine, apomorphine, pergolide, pramipexole, piribedil, levodopa, ropinrole) used to treat hiccup (Welsh, 1904;Garrick, 1917;Askenasy et al, 1988;Martinez-Ruiz et al, 2004;Sharma et al, 2006;Lester et al, 2007;Gerschlager and Bloem, 2009;Coletti Moja, 2010). • Reports of failure of selective anti-dopaminergic agents (haloperidol) to control hiccups (Nishikawa et al, 2015).…”

Hiccup: Mystery, Nature and Treatment

“…Replacement therapy with dopamine agonists in PD patients is considered to induce certain episodes of hiccup; however, in others, hiccup may occur as the non-motor symptom of PD rather than as side effect of anti-PD treatment 48. The pathogenesis is believed to be related to the fact that dopamine agonists share a high affinity for D 3 receptors which may be involved in the hiccup reflex arc 49. Hence, the drugs to block dopaminergic neurotransmission including chlorpromazine and metoclopramide may be employed in treating hiccup episodes 48.…”

Acupuncture Treatment for Persistent Hiccups in Patients with Cancer

“…Persistent hiccups have been linked to drug-related causes, including chemotherapies and anesthetics, as well as many other conditions, such as nervous system disease, infection, and metabolic disorders 5,6. Pharmacologic approaches including baclofen, gabapentin, chlorpromazine, haloperidol, metoclopramide, lidocaine, valproic acid, and nifedipine, have been used with varying degrees of effectiveness7,8 but have not proved consistently effective 9–11.…”