Severe hiccups during chemotherapy: corticosteroids the likely culprit

Abstract

Hiccups generally are self-limiting and of short duration. Those lasting more than 48 h or recurring at frequent intervals are termed persistent. There are numerous causes of hiccups, with medications implicated only rarely. While hiccups are usually benign, severe attacks may lead to exhaustion, eating difficulties, and affect quality of life. We report a case of severe hiccups in a patient receiving chemotherapy (oxaliplatin, 5-fluorouracil, leucovorin) for metastatic colorectal cancer. Hiccups began on the day following chemotherapy and continued constantly for over 30 h until relief was obtained by sucking the juice of a fresh lemonade. A similar pattern occurred in the next two chemotherapy cycles. Dexamethasone had been prescribed as prophylaxis against emesis and this was considered a possible cause. Withholding dexamethasone in the next cycle led to elimination of hiccups without having an impact on control of nausea and vomiting. A number of case reports have linked corticosteroids, particularly dexamethasone, to the occurrence of hiccups. Antineoplastic agents have occasionally been reported as causing hiccups; however, in most of these cases, corticosteroids, as part of the treatment protocol or as antiemetics, may have been a more likely cause. This case serves an as important reminder that adverse effects appearing during chemotherapy may not necessarily be due to antineoplastic agents. In the case of hiccups, oncology health professionals should review all medications and non drug-related factors before assigning causality.

Immediate and Acute Adverse Effects Following Transforaminal Epidural Steroid Injections with Dexamethasone

“…In our study, 3 (10.69%) of the patients reported hiccups, 2 (1.8%) of which lasted for 3 days; the other resolved in 24 hours. While hiccups are usually benign, severe attacks may lead to exhaustion, eating difficulties, and affect quality of life (57). Several authors reported dysphonia following steroid injections (58-60) but none of them as well used dexamethasone.…”

Transient Hiccups Associated with Oral Dexamethasone

“…This is especially true for treatments involving steroids [35], drugs that are commonly used in medicine, including dental medicine. Being able to recognize the potential “drug-hiccup link” will better prepare health care practitioners manage any unexpected complications.…”

Preventing Chemotherapy-Induced Nausea and Vomiting with Netupitant/Palonosetron, the First Fixed Combination Antiemetic: Current and Future Perspective

“…Most AEs were mild or moderate in intensity. The most frequently observed TRAEs were hiccups [35,88], constipation and headache [36,44], AEs that are associated with the class effects of 5-HT 3 RAs (headache and constipation) [31], NK 1 RAs and high-dose steroids (hiccups) [94,95].…”