The adjuvant use of lansoprazole, clonazepam and dimenhydrinate for treating intractable hiccups in a patient with gastritis and reflux esophagitis complicated with myocardial infarction: a case report

Abstract

BackgroundHiccup (Singultus) is a sudden and involuntary contraction of the diaphragm followed by a sharp closure of the epiglottis which results in the production of a specific “hic” sound. Normally, hiccups are treated without intervention. Intractable hiccups occur rarely but are a disturbing symptom underlying other health related disorders.Case presentationWe report the clinical case of a 67-year-old male patient with myocardial infarction accompanied by intractable hiccups during the course of 8 months, and who was non-responsive to chlorpromazine or metoclopramide, and baclofen; drugs routinely used to treat this condition. This sustained hiccup had severely restricted the patient's ability to intake food and sleep. To explore alternative treatments, we investigated the adjuvant administration of lansoprazole, dimenhydrinate and clonazepam in this patient. We discovered that this drug combination was capable of successfully terminating his intractable hiccups, with no further evidence of recurrence. No similar treatment is previously reported for intractable hiccups. We further suggest a hypothesis concerning a potential mechanism on the anti-hiccup effect of dimenhydrinate.ConclusionWe identified that the adjuvant use of lansoprazole, clonazepam and dimenhydrinate was capable of attenuating the symptoms of our patient with intractable hiccups.

Management of hiccups in palliative care patients

“…A case report by Maximov and Kamnasaran showed significant improvement of hiccups with the use of lansoprazole, clonazepam and dimenhydrinate in a patient with gastritis, reflux esophagitis and recent myocardial infarction 17. This patient was not responsive to chlorpromazine, metoclopramide or baclofen.…”

Myocardial Ischemia Presenting with Hiccups

“…The underlying etiology was myocardial infarction in 127 (98.4%) patients, 5,[7][8][9][10][11][12][13][14][15][16][17][19][20][21][22][23][24][25][26][27][28][29] and myocardial ischemia in 2 (1.6%) patients. 6,18 Of the myocardial infarction group, one patient each was diagnosed with Dressler syndrome, 16 associated with ischemic cardiomyopathy and atrial fibrillation, 15 and had in-stent thrombosis of the right coronary artery.…”

“…For patients with AMI or acute myocardial ischemia, the hiccup duration was recorded as a minus when hiccups occurred post-admission. [5][6][7][8]10,12,14,16,17,[19][20][21]27 It was 1,460 days (4 years, n=1) for the patients with chronic myocardial infarction. 15 The situation of hiccups among other symptoms was described in 21 (16.3%) patients: hiccups as an only presentation of myocardial infarction in 7 (33.3%) patients, 5,10,12,14,21,27 as a primary symptom in 8 (38.1%) patients, [6][7][8]15,20,23,29 and as an accompanying symptom in 6 (28.6%) patients.…”

“…[5][6][7][8]10,12,14,16,17,[19][20][21]27 It was 1,460 days (4 years, n=1) for the patients with chronic myocardial infarction. 15 The situation of hiccups among other symptoms was described in 21 (16.3%) patients: hiccups as an only presentation of myocardial infarction in 7 (33.3%) patients, 5,10,12,14,21,27 as a primary symptom in 8 (38.1%) patients, [6][7][8]15,20,23,29 and as an accompanying symptom in 6 (28.6%) patients. 13,[16][17][18][19]26 Hiccups could be defined according to Thompson and Brooks' classification in 21 (16.3%) patients: Hiccups were persistent in 15 (71.4%) patients, [5][6][7][8]12,14,17,18,21,23,26,27 and intractable in 6 (28.6%) patients, 10,…”

“…7,18 The time intervals between the onset of myocardial infarction and that of hiccups were available for 7 (5.4%) patients, showing that hiccups occurred 3.7 ±0.7 days after myocardial infarction (n=6). 14,16,17,19,20,26 Journal of the College of Physicians and Surgeons Pakistan 2019, Vol. 29 ( 5): 469-473 The timing of treatment of hiccups was 20.8 ±13.8 days (n=14) after hiccup onset in AMI or acute myocardial ischemia patients, [5][6][7][8]10,12,14,16,21,29,26,27 and 4 years after chronic myocardial infarction.…”