Amitriptyline for Refractory Idiopathic Intractable Hiccups: A Case Report

Objective: Intractable hiccups, which are hiccups that can last longer than 1 month, may be very debilitating for patients. With limited evidence and a lack of treatment guidelines, refractory hiccups can be difficult to manage. We aim to present a case of refractory idiopathic intractable hiccups treated with amitriptyline in conjunction with other medications shown to produce hiccups relief. Materials and Methods: The patient’s electronic health record, direct patient care experiences, and a systematic literature review were used for this case report. We report a 53-year-old male patient with refractory idiopathic intractable hiccups. Treatment was improved with the addition of amitriptyline to his regimen of medications used for hiccups management. Medline and PubMed were searched using the key terms “hiccup” or “singultus” and “amitriptyline.” Results: The literature search yielded 3 unique articles, which resulted in 4 unique cases with intractable hiccups responding to amitriptyline therapy. In all cases, patients tried multiple medications before amitriptyline initiation. Conclusions: This is the first case in over 30 years providing additional evidence for amitriptyline use in the relief of intractable hiccups. Amitriptyline may be more useful in patients experiencing intractable hiccups with comorbid mood disorders and in cases of suspected psychogenic origin.