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e presence of hiccups was routinely assessed. Patients with severe chronic hiccups were treated with gabapentin (300 mg t.i.d.). Doses of gabapentin were titrated based on the response to treatment. Gabapentin-related adverse effects were recorded. Results: Thirty-seven (3.9%) of 944 in-hospital patients and 6 (4.5%) of 134 patients observed at home presented severe chronic hiccups. We Gabapentin has a similar body of evidence as other pharmacotherapeutic agents used to treat hiccups. Gabapentin is well tolerated and should be considered as a second-line agent in selected patients. Gabapentin can be useful alone or as add-on therapy. Reducing the frequency of recurrent or persistent hiccups is important, as it will improve overall quality of life. BOTTOM LINE Hiccups are a common human experience, but can create a great deal of physical and emotional discomfort in end-stage disease. Evaluation of gabapentin eficacy in palliative care persistent hiccups management: case series Abstract We have noticed it’s common to see hiccups in the palliative patients and in most cases need pharmacological intervention. Indeed, gabapentin probably increases the endogenous release of GABA, modulating excitability of the diaphragm and the other inspiratory muscles (4,5). In this patient, the most probable cause for hiccup was the neoplastic infiltration of the diaphragm and thus gabapentin may have been useful for the former reason. Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective. In our case, we successfully treated persistent hiccups of more than four days duration in a patient with acute myeloblastic leukemia with gabapentin. Keywords: palliative care, persistent hiccups, gabapentin, acute myeloid leukemia (aml), anti-epileptics Introduction Hiccups, or Singultus, are a common condition among individuals. Several medications are under research for hiccup management, including Gabapentin, an analog of the neurotransmitter γ-aminobutyric acid (GABA), which has shown effective outcomes in patients with persistent hiccups, highlighting the need for larger clinical studies to evaluate their efficacy and safety. Despite that Hiccups, while often seen as a minor inconvenience, can become a significant health issue when they are persistent or intractable. This episode explores the science behind hiccups, their potential medical causes, and treatment options, particularly the use of gabapentin as an off-label solution.• Gabapentin is useful in the management of persistent hiccups in malignancy and has the advantage of low dosing, gradual titration of dosage, fewer drug interactions, and systemic effects. This review aims to identify literature concerning the use of pharmacologic treatments for intractable and persistent hiccups with the goal of evaluating therapies in terms of their level of evidence, mechanism of action, efficacy, dosing, onset of action, and adverse effects. The results of the study allow suggesting gabapentin at least as a promising drug in the treatment of severe chronic hiccups in advanced cancer patients. A search of MEDLINE (1966-March 2013) using the MeSH search terms gabapentin, hiccups, and hiccups/drug therapy was performed. Additional databases searched included Web of Science (1945-March 2013) and International Pharmaceutical Abstracts (1970-March 2013) using the text words gabapentin and hiccups. Bibliographies of relevant articles were reviewed for additional citations. Evidence on the use of gabapentin for persistent or intractable hiccups is limited. This case series expands on the current literature by examining and comparing the current literature to our cases and exploring issues related to dosing, titration, side effects, and adjuncts to gabapentin. Gabapentin was reinitiated by the geriatric medicine team, and the patient's hiccups resolved once again. Conclusion: Randomized, controlled trials evaluating the use of gabapentin in the treatment of hiccups associated with neurogenic etiologies are lacking; however, case reports suggest that this agent may be an effective treatment option. However, there is little evidence as to which interventions are effective or harmful. Drugs used in the treatment of hiccups have included chlorpromazine, metoclopramide, sodium valproate, haloperidol, amitriptyline, carbamazepine, magnesium sulphate, baclofen, gabapentin, peppermint water, simeticone, benzodiazepines and nifedipine. Gabapentin: Gabapentin modulates neuronal activity, which can help interrupt the reflex arc responsible for hiccups. Gabapentin can be considered when hiccups are resistant to other treatments or when a neuropathic component is suspected. Objective To describe the use of gabapentin for treatment of persistent or intractable hiccups in post-stroke patients. A search of MEDLINE (1966-March 2013) using the MeSH search terms gabapentin, hiccups, and hiccups/drug therapy was performed. Additional databases searched included Web of Science (1945-March 2013) and International Pharmaceutical Abstracts (1970-March 2013) using the text words gabapentin and hiccups. Bibliographies of relevant articles were reviewed for additional citations.
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