Intractable
hiccups can be a serious complication in transplant recipients. Unfortunately, many of the
pharmacotherapies used to stop
hiccups are associated with severe side effects as well as
drug-drug interactions with
immunosuppressants. We report a case of a heart transplant recipient who had had intractable
hiccups for 2 months, resulting in severe
insomnia, diminished appetite, and
weight loss. To treat the
hiccups, treatment with oral
baclofen (5-10 mg 3 times daily) was started. After 6 weeks of
therapy, the
baclofen was titrated down and discontinued because it had not stopped the
hiccups and was causing severe central nervous system side effects.
Gabapentin (100 mg twice daily) was then prescribed and within 24 hours of the start of that treatment, the
hiccups had resolved completely. After 3 weeks of
therapy, the patient had no side effects and the
gabapentin was subsequently discontinued. One year after stopping the
gabapentin, the patient remains free of
hiccups.
Gabapentin appears to be a promising medication for the treatment of intractable
hiccups in thoracic transplant recipients because of its lack of serious side effects at low doses, rapid onset of action, and lack of
drug-drug interactions with transplant medications.