Hiccups are involuntary spasms of the diaphragm, followed by a rapid closure of the glottis. While typically harmless and temporary, they can sometimes be linked to medical treatments. This raises a question for many undergoing cancer therapy: can chemotherapy contribute to hiccups?
Understanding Chemotherapy’s Role in Hiccups
Chemotherapy can indeed lead to hiccups. Certain drug classes are more frequently associated with this. Corticosteroids, particularly dexamethasone (used as anti-nausea medication or in chemotherapy regimens), are often implicated. In some instances, corticosteroids may be a more likely cause than the antineoplastic agents themselves.
Platinum-based chemotherapy drugs like cisplatin, carboplatin, etoposide, and irinotecan can also induce hiccups. Hiccups were reported in a notable percentage of patients receiving cisplatin-containing regimens, sometimes as high as 42%, with a combination of cisplatin and dexamethasone showing an even higher incidence. This association is well-documented, with a higher prevalence observed in men.
The Mechanisms Behind Chemotherapy-Induced Hiccups
Chemotherapy-induced hiccups involve a complex reflex arc controlling the diaphragm and intercostal muscles. This arc includes the phrenic and vagus nerves, and specific brainstem regions. Irritation or disruption along this pathway can trigger involuntary diaphragmatic contractions.
One proposed mechanism involves direct nerve irritation. Platinum agents can stimulate the vagus nerve, initiating a reflex that leads to hiccups. Additionally, some chemotherapy drugs and supportive medications, like dexamethasone, can influence central nervous system components.
Beyond direct nerve and central nervous system effects, other cancer treatment factors can contribute. Gastric reflux, a common chemotherapy side effect, can irritate the vagus nerve and trigger hiccups. Electrolyte imbalances may also play a role in inducing or exacerbating hiccups.
Strategies for Managing Hiccups During Chemotherapy
Managing hiccups during chemotherapy often involves medical and non-pharmacological strategies. For persistent hiccups, healthcare providers may prescribe medications. Common options include baclofen (a muscle relaxant) and metoclopramide (an anti-sickness drug).
Chlorpromazine, an antipsychotic, is also used and is the only medication specifically approved by the U.S. Food and Drug Administration for intractable hiccups. Gabapentin, typically used for nerve pain, has shown effectiveness in some cancer patients. If gastric reflux is suspected, proton pump inhibitors might be considered.
Several non-pharmacological methods can offer relief. Simple techniques include holding your breath, slowly sipping cold water, or gargling with iced water to interrupt the hiccup reflex. Breathing into a paper bag can help by increasing blood carbon dioxide levels, which may calm the diaphragm. Dietary adjustments, such as eating smaller meals, avoiding fizzy drinks, spicy foods, or sudden temperature changes in ingested food, may also be beneficial.
Communicate any persistent hiccups to the oncology care team. Hiccups lasting longer than 48 hours, or those that significantly interfere with eating, drinking, sleeping, or overall well-being, warrant medical attention. The healthcare team can assess the situation, identify potential causes, and recommend appropriate interventions to manage this symptom and support the patient’s quality of life.