First Report of Tetrabenazine Use to Treat Intractable Hiccups After Stroke
the MPR take:
A case study in the journal Pharmacotherapy describes the successful use of tetrabenazine in a patient with intractable hiccups following right insular ischemic stroke. The patient, a 60-year-old-man, presented with frequent- intense, and disabling persistent hiccups that had lasted for more than one month following discharge from a 45-day treatment for right insular ischemic stroke with mild left hemiparesis. Breath repercussions were associated with glottis spasms and a choking sensation, leaving the patient with anxiety and exhaustion. In an attempt to limit the hiccups, the patient reduced his food intake; this resulted in some weight loss. After common causes were ruled out and there were no indicators of psychogenic origin, the patient was unsuccessfully treated for six months with various psychotropic medications that were withdrawn due to adverse effects. Finally, tetrabenazine was initiated at a starting dose of 25mg/day and a mild reduction in hiccup frequency and intensity occurred after five days. Near complete remission of the hiccup symptomology was reached after gradually increasing the dose to 150mg/day. Twelve months after stroke onset, the patient’s condition was stable with a dose of <100mg/day with plans for a gradual discontinuation. The pathophysiology of supratentorial hiccups after stroke is unknown, but the authors believe that the tetrabenazine was effective due to its action on dopamine neurotransmission mainly within the basal ganglia.
A hiccup is a myoclonic jerk of the diaphragm, and cases of hiccups may last for more than 48 hours (persistent hiccups) or even more than 2 months (intractable hiccups). Indeed, dyskinesia after chlorpromazine (up to 75 mg/day for 4 wks), as well as somnolence and dyskinesia after haloperidol ...
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