Hi Doc or others I had my first treatment on Tuesday (Chemo & RT)and had to go in today for my next RT. Question ? does cisplatin cause Hiccups?. I have never been one to have it constantly but am having it now with only short breaks now and then.Any sujestions.
Posts: 393 | Location: Willaston Sth Australia Australia | Registered: 09 July 2007
According to an evidence summary produced by the Joanna Briggs Institute Clinical Information Service, chronic hiccups can be a distressing side effect of chemotherapy. Some researchers have stated that chemotherapy-related hiccups are uncommon, however others have stated that they occur relatively frequently.
Chemotherapy-related hiccups can result in insomnia, depression, inability to eat, and weight loss. When hiccups are severe, they can be incapacitating and difficult to treat.
The management of chronic hiccups can be approached in both a drug-related and non-drug related manner. Non-drug treatment of chemotherapy-related hiccups includes methods that interrupt the diaphragm rhythm, such as holding the breath, pressing on the eyeballs, and swallowing. However, these methods are not always successful with chronic hiccups, so drug treatment is often required.
I have also read that it is more common in men! A Taiwanese paper concluded that cisplatin-related hiccups are predominant in males, dexamethasone-induced, and associated with protection against nausea/vomiting. The only one on the board who mentioned getting hiccups with chemotherapy (cisplatin) was Parky, another man. It would be interesting to see who else experienced this?
Definition: Hiccups or singultus are sudden involuntary contractions of the diaphragm, terminated by closure of the glottis. Although typically common, transient, and benign, when hiccups fail to resolve spontaneously, patients seek treatment for fatigue and incapacitation. Management consists of the identification and treatment of a serious underlying cause of hiccups.
Risk factors: A lowered pCO2, alcohol ingestion, smoking, and changes in temperature--particularly of the gastrointestinal tract--commonly cause hiccups. Gastric distention is the most common cause in patients with advanced cancer, which is why hiccups are quite common in dying patients. This symptom commonly is related to upper gastrointestinal disease as well as other conditions that can affect the vagus or phrenic nerve. Central nervous system disorders, renal disease, and hypocalcemia also can result in hiccups. Infections, including herpes zoster and tuberculosis, have been implicated as a cause of hiccups. Some drugs have been linked to hiccups, including barbituates, dexamethasone, and diazepam.
Adverse effects include fatigue, decreased nutritional intake, dehydration, wound dehiscence, and reflux esophagitis. However, the effect on quality of life is the primary reason patients seek treatment.
What are the etiologies of hiccups in a person with advanced cancer? Hiccups are defined as repetitive, sharp inspiratory sounds that occur because of spasms of the glottis and diaphragm. Anatomically, hiccups originate in the phrenic or vagus nerve pathways. The more common case of hiccups, lasting from a few minutes to hours, may be related to decreased pCO2 or gastric distention. Persistent hiccups, lasting more than 48 hours, can result from decreased pCO2, gastric distention, ingestion of alcohol, smoking, sudden excitement, or a change in gastrointestinal temperature (e.g., caused by drinking a hot or cold beverage). Intractable hiccups, lasting more than a month, have multiple causes: structural (e.g., disease affecting the phrenic and vagus nerves), metabolic (e.g., drug-related), infectious, or psychogenic. In a person with advanced cancer, structural and drug-related etiologies are more likely.
What nonpharmacologic therapies should be attempted initially? Respiratory strategies, such as holding one's breath, are well known in the lay community, and most patients will have attempted them before seeking nursing intervention. Oropharyngeal stimulation, such as ice application in the mouth, pressure on the nose, eating soft bread, or stimulating the soft palate with a cotton swab, can be attempted. Other techniques include breathing into a paper bag, swallowing a teaspoon of sugar, and biting a lemon wedge. Physical changes that may promote the cessation of hiccups include pulling the knees to chest, leaning forward to compress the chest, tapping over the fifth cervical vertebra, or applying ice over the phrenic nerve. Vagal stimulation (e.g., carotid massage) has been reported to be effective in some patients. Relief of gastric distention with techniques such as the use of a nasogastric tube, the induction of vomiting, or fasting also can be effective. For intractable cases where quality of life is affected severely, anesthetic disruption of the phrenic nerve should be considered.
What pharmacologic treatments should be considered? Initial drug treatment should be aimed at relieving gastric distention and increasing gastric emptying. Simethicone (15-30 cc by mouth every four hours), metoclopramide (10-20 mg by mouth every six hours), or baclofen (5-10 mg by mouth every 6-12 hours) is therapeutic. Antacids and antiemetics also have been reported to be effective in some patients. If hiccups persist, chlorpromazine (10-25 mg by mouth or IM every six hours) or haloperidol (1-5 mg orally or subcutaneously every 12 hours) can be attempted. Nefopam (10 mg infusion) and lidocaine (1 mg/kg loading dose, followed by a continuous infusion of 2 mg/minute for six hours) reportedly have been successful. If hiccups persist, amitriptyline, valproic acid, or nifedipine can be considered. However, nurses may refer patients to an anesthesia or pain service.
How else should this (patient) be managed? Hiccups are very irritating and often painful for patients. L.D. would require emotional support as various strategies are attempted. Little research has been conducted in this area; therefore, trial and error is the only way to manage this symptom. Of course, symptoms related to his chemotherapeutic regimen can overlap and complicate management of hiccups. Both 5-fluorouracil and irinotecan can cause abdominal distress and changes in gastric emptying. Drugs such as loperamide can contribute to the problem, although metoclopramide was particularly effective in L.D.'s treatment. However, for complex situations such as this, each drug aimed at symptom relief should be added individually.
Nondrug treatment includes advising patients to gargle with ice water or hold their breath, which can produce mild respiratory acidosis, thereby suppressing diaphragmatic action. Pharyngeal stimulation with a cotton swab or vagal stimulation with the Valsalva maneuver or carotid massage also can be effective treatments.
Drug treatment can include chlorpromazine (25-50 mg via IV, orally, or rectally three to four times a day), metoclopramide (10-20 mg via IV, IM, or orally four times a day), carbamazepine (200 mg three times a day), cisapride (10-20 mg four times a day), amitriptyline (10 mg three times a day), and baclofen (10-20 mg three times a day). Metoclopramide is very effective in patients with gastric distention but is contraindicated in those with bowel obstruction.
Hope that helps.
Best wishes Vinod This message has been edited. Last edited by: Dr Vinod K Joshi,
Disclaimer: Please see your own dentist/doctor for a proper diagnosis as my words should not, in any circumstances, be taken as dental/medical advice.
"If you see what is small as it sees itself, and accept what is weak for what strength it has, and use what is dim for the light it gives, then all will go well. This is called Acting Naturally." Lao-Tsu, Tao Teh King
Posts: 3779 | Location: St Luke's Hospital, Bradford and Pinderfields Hospital, Wakefield | Registered: 14 December 2002
This message has been edited. Last edited by: Dr Vinod K Joshi, 