Novel use of baclofen in cancer patients for the treatment of hiccups

Indications:2 patients with hiccup. Coexisting diseases: cervical ependymoma (1), rectal cancer, prostate cancer and stroke (1).

Patients:2 patients, both men, aged 22 and 72 years, treated as inpatients.

TypeofStudy:Lioresal was effective in cancer patients with hiccups. Case reports.

DosageDuration:5 mg (patient 1), 10 mg (patient 2) on 2 occasions 6 hours apart. Duration: 1 day.

AuthorsConclusions:Baclofen is a gamma-aminobutyric acid (GABA) derivative, which has been frequently used in the treatment of spasticity and spasms in the rehabilitation population. Its effective use in the treatment of hiccups has been reported. The mechanism of action of baclofen on the treatment of hiccups could be similar to that for spasms. Hiccups could be considered to be the dysfunction of the reciprocal inhibition of the inspiratory complex, similar in a way to spasticity, which is a lack of inhibition and "over-firing" in the central nervous system. The use of baclofen as a first line treatment for hiccups could be considered when the patient has no underlying oesophageal disease and if the patient has concomitant spasticity or recurrent hiccups. Baclofen was also found to be helpful in the treatment of chronic hiccups.

Results:In case 1, hiccup was resolved after 2 doses of Lioresal. A lower dose of Lioresal was prescribed as he was at risk of sedation from Lioresal. In case 2, hiccups resolved with 2 doses of Lioresal. A higher dose was prescribed as he was further out from the stroke, with no cognitive deficits. Both patients did not have prior non-pharmacological treatment and remained symptom free after discontinuation of Lioresal.

AdverseEffects:No adverse events were mentioned.

FreeText:Case 1 patient had a history of neurofibromatosis type 2 with numerous resections for various tumors including a right vestibular schwannoma and a foramen magnum meningioma. He last underwent resection of 4 intramedullary cervical ependymomas with associated syrinx. During his postoperative recovery, he developed acute hiccups. 2 doses of Lioresal were given. Case 2 had concomitant rectal and prostate cancer that underwent abdominal and pelvic surgery that involved extensive resection and reconstruction. He suffered a stroke postoperatively. He also experienced abdominal bloating associated with hiccups. He was given 2 doses Lioresal.