4.9.3 Drugs used in intractable hiccups, essential tremor and related disorders

Intractable hiccups

ChoiceDrugDosage
1st choiceChlorpromazine tablets, 25mg, 50mg; oral solution 25mg/5ml Dose: 25-50mg 3-4 times daily

Prescribing Notes

  • In the management of intractable hiccups, chlorpromazine should be for short-term use only as there is a risk of extrapyramidal effects.

Essential tremor or tremors associated with anxiety or thyrotoxicosis

ChoiceDrugDosage
1st choicePropranolol tablets 10mg, 40mg, 80mg, 160mg; capsules m/r 80mg, 160mg

Dose:
Anxiety with symptoms such as palpatations, sweating, tremor: 40mg once daily, increased to 40mg 3 times daily if necessary

Essential tremor: initially 40mg 2-3 times daily, increased if necessary; 80-160mg daily is usually required for maintenance

Prescribing Notes

  • The continued benefit of treatment with a beta blocker should be reviewed.
  • Primidone may be useful for essential tremor in patients unable to take beta-blockers due to, for example, asthma or peripheral vascular disease, although primidone can be poorly tolerated.