Home Formulary 4.0 Central Nervous System 4.9 Drugs used in parkinsonism and related disorders 4.9.3 Drugs used in intractable hiccups, essential tremor and related disorders

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.