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Eduardo Bruera - One of the best experts on this subject based on the ideXlab platform.
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antiemetic corticosteroid rotation from dexamethasone to methylprednisolone to prevent dexamethasone induced Hiccup in cancer patients treated with chemotherapy a randomized single blind crossover phase iii trial
Oncologist, 2017Co-Authors: Se Il Go, Sung Yong Oh, Seong Yoon Yi, Jun Ho Ji, Eduardo Bruera, Haa Na Song, Joung Soon Jang, Lee Chun Park, Byeong Bae Park, In Gyu HwangAbstract:BACKGROUND: To assess whether the rotation of dexamethasone to methylprednisolone decreases the intensity of dexamethasone-induced Hiccup (DIH) in cancer patients treated with chemotherapy. MATERIALS AND METHODS: Adult patients who experienced DIH within 3 days after the administration of dexamethasone as an antiemetic were screened. Eligible patients were randomly assigned to receive dexamethasone (n = 33) or methylprednisolone (n = 32) as an antiemetic (randomization phase). In the next cycle of chemotherapy, the dexamethasone group received methylprednisolone and vice versa in the methylprednisolone group (crossover phase). The primary endpoint was the difference in Hiccup intensity as measured using the numeric rating scale (NRS) between two groups. RESULTS: No female patients were enrolled, although the study did not exclude them. At the randomization phase, Hiccup frequency was 28/33 (84.8%) in the dexamethasone group versus 20/32 (62.5%) in the methylprednisolone group (p = .04). Intensity of Hiccup was significantly higher in the dexamethasone group than that in the methylprednisolone group (mean NRS, 3.5 vs. 1.4, p < .001). At the crossover phase, Hiccup intensity was further decreased after the rotation of dexamethasone to methylprednisolone in the dexamethasone group (mean NRS, 3.5 to 0.9, p < .001), while it was increased by rotating methylprednisolone to dexamethasone in the methylprednisolone group (mean NRS, 1.4 to 3.3, p = .025). There were no differences in emesis intensity between the two groups at either the randomization or crossover phases. Clinicaltrials.gov identifier: NCT01974024. CONCLUSION: Dexamethasone-induced Hiccup is a male-predominant phenomenon that can be ameliorated by rotating dexamethasone to methylprednisolone without compromising the antiemetic efficacy. IMPLICATIONS FOR PRACTICE: In this randomized, multicenter, phase III trial, Hiccup intensity was significantly lower when the antiemetic corticosteroid was rotated from dexamethasone to methylprednisolone without a change in emesis intensity than that when dexamethasone was maintained. At the crossover phase, Hiccup intensity was increased again if dexamethasone was readministered instead of methylprednisolone. The present study demonstrated that dexamethasone-induced Hiccup can be improved by rotating from dexamethasone to methylprednisolone without compromising its antiemetic efficacy.
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gender differences in Hiccup patients analysis of published case reports and case control studies
Journal of Pain and Symptom Management, 2016Co-Authors: Se Il Go, Eduardo Bruera, Jung Hun KangAbstract:Abstract Context Although sporadic male predominance in Hiccup patients has been reported, the association between gender differences and triggering factors has rarely been evaluated in patients with Hiccups. Objectives The aim of this study was to investigate whether gender differences exist in Hiccup patients by analyzing all previously published Hiccup literature containing gender and etiology information. Methods Published literature on this topic was identified using a standardized search strategy in the PubMed, SCOPUS, and CINAHL electronic databases. The literature search included studies published from January 1990 to December 2013. Searches were limited to English-language publications. Of 476 identified studies, 318 studies were eligible including eight case-control studies that contained nonHiccup control groups. Triggering factors for Hiccups were categorized into two types: central nervous system (CNS) and non-CNS causes. Odds ratios (ORs) were calculated for the eight case-control studies and event rates for the other studies by meta-analysis. In addition, gender differences and mean ages were analyzed for the case studies. Results Pooled OR was 2.42 (95% confidence interval [CI] 1.40–4.17) with inclination for male predominance. Subgroup analysis by cause showed clear male predominance in the non-CNS type with OR of 11.72 (95% CI 3.16–43.50), whereas indistinct in the CNS type with OR of 1.74 (95% CI 0.95–3.16). Of the remaining 310 studies with 864 patients, previous findings were consistent. Male predominance was consistent in non-CNS (85.1%, 95% CI 78.2–90.2) and unknown origin (82.2%, 95% CI 75.8–87.2) patients, whereas mitigating the sex discrepancy in those with CNS origin (65.8%, 95% CI 53.1–76.5). Conclusion We demonstrated male predominance in Hiccup patients. This gender difference for Hiccups was more pronounced in patients with non-CNS causes, whereas indistinct in patients with CNS causes.
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treatment of dexamethasone induced Hiccup in chemotherapy patients by methylprednisolone rotation
Oncologist, 2013Co-Authors: Sung Yong Oh, Myounghee Kang, Jung Hun Kang, Se Hoon Park, In Gyu Hwang, Seong Yoon Yi, Young Jin Choi, Jun Ho Ji, Eduardo BrueraAbstract:: Dexamethasone-induced Hiccup (DIH) is an underrecognized symptom in patients with cancer, and little information is available about its treatment. The aims of this study were to investigate the feasibility of methylprednisolone rotation as treatment and to confirm the male predominance among those with cancer who experienced DIH during chemotherapy. Methods. Persons with cancer who experienced Hiccups during chemotherapy treatment and who were receiving treatment with dexamethasone were presumed to have DIH. The following algorithmic practice was implemented for antiemetic corticosteroid use: rotation from dexamethasone to methylprednisolone in the next cycle and dexamethasone re-administration in the second cycle of chemotherapy after recognition of Hiccups to confirm DIH. All other antiemetics except corticosteroid remained unchanged. Patients (n = 40) were recruited from eight cancer centers in Korea from September 2012 to April 2013. Data were collected retrospectively. Results. Hiccup intensity (numeric rating scale [NRS]: 5.38 vs. 0.53) and duration (68.44 minutes vs. 1.79 minutes) were significantly decreased after rotation to methylprednisolone, while intensity of emesis was not increased (NRS: 2.63 vs. 2.08). Median dose of dexamethasone and methylprednisolone were 10 mg and 50 mg, respectively. Thirty-four (85%) of 40 patients showed complete resolution of Hiccups after methylprednisolone rotation in the next cycle. Of these 34 patients, 25 (73.5%) had recurrence of Hiccups after dexamethasone re-administration. Compared with baseline values, Hiccup intensity (NRS: 5.24 vs. 2.44) and duration (66.43 minutes vs. 22.00 minutes) were significantly attenuated after dexamethasone re-administration. Of the 40 eligible patients, 38 (95%) were male. Conclusion. DIH during chemotherapy could be controlled without losing antiemetic potential by replacing dexamethasone with methylprednisolone. We also identified a male predominance of DIH. Further prospective studies are warranted.
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baclofen a treatment for chronic Hiccup
Journal of Pain and Symptom Management, 1998Co-Authors: Paul Walker, Sharon Watanabe, Eduardo BrueraAbstract:Abstract The efficacy of baclofen in the treatment of chronic Hiccup is demonstrated in two cases. These cases highlight the present state of knowledge related to Hiccup. This discussion focuses on the definition and classification of Hiccup, etiologies, postulated theories to explain its function, the few studies performed to date, and non-pharmacologic and pharmacologic treatment. Baclofen appears to be the agent most efficacious in the treatment of chronic Hiccup. Its commonest side effect is sedation; insomnia, dizziness, weakness, ataxia, and confusion also can occur. Following regular use, abrupt discontinuation can lead to withdrawal symptoms, such as seizure, and gradual discontinuation is recommended.
Jeanphilippe Derenne - One of the best experts on this subject based on the ideXlab platform.
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linkage of Hiccup with heartbeat
Journal of Applied Physiology, 2000Co-Authors: B Y Chen, K Vasilakos, Daniela Boisteanu, L Garma, Jeanphilippe Derenne, William A WhitelawAbstract:We explored a possible link between the cardiac cycle and the timing of recurrent Hiccups in 10 patients with chronic, intractable Hiccups. Recordings made during daytime naps in a sleep laboratory included sleep state; electrocardiogram; and respiration by means of a thermistor to detect airflow, bands around the rib cage and abdomen to assess expansion, and a bipolar surface electrode electromyogram over parasternal intercostal muscles. Hiccups could be detected on the abdominal bands and the parasternal electromyogram. The time of occurrence of each Hiccup and each R wave in a continuous tracing of 100 or more Hiccups were recorded and analyzed together with semiquantitive estimates of the phase of Hiccup respiration. Whereas the Hiccup rate ranged from approximately one-third to one-eighth of heart rate and was more variable than heart rate, Hiccups showed a tendency, stronger in some subjects than others, to occur in midsystole. Variation in R-wave-R-wave (R-R) interval in association with Hiccups was found in five patients. In three of these patients, Hiccups were synchronized with respiration so that the cyclic change in R-R interval postHiccup could be explained as sinus arrhythmia, but, in two patients, the Hiccups were not synchronized with respiration, so that Hiccups are most likely responsible for the variation in heart rate. Also, the variation of R-R interval with Hiccups suggests that there is some phasic autonomic efferent activity associated with Hiccups.
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Chronic Hiccups and sleep.
Sleep, 1996Co-Authors: Isabelle Arnulf, William A Whitelaw, Daniella Boisteanu, Jean Cabane, Lucile Garma, Jeanphilippe DerenneAbstract:: To explore the effect of sleep on Hiccups, we studied eight patients aged 20-81 years, all males with chronic Hiccups lasting 7 days to 7 years, by means of overnight polysomnography. The incidence of new bouts of Hiccups and the likelihood of Hiccups being present were both highest in wakefulness and became progressively lower through stages I-IV of slow wave sleep (SWS) to rapid eye movement sleep (REMS). There was a significant tendency for Hiccups to disappear at sleep onset and REMS onset. Of all 21 bouts of Hiccups that were observed to stop, 10/21 did so during an apnea or hypopnea. Frequency of Hiccups within a bout slowed progressively from wakefulness through the stages of SWS to REMS. For the whole group, mean frequency decreased significantly from wakefulness [(25.6 +/- 12.1), (mean +/- SD)] to sleep onset or stage I (22.3 +/- 12.2). Sleep latency was increased from 8 +/- 16.3 minutes when Hiccups were absent to 16.35 +/- 19.9 minutes when it was present. Sleep efficiency was poor because of long waking periods, and there were deficiencies of both SWS and REMS. Hiccups themselves were not responsible for any arousals or awakenings. We conclude that neural mechanisms responsible for Hiccups are strongly influenced by sleep state and that Hiccups disrupt sleep onset but not established sleep.
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baclofen therapy for chronic Hiccup
European Respiratory Journal, 1995Co-Authors: C Guelaud, William A Whitelaw, Thomas Similowski, J L Bizec, J Cabane, Jeanphilippe DerenneAbstract:Chronic Hiccup is a rare but potentially severe condition, that can be symptomatic of a variety of diseases, or idiopathic. Many therapeutic interventions have been reported, most often as case reports. Among other drugs, baclofen has been suggested as a therapy for chronic Hiccup. In a large series of patients, we have evaluated its therapeutic position. In patients with chronic Hiccup, defined as Hiccup spell or recurring Hiccup attacks lasting more than 7 days, investigation of the upper gastro-oesophageal tract (fibroscopy, manometry, and pH monitoring) was systematically performed. Most patients had tried numerous drugs in the past, without success. Baclofen was used as a first treatment in patients without evidence of any gastro-oesophageal disease (n = 17), and was undertaken only after full treatment of such disease (n = 55) had failed to solve the Hiccup problem (n = 20). Baclofen has, therefore, been administered to 37 patients with chronic Hiccup (average duration 4.6 yrs). Baclofen produced a long-term complete resolution (18 cases) or a considerable decrease (10 cases) of Hiccups in 28 of the 37 patients. There was no significant difference between patients with or without gastro-oesophageal disease. We conclude that so-called idiopathic chronic Hiccup often results from gastro-oesophageal abnormalities. Also, if controlled studies confirm our encouraging results, baclofen can be a major element in the treatment of chronic Hiccup that is idiopathic, or that cannot be helped by treatment of gastro-oesophageal diseases.
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Hiccup in adults an overview
European Respiratory Journal, 1993Co-Authors: S Launois, J Cabane, J L Bizec, W A Whitelaw, Jeanphilippe DerenneAbstract:Hiccup is a forceful, involuntary inspiration commonly experienced by fetuses, children and adults. Its purpose is unknown and its pathophysiology still poorly understood. Short Hiccup bouts are mostly associated with gastric distention or alcohol intake, resolve spontaneously or with simple folk remedies and do not require medical attention. In contrast, prolonged Hiccup is a rare but disabling condition which can induce depression, weight loss and sleep deprivation. A wide variety of pathological conditions can cause chronic Hiccup: myocardial infarction, brain tumour, renal failure, prostate cancer, abdominal surgery etc. Detailed medical history and physical examinations will often guide diagnostic investigations (abdominal ultrasound, chest or brain CT scan...). Gastric and duodenal ulcers, gastritis, oesophageal reflux and oesophagitis are commonly observed in chronic Hiccup patients and upper gastrointestinal investigations (endoscopy, pH monitoring and manometry) should be included in the diagnostic evaluation systematically. Etiological treatment is not always available and chronic Hiccup treatment has classically relied on metoclopramide and chlorpromazine. Recently, baclofen (LIORESAL) has emerged as a safe and often effective treatment.
William A Whitelaw - One of the best experts on this subject based on the ideXlab platform.
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linkage of Hiccup with heartbeat
Journal of Applied Physiology, 2000Co-Authors: B Y Chen, K Vasilakos, Daniela Boisteanu, L Garma, Jeanphilippe Derenne, William A WhitelawAbstract:We explored a possible link between the cardiac cycle and the timing of recurrent Hiccups in 10 patients with chronic, intractable Hiccups. Recordings made during daytime naps in a sleep laboratory included sleep state; electrocardiogram; and respiration by means of a thermistor to detect airflow, bands around the rib cage and abdomen to assess expansion, and a bipolar surface electrode electromyogram over parasternal intercostal muscles. Hiccups could be detected on the abdominal bands and the parasternal electromyogram. The time of occurrence of each Hiccup and each R wave in a continuous tracing of 100 or more Hiccups were recorded and analyzed together with semiquantitive estimates of the phase of Hiccup respiration. Whereas the Hiccup rate ranged from approximately one-third to one-eighth of heart rate and was more variable than heart rate, Hiccups showed a tendency, stronger in some subjects than others, to occur in midsystole. Variation in R-wave-R-wave (R-R) interval in association with Hiccups was found in five patients. In three of these patients, Hiccups were synchronized with respiration so that the cyclic change in R-R interval postHiccup could be explained as sinus arrhythmia, but, in two patients, the Hiccups were not synchronized with respiration, so that Hiccups are most likely responsible for the variation in heart rate. Also, the variation of R-R interval with Hiccups suggests that there is some phasic autonomic efferent activity associated with Hiccups.
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Chronic Hiccups and sleep.
Sleep, 1996Co-Authors: Isabelle Arnulf, William A Whitelaw, Daniella Boisteanu, Jean Cabane, Lucile Garma, Jeanphilippe DerenneAbstract:: To explore the effect of sleep on Hiccups, we studied eight patients aged 20-81 years, all males with chronic Hiccups lasting 7 days to 7 years, by means of overnight polysomnography. The incidence of new bouts of Hiccups and the likelihood of Hiccups being present were both highest in wakefulness and became progressively lower through stages I-IV of slow wave sleep (SWS) to rapid eye movement sleep (REMS). There was a significant tendency for Hiccups to disappear at sleep onset and REMS onset. Of all 21 bouts of Hiccups that were observed to stop, 10/21 did so during an apnea or hypopnea. Frequency of Hiccups within a bout slowed progressively from wakefulness through the stages of SWS to REMS. For the whole group, mean frequency decreased significantly from wakefulness [(25.6 +/- 12.1), (mean +/- SD)] to sleep onset or stage I (22.3 +/- 12.2). Sleep latency was increased from 8 +/- 16.3 minutes when Hiccups were absent to 16.35 +/- 19.9 minutes when it was present. Sleep efficiency was poor because of long waking periods, and there were deficiencies of both SWS and REMS. Hiccups themselves were not responsible for any arousals or awakenings. We conclude that neural mechanisms responsible for Hiccups are strongly influenced by sleep state and that Hiccups disrupt sleep onset but not established sleep.
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baclofen therapy for chronic Hiccup
European Respiratory Journal, 1995Co-Authors: C Guelaud, William A Whitelaw, Thomas Similowski, J L Bizec, J Cabane, Jeanphilippe DerenneAbstract:Chronic Hiccup is a rare but potentially severe condition, that can be symptomatic of a variety of diseases, or idiopathic. Many therapeutic interventions have been reported, most often as case reports. Among other drugs, baclofen has been suggested as a therapy for chronic Hiccup. In a large series of patients, we have evaluated its therapeutic position. In patients with chronic Hiccup, defined as Hiccup spell or recurring Hiccup attacks lasting more than 7 days, investigation of the upper gastro-oesophageal tract (fibroscopy, manometry, and pH monitoring) was systematically performed. Most patients had tried numerous drugs in the past, without success. Baclofen was used as a first treatment in patients without evidence of any gastro-oesophageal disease (n = 17), and was undertaken only after full treatment of such disease (n = 55) had failed to solve the Hiccup problem (n = 20). Baclofen has, therefore, been administered to 37 patients with chronic Hiccup (average duration 4.6 yrs). Baclofen produced a long-term complete resolution (18 cases) or a considerable decrease (10 cases) of Hiccups in 28 of the 37 patients. There was no significant difference between patients with or without gastro-oesophageal disease. We conclude that so-called idiopathic chronic Hiccup often results from gastro-oesophageal abnormalities. Also, if controlled studies confirm our encouraging results, baclofen can be a major element in the treatment of chronic Hiccup that is idiopathic, or that cannot be helped by treatment of gastro-oesophageal diseases.
In Gyu Hwang - One of the best experts on this subject based on the ideXlab platform.
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antiemetic corticosteroid rotation from dexamethasone to methylprednisolone to prevent dexamethasone induced Hiccup in cancer patients treated with chemotherapy a randomized single blind crossover phase iii trial
Oncologist, 2017Co-Authors: Se Il Go, Sung Yong Oh, Seong Yoon Yi, Jun Ho Ji, Eduardo Bruera, Haa Na Song, Joung Soon Jang, Lee Chun Park, Byeong Bae Park, In Gyu HwangAbstract:BACKGROUND: To assess whether the rotation of dexamethasone to methylprednisolone decreases the intensity of dexamethasone-induced Hiccup (DIH) in cancer patients treated with chemotherapy. MATERIALS AND METHODS: Adult patients who experienced DIH within 3 days after the administration of dexamethasone as an antiemetic were screened. Eligible patients were randomly assigned to receive dexamethasone (n = 33) or methylprednisolone (n = 32) as an antiemetic (randomization phase). In the next cycle of chemotherapy, the dexamethasone group received methylprednisolone and vice versa in the methylprednisolone group (crossover phase). The primary endpoint was the difference in Hiccup intensity as measured using the numeric rating scale (NRS) between two groups. RESULTS: No female patients were enrolled, although the study did not exclude them. At the randomization phase, Hiccup frequency was 28/33 (84.8%) in the dexamethasone group versus 20/32 (62.5%) in the methylprednisolone group (p = .04). Intensity of Hiccup was significantly higher in the dexamethasone group than that in the methylprednisolone group (mean NRS, 3.5 vs. 1.4, p < .001). At the crossover phase, Hiccup intensity was further decreased after the rotation of dexamethasone to methylprednisolone in the dexamethasone group (mean NRS, 3.5 to 0.9, p < .001), while it was increased by rotating methylprednisolone to dexamethasone in the methylprednisolone group (mean NRS, 1.4 to 3.3, p = .025). There were no differences in emesis intensity between the two groups at either the randomization or crossover phases. Clinicaltrials.gov identifier: NCT01974024. CONCLUSION: Dexamethasone-induced Hiccup is a male-predominant phenomenon that can be ameliorated by rotating dexamethasone to methylprednisolone without compromising the antiemetic efficacy. IMPLICATIONS FOR PRACTICE: In this randomized, multicenter, phase III trial, Hiccup intensity was significantly lower when the antiemetic corticosteroid was rotated from dexamethasone to methylprednisolone without a change in emesis intensity than that when dexamethasone was maintained. At the crossover phase, Hiccup intensity was increased again if dexamethasone was readministered instead of methylprednisolone. The present study demonstrated that dexamethasone-induced Hiccup can be improved by rotating from dexamethasone to methylprednisolone without compromising its antiemetic efficacy.
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treatment of dexamethasone induced Hiccup in chemotherapy patients by methylprednisolone rotation
Oncologist, 2013Co-Authors: Sung Yong Oh, Myounghee Kang, Jung Hun Kang, Se Hoon Park, In Gyu Hwang, Seong Yoon Yi, Young Jin Choi, Jun Ho Ji, Eduardo BrueraAbstract:: Dexamethasone-induced Hiccup (DIH) is an underrecognized symptom in patients with cancer, and little information is available about its treatment. The aims of this study were to investigate the feasibility of methylprednisolone rotation as treatment and to confirm the male predominance among those with cancer who experienced DIH during chemotherapy. Methods. Persons with cancer who experienced Hiccups during chemotherapy treatment and who were receiving treatment with dexamethasone were presumed to have DIH. The following algorithmic practice was implemented for antiemetic corticosteroid use: rotation from dexamethasone to methylprednisolone in the next cycle and dexamethasone re-administration in the second cycle of chemotherapy after recognition of Hiccups to confirm DIH. All other antiemetics except corticosteroid remained unchanged. Patients (n = 40) were recruited from eight cancer centers in Korea from September 2012 to April 2013. Data were collected retrospectively. Results. Hiccup intensity (numeric rating scale [NRS]: 5.38 vs. 0.53) and duration (68.44 minutes vs. 1.79 minutes) were significantly decreased after rotation to methylprednisolone, while intensity of emesis was not increased (NRS: 2.63 vs. 2.08). Median dose of dexamethasone and methylprednisolone were 10 mg and 50 mg, respectively. Thirty-four (85%) of 40 patients showed complete resolution of Hiccups after methylprednisolone rotation in the next cycle. Of these 34 patients, 25 (73.5%) had recurrence of Hiccups after dexamethasone re-administration. Compared with baseline values, Hiccup intensity (NRS: 5.24 vs. 2.44) and duration (66.43 minutes vs. 22.00 minutes) were significantly attenuated after dexamethasone re-administration. Of the 40 eligible patients, 38 (95%) were male. Conclusion. DIH during chemotherapy could be controlled without losing antiemetic potential by replacing dexamethasone with methylprednisolone. We also identified a male predominance of DIH. Further prospective studies are warranted.
Sung Yong Oh - One of the best experts on this subject based on the ideXlab platform.
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antiemetic corticosteroid rotation from dexamethasone to methylprednisolone to prevent dexamethasone induced Hiccup in cancer patients treated with chemotherapy a randomized single blind crossover phase iii trial
Oncologist, 2017Co-Authors: Se Il Go, Sung Yong Oh, Seong Yoon Yi, Jun Ho Ji, Eduardo Bruera, Haa Na Song, Joung Soon Jang, Lee Chun Park, Byeong Bae Park, In Gyu HwangAbstract:BACKGROUND: To assess whether the rotation of dexamethasone to methylprednisolone decreases the intensity of dexamethasone-induced Hiccup (DIH) in cancer patients treated with chemotherapy. MATERIALS AND METHODS: Adult patients who experienced DIH within 3 days after the administration of dexamethasone as an antiemetic were screened. Eligible patients were randomly assigned to receive dexamethasone (n = 33) or methylprednisolone (n = 32) as an antiemetic (randomization phase). In the next cycle of chemotherapy, the dexamethasone group received methylprednisolone and vice versa in the methylprednisolone group (crossover phase). The primary endpoint was the difference in Hiccup intensity as measured using the numeric rating scale (NRS) between two groups. RESULTS: No female patients were enrolled, although the study did not exclude them. At the randomization phase, Hiccup frequency was 28/33 (84.8%) in the dexamethasone group versus 20/32 (62.5%) in the methylprednisolone group (p = .04). Intensity of Hiccup was significantly higher in the dexamethasone group than that in the methylprednisolone group (mean NRS, 3.5 vs. 1.4, p < .001). At the crossover phase, Hiccup intensity was further decreased after the rotation of dexamethasone to methylprednisolone in the dexamethasone group (mean NRS, 3.5 to 0.9, p < .001), while it was increased by rotating methylprednisolone to dexamethasone in the methylprednisolone group (mean NRS, 1.4 to 3.3, p = .025). There were no differences in emesis intensity between the two groups at either the randomization or crossover phases. Clinicaltrials.gov identifier: NCT01974024. CONCLUSION: Dexamethasone-induced Hiccup is a male-predominant phenomenon that can be ameliorated by rotating dexamethasone to methylprednisolone without compromising the antiemetic efficacy. IMPLICATIONS FOR PRACTICE: In this randomized, multicenter, phase III trial, Hiccup intensity was significantly lower when the antiemetic corticosteroid was rotated from dexamethasone to methylprednisolone without a change in emesis intensity than that when dexamethasone was maintained. At the crossover phase, Hiccup intensity was increased again if dexamethasone was readministered instead of methylprednisolone. The present study demonstrated that dexamethasone-induced Hiccup can be improved by rotating from dexamethasone to methylprednisolone without compromising its antiemetic efficacy.
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treatment of dexamethasone induced Hiccup in chemotherapy patients by methylprednisolone rotation
Oncologist, 2013Co-Authors: Sung Yong Oh, Myounghee Kang, Jung Hun Kang, Se Hoon Park, In Gyu Hwang, Seong Yoon Yi, Young Jin Choi, Jun Ho Ji, Eduardo BrueraAbstract:: Dexamethasone-induced Hiccup (DIH) is an underrecognized symptom in patients with cancer, and little information is available about its treatment. The aims of this study were to investigate the feasibility of methylprednisolone rotation as treatment and to confirm the male predominance among those with cancer who experienced DIH during chemotherapy. Methods. Persons with cancer who experienced Hiccups during chemotherapy treatment and who were receiving treatment with dexamethasone were presumed to have DIH. The following algorithmic practice was implemented for antiemetic corticosteroid use: rotation from dexamethasone to methylprednisolone in the next cycle and dexamethasone re-administration in the second cycle of chemotherapy after recognition of Hiccups to confirm DIH. All other antiemetics except corticosteroid remained unchanged. Patients (n = 40) were recruited from eight cancer centers in Korea from September 2012 to April 2013. Data were collected retrospectively. Results. Hiccup intensity (numeric rating scale [NRS]: 5.38 vs. 0.53) and duration (68.44 minutes vs. 1.79 minutes) were significantly decreased after rotation to methylprednisolone, while intensity of emesis was not increased (NRS: 2.63 vs. 2.08). Median dose of dexamethasone and methylprednisolone were 10 mg and 50 mg, respectively. Thirty-four (85%) of 40 patients showed complete resolution of Hiccups after methylprednisolone rotation in the next cycle. Of these 34 patients, 25 (73.5%) had recurrence of Hiccups after dexamethasone re-administration. Compared with baseline values, Hiccup intensity (NRS: 5.24 vs. 2.44) and duration (66.43 minutes vs. 22.00 minutes) were significantly attenuated after dexamethasone re-administration. Of the 40 eligible patients, 38 (95%) were male. Conclusion. DIH during chemotherapy could be controlled without losing antiemetic potential by replacing dexamethasone with methylprednisolone. We also identified a male predominance of DIH. Further prospective studies are warranted.