Baclofen for Intractable Hiccups

Practical Dosing Approach

The American Geriatrics Society recommends starting with 5 mg of baclofen three times daily, particularly in elderly patients (≥65 years) who typically cannot tolerate doses greater than 30-40 mg per day 1
The American College of Clinical Pharmacology suggests administering doses with meals to reduce gastrointestinal side effects, and considering timing the largest dose before sleep to allow peak sedative effects to occur during rest 2

The British Journal of Pharmacology advises avoiding baclofen entirely in patients with obstructive sleep apnea, as it provokes upper airway collapse during sleep, worsens OSA, and can induce central apneas by depressing respiratory drive 3
The American Academy of Neurology recommends that dementia patients avoid baclofen due to cognitive and safety concerns 1
The American Thoracic Society suggests that patients with compromised respiratory function (COPD, asthma) require careful monitoring when taking baclofen 4
The American Society of Health-System Pharmacists recommends eliminating or minimizing concomitant CNS depressants (opioids, benzodiazepines, alcohol) due to additive sedative effects 1, 2

The American College of Clinical Pharmacology advises never discontinuing baclofen abruptly—always taper gradually to avoid potentially life-threatening withdrawal syndrome 2

The American Academy of Pediatrics notes that chlorpromazine is FDA-approved for hiccups but causes more side effects than baclofen or gabapentin during prolonged therapy 5

The American College of Chest Physicians mentions baclofen only as an experimental approach for opioid-resistant cough in lung cancer patients, noting it should be considered in N-of-1 trials when standard treatments fail 6