Persistent or intractable hiccups are not uncommon at the end of life, occurring in approximately 4% to 9% of patients, and can cause considerable suffering, including difficulties in eating, drinking, and speaking, insomnia, pain, fatigue, and depression. In palliative practice, the etiology of hiccups is often either unknown or untreatable, and empirical pharmacologic treatment is the norm. Unfortunately, many of the agents reported as effective for hiccups can cause undesirable sedation. The authors describe a patient with end-stage vascular dementia and a 4-year history of idiopathic intractable hiccups who responded dramatically to amantadine, a nonsedating dopamine agonist. The role of dopamine in hiccups is somewhat ambiguous and likely not central to their cause or treatment. Amantadine may be a reasonable option for patients with distressing hiccups who cannot tolerate a sedating agent.
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