Meeting abstract

https://doi.org/10.24869/spsih.2026.278

Development of Persistent Hiccups Following Clonazepam Initiation – A Case Report

Julija Erceg ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia *
Ana Čikara ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Kristina Divić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
Ivan Mustapić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Marina Mustapić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
Tonći Mastelić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia; Department of Psychological Medicine, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
Trpimir Glavina ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia

* Corresponding author.

Abstract

We present the case of an 18‑year‑old patient in
psychiatric treatment due to emotional difficulties,
social withdrawal, and obsessive–compulsive
symptoms. Psychomotor development was
normal, with no family history of psychiatric
disorders. The patient had previously been treated
with fluvoxamine, with partial improvement,
but due to symptom worsening, a gradual switch
to venlafaxine was planned. As part of the medication
change, clonazepam was introduced at a
dose of 0.5 mg three times daily for short‑term
anxiolysis. On the very first day of use, persistent
hiccups appeared, present continuously during
both day and night. At the time of contacting the
psychiatrist, the symptoms had lasted approximately 36 hours, and venlafaxine treatment
had not yet been started. After discontinuation
of clonazepam, the hiccups completely resolved
within three days. The mechanism of hiccup onset
during clonazepam use is not fully understood.
It is assumed that increased GABAergic activity
may, through inhibition of interneurons that tonically
suppress the brainstem neuronal network
responsible for generating the hiccup reflex, paradoxically
disinhibit this reflex. An additional possible
peripheral mechanism involves relaxation of
the lower esophageal sphincter, which can promote
gastroesophageal reflux as a known trigger
of hiccups. Benzodiazepines have been described
in some case reports as a treatment for persistent
and refractory hiccups, but have also rarely been
reported as a trigger, suggesting a complex and
still insufficiently clarified role of GABAergic
modulation in the regulation of the hiccup reflex.
This case highlights the importance of recognizing
atypical side effects of benzodiazepines and
the individual variability of responses to GABAergic
modulation in clinical practice.

Keywords

hiccups; clonazepam; benzodiazepines; side effect

Hrčak ID:

352964

URI

https://hrcak.srce.hr/352964

Publication date:

15.6.2026.

Article data in other languages: croatian

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