Comparison of Efficacy of Combination Therapy with Chlorpromazine and Olanzapine with Chlorpromazine alone for Treatment of Hiccups in Traumatic Brain Injury Patients- A Randomised Control Trial

Abstract

Introduction: Chlorpromazine belongs to the category of typical antipsychotics or neuroleptics, also known as First-Generation Antipsychotics (FGAs). It is found to be effective in hiccup management by its action as dopamine antagonist in the hypothalamus. Olanzapine act as an antagonist at postsynaptic serotonergic receptors which augment phrenic motoneuronal activity and play a role in the generation of hiccups. Aim: To compare the effectiveness of combination therapy (olanzapine plus chlorpromazine) with monotherapy (chlorpromazine) in Traumatic Brain Injury (TBI) patient admitted to trauma Intensive Care Unit (ICU). Material and Methods: This randomised control trial was conducted between November 2020 to October 2021 on patients aged 18-65 years diagnosed with intracranial injury due to trauma. A total of 100 patients (50 in each group) were randomised into group 1 (patients receiving chlorpromazine 25 mg thrice daily for five days) and group 2 (patients receiving chlorpromazine 25 mg thrice daily and olanzapine 5 mg once daily for five days). The primary outcome measure was to compare cessation or reduction in the frequency of hiccups. Various laboratory parameters were investigated and compared between both the groups on day zero and day five. The secondary outcome was side-effects of the drugs. Results: In the present study, the distributions of age and gender were similar in both groups with mean age of patients being 39.16±13.88 years and 43.30±12.51 years in group 1 and 2, respectively. Cessation of hiccups were found in 29 (58%) of the patients in group 2 as compared to 27 (54%) patients in group 1, which was not statistically significant. However, improvement in the status of patients were observed in 18 (36%) in group 2, as compared to 10 (20%) in group 1 (p-value=0.02). No serious adverse events were documented in either groups. Conclusion: A better outcome was observed with combination of chlorpromazine and olanzapine than chlorpromazine alone, in treating hiccups due to TBI. The present trial has established the role of drugs for managing hiccups caused after TBI.

Keywords

• antipsychotic drugs
• intensive care
• trauma