The hiccup (Latin singultus) is an involuntary periodic contraction of
the diaphragm followed by glottic closure, which can be a rare side effect of
aripiprazole. In contrast to the structurally closely related aripiprazole,
brexpiprazole was not associated with this particular adverse drug reaction.
Having two very similar drugs that differ in their ability to induce hiccups
represents a unique opportunity to gain insight into the receptors involved in
the pathophysiology of the symptom and differences in clinical effects between
aripiprazole and brexpiprazole. The overlap between maneuvers used to terminate
paroxysmal supraventricular tachycardia and those employed to terminate bouts of
hiccups suggests that activation of efferent vagal fibers can be therapeutic in
both instances. Recent work seems to support a pivotal role for serotonin
receptors in such vagal activation. It is unlikely that a unique receptor-drug
interaction could explain the different effects of the examined drugs on hiccup.
The different effect is most likely the consequence of several smaller effects at
more than one receptor. Brexpiprazole is a highly affine (potent)
