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Neurological Rehabilitation

Hiccups as a Side Effect of Amantadine in a 70-Year-Old Male with a Severe Traumatic Brain Injury: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Audrey Simpson, DO

    Resident Physician
    Geisinger Health System PM&R Program
    Danville, Pennsylvania

  • AP

    Annamarie Pontier, DO

    Resident Physician
    Geisinger Health System PM&R Program
    Danville, Pennsylvania

    • Co-Author(s)

  • SX

    Shaohua Xu, MD, PhD

    Staff Physician
    Geisinger Health System PM&R Program
    Danville, Pennsylvania

  • RR

    Ryan Roza, MD

    Program Director PM&R, Physician of Sports Medicine, Physiatrist
    Geisinger Health System PM&R Program
    Orangeville, Pennsylvania

Disclosure(s):
Audrey Simpson, DO: No financial relationships to disclose
Case Diagnosis: This case discusses hiccups as a rare side effect of amantadine hydrochloride (amantadine) being utilized to address neurochemical changes associated with traumatic brain injury (TBI).

Case Description or Program Description: A 70-year-old male presented to Geisinger Medical Center (GMC) following a motorcycle accident resulting in multicompartmental intracranial hemorrhages, cranial and facial fractures, left infraorbital hematoma, and multiple left-sided rib fractures. The patient had an initial Rancho Los Amigos Scale of 4-5, fluctuating mentation, and periods of agitation requiring 1:1, supervision and mitts after self-extubation. During his acute hospitalization, physical medicine and rehabilitation was consulted for TBI recommendations and assistance with placement to acute rehabilitation. The patient was trialed on 100mg amantadine twice a day, but developed hiccups intractable to medications, resulting in severe pain from healing rib fractures. The hiccups only resolved after amantadine discontinuation.

Setting: Acute care hospital (GMC) with admission to the trauma surgery service with multiple consultants, including Physiatry.

Assessment/Results: After administration of amantadine to improve his level of arousal, the patient developed hiccups, exacerbating his pain. The hiccups ceased only when amantadine was discontinued. Highlighting hiccups as a rare side effect of a commonly used medication in severe TBI management.

Discussion (relevance): This case report highlights hiccups as a rare but potentially significant side effect of the neurostimulant, amantadine. Hiccups can trigger severe pain from associated fractures in TBI patients, who often struggle to identify or verbalize noxious stimuli, leading to agitation and aggressive behavior. This can also contribute to missed therapy minutes during an inpatient rehabilitation admission.

Conclusions: Amantadine, a commonly used neurostimulant in severe TBI management, can lead to intractable hiccups, exacerbating pain and agitation. Clinicians should consider this rare side effect, especially in patients with fractures, to optimize pain control and rehabilitation outcomes.