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Hiccup secondary to dopamine agonists in Parkinson's Disease

This 76-year-old man with a history of arterial hypertension, acute myocardial infarction (AMI) in 1988, and hypercholesterolemia developed progressive resting tremor and bradykinesia, initially involving the left side of his body and later becoming bilateral. He was given a diagnosis of PD 7 years ago and received levodopa/benserazide (500/120 mg/day) and piribedil (150 mg/ day) divided in three doses for the last 8 months. However, because of economic reasons and issues related to his medical insurance, the patient asked if he could change piribedil for another drug. To this end, he started pramipexol (3 mg/day). Two hours after taking the first pramipexol dose, however, he developed hiccups, which persisted for 3 days and stopped after discontinuing pramipexol. He was then switched back to piribedil at a higher dose than his original prescription (200 mg/day) but once again hiccups developed. They stopped after he decreased the dose to 150 mg/day.