Brompton cocktail, sometimes called Brompton mixture or Brompton's cocktail, was an

elixir ELIXIR (the European life-sciences Infrastructure for biological Information) is an initiative that will allow life science laboratories across Europe to share and store their research data as part of an organised network. Its goal is to bring t ...

meant for use as a pain suppressant dosed for

prophylaxis Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...

. Made from

morphine Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a analgesic, pain medication, and is also commonly used recreational drug, recreationally, or to make ...

diacetylmorphine Heroin, also known as diacetylmorphine and diamorphine among other names, is a potent opioid mainly used as a recreational drug for its euphoric effects. Medical grade diamorphine is used as a pure hydrochloride salt. Various white and brown ...

(heroin),

cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a central nervous system (CNS) stimulant mainly recreational drug use, used recreationally for its euphoria, euphoric effects. It is primarily obtained from t ...

, highly-pure

ethyl alcohol Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a hyd ...

(some recipes specify gin), and sometimes with

chlorpromazine Chlorpromazine (CPZ), marketed under the brand names Thorazine and Largactil among others, is an antipsychotic medication. It is primarily used to treat psychotic disorders such as schizophrenia. Other uses include the treatment of bipolar dis ...

(Thorazine) to counteract nausea, it was given to terminally-ill individuals (especially

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

patients) to relieve

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

and promote sociability near death. A common formulation included "a variable amount of morphine, 10 mg of cocaine, 2.5 mL of 98% ethyl alcohol, 5 mL of syrup BP and a variable amount of chloroform water." Brompton's cocktail was given most in the mid twentieth century. It is now considered obsolete.Brompton's Cocktail
Hospice Education Institute

History

The original idea for an oral mixture of morphine and cocaine helping patients in agony with advanced disease is credited to surgeon Herbert Snow in 1896. The Brompton cocktail is named after the

Royal Brompton Hospital Royal Brompton Hospital is the largest specialist heart and lung medical centre in the United Kingdom. It is managed by Guy's and St Thomas' NHS Foundation Trust. History Consumption in the 19th Century In the 19th century, consumption was a co ...

London London is the capital and largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary down to the North Sea, and has been a majo ...

, England, where the formulation of this mixture was standardized in the late 1920s for patients with

. While its use has been rare in the 21st century, it is not entirely unheard of today. It was far more common in the late 19th and early 20th centuries.

Variants

Some specifications for variants of Brompton cocktail call for

methadone Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid agonist used for chronic pain and also for opioid dependence. It is used to treat chronic pain, and it is also used to treat addiction to heroin ...

hydromorphone Hydromorphone, also known as dihydromorphinone, and sold under the brand name Dilaudid among others, is an opioid used to treat moderate to severe pain. Typically, long-term use is only recommended for pain due to cancer. It may be used by mou ...

diamorphine Heroin, also known as diacetylmorphine and diamorphine among other names, is a potent opioid mainly used as a recreational drug for its euphoric effects. Medical grade diamorphine is used as a pure hydrochloride salt. Various white and brown ...

(heroin), or other strong

opioids Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use ...

in the place of morphine;

diphenhydramine Diphenhydramine (DPH) is an antihistamine and sedative mainly used to treat allergies, insomnia, and symptoms of the common cold. It is also less commonly used for tremor in parkinsonism, and nausea. It is taken by mouth, injected into a vein ...

tincture of cannabis Tincture of cannabis, sometimes known as green dragon, is an alcoholic cannabis concentrate. The solubility of THC in ethanol is greater than 1 g/mL. Cannabis tinctures are used in the production of specific extracts, like nabiximols. History ...

in place of the chlorpromazine; and

methamphetamine Methamphetamine (contracted from ) is a potent central nervous system (CNS) stimulant that is mainly used as a recreational drug and less commonly as a second-line treatment for attention deficit hyperactivity disorder and obesity. Methamph ...

amphetamine Amphetamine (contracted from alpha- methylphenethylamine) is a strong central nervous system (CNS) stimulant that is used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. It is also commonly used ...

dextroamphetamine Dextroamphetamine is a central nervous system (CNS) stimulant and an amphetamine enantiomer that is prescribed for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is also used as an athletic performance and ...

, co-phenylcaine (

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...

and

phenylephrine Phenylephrine is a medication primarily used as a decongestant, to dilate the pupil, to increase blood pressure, and to relieve hemorrhoids. In the United States, it was previously used orally as an over-the-counter decongestant to relieve nas ...

hydrochloride),

methylphenidate Methylphenidate, sold under the brand names Ritalin and Concerta among others, is the most widely prescribed central nervous system (CNS) stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) and, to a lesser extent, ...

, or other stimulants in the place of cocaine. The original recipe for Brompton cocktail also calls for

chloroform Chloroform, or trichloromethane, is an organic compound with chemical formula, formula Carbon, CHydrogen, HChlorine, Cl3 and a common organic solvent. It is a colorless, strong-smelling, dense liquid produced on a large scale as a precursor to ...

, cherry syrup to help mask the bitter taste of some of the components, and distilled water in some quantity to dilute the chloroform (hence, chloroform water) or to add volume to allow for more precise

titration Titration (also known as titrimetry and volumetric analysis) is a common laboratory method of quantitative chemical analysis to determine the concentration of an identified analyte (a substance to be analyzed). A reagent, termed the ''titrant'' ...

of doses.

Synergy among constituents

While each of the ingredients combats pain or other problems that occur with it in those who may be nauseated from effects of chemotherapy, radiation or high and escalating doses of morphine (which can also cause somnolence or sleepiness, necessitating the stimulant), it is also anecdotally acknowledged that the whole is greater than the sum of its parts, with the various active ingredients all potentiating the morphine or other opioid in their own ways. The synergy between opioid analgesics and centrally-acting stimulants is widely reported and commonly used: for example, the caffeine content of many codeine-based pain relievers, and prescription of dextroamphetamine or methylphenidate to patients on high doses of opioids both to combat somnolence from the painkillers and to boost their pain-killing ability.

References

External links

* * * {{cite journal , url= http://www.bmj.com/archive/7072iv1.htm, archive-url = https://web.archive.org/web/20090215173427/http://www.bmj.com/archive/7072iv1.htm , url-status = dead , archive-date = 2009-02-15 , pmid = 8991003 , pmc = 2359110 , year = 1996 , last1 = Saunders , first1 = C. , title = A personal therapeutic journey , journal = BMJ (Clinical Research Ed.) , volume = 313 , issue = 7072 , pages = 1599–601 , doi = 10.1136/bmj.313.7072.1599 Palliative care Historical polysubstance drinks

History

Variants

Synergy among constituents

See also

References

External links