Brompton Cocktail

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The Brompton cocktail is a powerful mixture of painkilling drugs that was previously used to alleviate the suffering associated with terminal cancer or the intractable coughing associated with advanced tuberculosis.

Contents

Other Names

Brompton's mixture; hospice mix

How Brompton Cocktail Is Taken

Brompton cocktail is made up as an elixir for drinking.

How It Works

Almost all formulations of Brompton cocktail include morphine, cocaine, and ethanol; occasionally other ingredients have been added to lessen or prevent the pain and distress associated with terminal illness, especially advanced cancer. Morphine is a powerful analgesic (painkiller) that can cause respiratory depression and constipation. Cocaine is a stimulant that is causes constriction of the blood vessels (vasoconstriction). Ethanol is the form of alcohol in alcoholic beverages and can lead to the familiar symptoms of drunkenness. Some formulations call for chlorpromazine (Thorazine), a powerful sedative.

Variant formulations call for opioid analgesics other than morphine (such as methadone, hydromorphone, or heroin). Diphenhydramine (Benadryl), a sedating antihistamine, was sometimes used in place of the chlorpromazine. Methamphetamine, amphetamine, dextroamphetamine, or methylphenidate were sometimes used in place of cocaine.

Benefits

The benefits are entirely dependent on the active ingredients, which varied considerably between practitioners. A uniform benefit was relief of pain; however, oral morphine alone (without the cocaine or ethanol) also provides significant—and almost always adequate—analgesia. Cough suppression was another important benefit in persons with airway malignancies or tuberculosis. The stimulatory effect of cocaine combined with ethanol's disinhibitory effect were thought to allow more favorable interactions with the patient's visitors and caregivers.

Risks and Precautions

Most or all of the active ingredients in Brompton cocktail are controlled substances with addictive potential and are potentially lethal if overdosed. Persons addicted to heroin may be tempted to inject the mixture.[1]

Expected side effects include sedation, confusion, constipation, decreased breathing, tolerization, and addiction.

History

Elixirs of morphine and cocaine were first described in 1896 as treatments for the pain associated with advanced cancer by the English surgeon Herbert Snow.[2] A specific mixture was published under the auspices of the Royal Brompton Hospital in London in 1952; the ingredients included morphine hydrochloride, cocaine hydrochloride, alcohol, and chloroform water. Several different formulations calling for heroin (diacetylmorphine), marijuana, antiemetics, various alcoholic beverages, and sedatives have been promoted over the years. It was widely used in the early 1970's, mostly in hospice care. Two of its main proponents were Cicely Saunders, founder of the modern hospice movement, and Elisabeth Kübler-Ross, a psychiatrist and authority on end-of-life care.[3]The mixture was promoted as more cost effective at treating intractable cancer pain than parenteral narcotics.

Several significant liabilities (mentioned above) have contributed to the disappearance of Brompton cocktail from modern practice. In 1979, controlled trials showed that oral morphine alone gave pain relief equivalent to the cocktail, that oral morphine and oral heroin were equally effective, and that oral cocaine had no effect on patients' alertness or sociability.[4] One study concluded that "the Brompton Cocktail is no more than a traditional British way of administering oral morphine to cancer patients in pain."

In the late 60's, and early 70's, before the Brompton Cocktail had it's demise, in the UK it was made up of diamorphine, cocaine, chlorpormazine, dissolved in either gin, whisky or brandy - many pharmacies carried these in stock and the patient would be asked their preference.In addition, after the active ingredients had been added, then a generous amout of honey would be added, as a sweetener. This mixture was entirely ad-hoc - ie it did not undergo any stability testing, and the fate of the active ingredients was unknown, but it was very popular, in end of life care before the advent of more modern preparations.

The name Brompton comes from the Brompton Hospital in London UK

Interesting Facts

  • Brompton Cocktail is the name of a song by the heavy metal group Avenged Sevenfold.
  • Brompton's Cocktail was a group of musicians that disbanded in 2003; their final show was with a group known as The Benzene Ring.

References

  1. Fischbeck KH, Mata M, D'Aquisto R, Caronna JJ. Brompton mixture taken intravenously by a heroin addict. West J Med. 1980 Jul;133(1):80. Citation | PDF
  2. Clark D. From margins to centre: a review of the history of palliative care in cancer. Lancet Oncol. 2007 May;8(5):430-8. Abstract
  3. Masters NJ. Brompton cocktail. Lancet. 1979 Jul 7;2(8132):47.Citation
  4. Melzack R, Mount BM, Gordon JM. The Brompton mixture versus morphine solution given orally: effects on pain. Can Med Assoc J. 1979 Feb 17;120(4):435-8. Abstract | PDF
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