Brompton cocktail
Encyclopedia
Brompton cocktail, sometimes called a Brompton mixture, is an elixir
meant for use as a pain suppressant, and dosed for prophylaxis. Made from morphine
or diacetylmorphine (heroin), cocaine
, highly-pure ethyl alcohol
(some recipes specify gin), and sometimes with chlorpromazine (Thorazine)
to counteract nausea, it was given to terminally-ill
individuals (especially cancer
patients) to relieve pain
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."1
The Brompton cocktail is named after the Royal Brompton Hospital
in London
, England
, where it was invented in the late 1920s for patients with tuberculosis
. While its use is rare in the 21st century, it is not unheard of. It was far more common in the late 19th and early 20th centuries. The original idea for an oral mixture of morphine and cocaine helping patients in agony with advanced disease is credited to surgeon Dr Herbert Snow in 1896.
While each of the ingredients combat pain and other problems that occur with it in those who may be nauseous from effects of chemotherapy, radiation, and/or high and escalating doses of morphine (which can also cause somnolence or sleepiness, hence the stimulant), it is also generally 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 well-known and widely 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 the somnolence from the painkillers and to boost their pain-killing ability. However, a 1979 study in the Canadian Medical Association Journal found no statistically significant advantage in pain suppression, confusion, nausea, or drowsiness to the Brompton mixture versus a solution of morphine.2
Some specifications for variants of Brompton Mixture call for methadone
, hydromorphone
, diamorphine (heroin), or other strong opioids in the place of morphine; diphenhydramine
or tincture
of cannabis
in place of the chlorpromazine; and/or methamphetamine
, amphetamine
, dextroamphetamine
, co-phenylcaine, methylphenidate
or other stimulants in the place of cocaine. The original recipe for Brompton Mixture also calls for chloroform, cherry syrup to help mask the bitter taste of some of the components, and distilled water in some quantity as a dilutant for the chloroform (hence, chloroform water) and/or to add volume to allow for more precise titration of doses.
band Avenged Sevenfold
released a song titled "Brompton Cocktail" on the album Avenged Sevenfold
Elixir
An elixir is a clear, sweet-flavored liquid used for medicinal purposes, to be taken orally and intended to cure one's ills. When used as a pharmaceutical preparation, an elixir contains at least one active ingredient designed to be taken orally....
meant for use as a pain suppressant, and dosed for prophylaxis. Made from morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
or diacetylmorphine (heroin), cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, highly-pure ethyl alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
(some recipes specify gin), and sometimes with chlorpromazine (Thorazine)
Chlorpromazine
Chlorpromazine is a typical antipsychotic...
to counteract nausea, it was given to terminally-ill
Terminal illness
Terminal illness is a medical term popularized in the 20th century to describe a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time. This term is more commonly used for progressive diseases such as...
individuals (especially cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
patients) to relieve pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
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."1
The Brompton cocktail is named after the Royal Brompton Hospital
Royal Brompton Hospital
Royal Brompton Hospital is the largest specialist heart and lung centre in the United Kingdom .The hospital is part of Royal Brompton & Harefield NHS Foundation Trust is a national and international specialist heart and lung centre based in Chelsea, London and Harefield, Middlesex...
in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
, where it was invented in the late 1920s for patients with tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
. While its use is rare in the 21st century, it is not unheard of. It was far more common in the late 19th and early 20th centuries. The original idea for an oral mixture of morphine and cocaine helping patients in agony with advanced disease is credited to surgeon Dr Herbert Snow in 1896.
While each of the ingredients combat pain and other problems that occur with it in those who may be nauseous from effects of chemotherapy, radiation, and/or high and escalating doses of morphine (which can also cause somnolence or sleepiness, hence the stimulant), it is also generally 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 well-known and widely 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 the somnolence from the painkillers and to boost their pain-killing ability. However, a 1979 study in the Canadian Medical Association Journal found no statistically significant advantage in pain suppression, confusion, nausea, or drowsiness to the Brompton mixture versus a solution of morphine.2
Some specifications for variants of Brompton Mixture call for methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...
, hydromorphone
Hydromorphone
Hydromorphone, a more common synonym for dihydromorphinone, commonly a hydrochloride is a very potent centrally-acting analgesic drug of the opioid class. It is a derivative of morphine, to be specific, a hydrogenated ketone thereof and, therefore, a semi-synthetic drug...
, diamorphine (heroin), or other strong opioids in the place of morphine; diphenhydramine
Diphenhydramine
Diphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
or tincture
Tincture
A tincture is an alcoholic extract or solution of a non-volatile substance . To qualify as a tincture, the alcoholic extract is to have an ethanol percentage of at least 40-60%...
of cannabis
Cannabis
Cannabis is a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. These three taxa are indigenous to Central Asia, and South Asia. Cannabis has long been used for fibre , for seed and seed oils, for medicinal purposes, and as a...
in place of the chlorpromazine; and/or methamphetamine
Methamphetamine
Methamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
, amphetamine
Amphetamine
Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
, dextroamphetamine
Dextroamphetamine
Dextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus as well as decreased fatigue and decreased appetite....
, co-phenylcaine, methylphenidate
Methylphenidate
Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...
or other stimulants in the place of cocaine. The original recipe for Brompton Mixture also calls for chloroform, cherry syrup to help mask the bitter taste of some of the components, and distilled water in some quantity as a dilutant for the chloroform (hence, chloroform water) and/or to add volume to allow for more precise titration of doses.
Popular culture references
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band Avenged Sevenfold
Avenged Sevenfold
Avenged Sevenfold is an American heavy metal band from Huntington Beach, California. Formed in 1999, the group consists of vocalist M. Shadows, lead guitarist Synyster Gates, rhythm guitarist Zacky Vengeance, bassist Johnny Christ....
released a song titled "Brompton Cocktail" on the album Avenged Sevenfold
Avenged Sevenfold (album)
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