The Brompton cocktail is a mixture containing morphine and cocaine in a vehicle of alcohol, syrup and chloroform water.
The first record of the combined use of morphine and cocaine appeared in the British Medical Journal in 1896. The first time that the composition of a morphine-cocaine elixir was published in the formulary of the Royal Brompton Hospital in London in 1952.
In this, it was called Haustus E
- Morphine hydrochloride: 1/4 grain (15 mg)
- Cocaine hydrochloride: 1/6 grain (10 mg)
- Alcohol 90%: 30 minims (2 ml)
- Syrup: 60 minims, (4 ml)
- Chloroform water: 1/2 half fl. oz. (15 ml)
This was a modification of the earlier formulation that contained gin and honey instead of alcohol and syrup.
The original inclusion of cocaine was said to counter the sedative effects of morphine and to enhance the patient’s mood and promote sociability. However, two careful studies conducted by Twycross et al at St. Christopher’s Hospice in the 1970s did not demonstrate any benefit for the inclusion of cocaine. The addition of cocaine hampers the doctor’s ability to adjust and titrate the dose of morphine and some patients, usually the frail or elderly, can become restless, agitated and confused on mixtures containing cocaine.
A considerable number of variations on the Brompton Cocktail have been advocated. In Britain, diamorphine (heroin) frequently replaced morphine. Other stimulants (e.g. dextroamphetamine, methylphenidate) have replaced the cocaine. Some recipes included chlorpromazine. The alcohol content was also varied in an attempt to mask the bitter taste and whisky, sherry or brandy were used.
The Brompton Cocktail has been replaced by a simple morphine or diamorphine solution. The addition of cocaine and/or chlorpromazine made titration of the opioid dose difficult. The studies at St. Christopher’s showed that cocaine probably added nothing to the analgesic properties and had the potential to cause significant adverse effects.
Twycross RG and Lack SA. Symptom control in far advanced cancer: Pain relief. Pitman, 1983. (p. 200)