Morphine Chlorobutanol

DeChristoforo R, Corden BJ, Hood JC, et al. High-dose morphine infusion complicated by chlorobutanol-induced somnolence. Ann Intern Med 1983 98 335-336. 

Chlorobutanol used as a preservative may possibfy contribute to the QT prolongation seen with methadone. Higher maximum total bilirubin levels were observed among newborns exposed to morphine that contained chlorobutanol than those exposed to morphine without chlorobutanol. Somnolence in a patient on high-dose morphine may have been due to the effects of morphine and also to a high intake of chlorobutanol preservative. 

A report describes a 19-year-old woman who required increasing doses of morphine to control pain, reaching a peak of 275 mg/hour, which was maintained for 4 days. After palliative radiotherapy the rate was reduced to 100 to 150 mg/hour, but only partial pain relief was achieved however the patient was somnolent, which was attributed to an effect of the chlorobutol. At doses of morphine 275 mg/hour, chlorobutanol intake was 90 mg/hour, which is in excess of the dose used to aid sleep (150 mg) ... 

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