Flumazenil causing convulsions and ventricular tachycardia.

Dr K COWCHER, Mr E McELLIGOTT, and Dr G W HANKS (Royal Marsden Hospital, Sutton, Surrey SM2 5PT) write: Recent experience with a patient with advanced cancer and insulin dependent diabetes has brought to our attention the sugar content of Oramorph, a recently introduced formulation of oral morphine sulphate solution. Oramorph is manufactured in two strengths, 10 mg in 5 ml and 100 mg in 5 ml, and the low strength version has a taste mask containing sucrose and corn syrup; 10 ml of this solution of Oramorph contains about 3'2 g sugar (sucrose, glucose, and maltose). The concentrated solution does not contain sugar. Morphine sulphate in solution is used when patients are first starting to take oral morphine and the dose is titrated to control their pain. Initially a low strength solution is used, and in this hospital we use the 10 mg in 5 ml strength of Oramorph. Patients may take up to 20 ml every four hours and occasionally more before being prescribed a more concentrated solution. The sugar content of a total dailv dose of 120 ml is 38 4 g. This dosage may result in a small but appreciable rise in blood sugar concentration in a diabetic patient. Most patients need at some stage to change to a more concentrated solution of morphine, and neither the in house formulation used at the Royal Marsden Hospital nor the high strength Oramorph solution contain sugar. It is important that the relative sugar content of these solutions is known because a change from one to the other may affect patients with cancer who also have diabetes. We understand from the manufacturers of Oramorph that the sugar content of the solution will be clearly labelled in future.