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If you’ve ever taken prescription medications, there is a good chance that you’ve seen warning labels advising not to mix with alcohol. But what about illicit drugs or over-the-counter medications? 

Mixing any drug or medication with alcohol is dangerous. Certain mixtures can lead to: 

  • Irreversible changes in brain chemistry
  • Negative mental health effects
  • Severe health complications
  • Legal issues
  • Financial issues
  • Risk of injuries
  • Overdosing and potentially death 

Alcohol and Substance Abuse: Common Drug Interactions

While not all mixtures will have fatal results, there is an inherent risk in combining any type of drug with alcohol. There are different results that develop based on how the substances interact. 

Each type of drug interacts differently with alcohol, and it is important to understand the potential effects of each combination.  

Illegal Drugs (Illicit Drugs)

There are many different types of illegal drugs, most of which are Schedule I Controlled Substances. Cannabinoids are perhaps the most ubiquitous, although they are not illegal everywhere (with legality increasing in the United States and elsewhere in the world). These are smoked or ingested to create a relaxed state, though this can sometimes bring on anxiety and paranoia.

Opioids and stimulants are Schedule II-IV Controlled substances. The majority of these drugs are legal under doctor supervision and prescription, but illegal on the street. They can be injected, smoked, swallowed, or snorted to create a sense of euphoria, drowsiness, and often serious impairment.

Lastly, “club drugs,” hallucinogens, and dissociative drugs are Schedule I-IV substances that can be swallowed, snorted, or injected. Substances in this subcategory can create extreme effects, from hallucinogenic and out of body experiences to lowered inhibition and severe sedation.

Below are some common interactions and risks associated with some of these drugs when they are mixed with alcohol.

Cocaine and Alcohol

When taken together, alcohol and cocaine mix to form a different substance called cocaethylene. This substance is more problematic to the body, particularly the liver. It also causes dehydration more readily than either alcohol or cocaine ingestion on their own, causing further issues such as heat stroke or bad “comedowns.”

Heroin and Alcohol

Both heroin and alcohol are depressants, leading to a more pronounced and often overwhelming intoxication when combined. 

Heroin, which is already one of the most addictive known substances, can be elevated as a dependent drug when mixed with alcohol. In addition, the likelihood of a fatal heroin overdose is more common when sedatives or other depressants, such as alcohol, are present in the bloodstream.

Methamphetamine and Alcohol 

When taking methamphetamines and alcohol together it can lead to negative changes in mood, raised heart rate, and severely impaired physiological abilities. Mixing these substances can also alter levels of certain neurotransmitters in the brain, affecting signals in the brain that help regulate critical functions.

Ecstasy/Molly and Alcohol

Ecstasy, which in recent years has shifted to become MDMA or “Molly,” is one of the most used party drugs in the world. When taken with alcohol, however, problems arise as both substances are metabolized by the liver. 

Alcohol, which is trying to be processed by the liver at the same time, can slow the removal of MDMA, leading to potential adverse effects such as confusion, muscle spasms, raised heart rate, and high blood pressure.

Prescription Drugs

Prescription drugs, as their name suggests, need to be prescribed by a doctor.

They are regulated by the FDA and there has been a growing problem with abuse of these legal drugs, from people using medication that was not prescribed for them to illegally obtaining these drugs without a prescription from street dealers. 

Whether or not they are obtained legally, many of these drugs have serious and problematic interactions with alcohol, even in small amounts.

Below are some of the effects when common prescription medications are mixed with alcohol.

Xanax and Alcohol

Since both Xanax and alcohol are depressants with sedative effects, especially in higher doses, when taken together they can cause fatigue, drowsiness, and a loss of muscle control, coordination, and balance.

Mixing these substances can also lead to: 

  • Mood and behavioral effects
  • Memory impairments
  • Physical side effects, such as headaches, low blood pressure, blurred vision
  • Gastrointestinal symptoms like nausea, vomiting, and diarrhea.
Opioids and Alcohol 

Combining alcohol with opioids can be extremely dangerous. On top of more common symptoms, such as nausea, vomiting, and low blood pressure, mixing these substances can lead to: 

  • Changes in heart rate
  • Dizziness
  • Loss of coordination
  • Loss of consciousness
  • Coma and even death
Benzodiazepines and Alcohol 

According to drug labels on all benzodiazepines, none of them should be mixed with alcohol (including Xanax). Combining these can lead to cognitive reduction and mental health disorders. It can also lead to developing a physical dependence on one or both substances.

Sleeping Pills and Alcohol

Mixing sleeping pills with alcohol can cause issues, such as: 

  • Excessive drowsiness
  • Disorientation
  • Memory problems
  • Slow reaction times
  • Low blood pressure
  • Changes in behavior

This is not only true of prescription sleeping pills, but also over-the-counter sleep-aids and herbal supplements, which can all have these effects when mixed with alcohol.

Antidepressants and Alcohol

Consuming alcohol while taking antidepressants is problematic because alcohol has the potential to further deepen depression, and can also cause unwanted side effects. Some side effects include drowsiness, dizziness, and decreased coordination.

Over-The-Counter Medications

Many people use over-the-counter (OTC) medications. A doctor's prescription is not required for these medications. Most of them can also be found in pharmacy aisles in addition to behind the pharmacist counter. They are generally considered safer than illicit drugs and are regulated by the FDA.

Some common examples of OTCs include:

  • Dramamine — motion sickness
  • NSAIDS (acetaminophen, ibuprofen, salicylic acid) — non-steroidal anti-inflammatory drugs
  • Loratadine — seasonal allergy medication
  • Bismuth subsalicylate — upset stomach
  • Hydroxycut — weight loss pills

Mixing OTCs with alcohol is often seen as less problematic than mixing other drugs with alcohol. However, that does not mean risks are absent. 

Depending on the amount of medication ingested and the amount of alcohol consumed, there could be serious consequences, including heart complications and death. There is enough medicine in a bottle of ibuprofen or acetaminophen, drugs often seen as harmless, to seriously harm adults. The risks increase when alcohol is added to the mix. 

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Bujarski, S., Roche, D. J., Lunny, K., Moallem, N. R., Courtney, K. E., Allen, V., Hartwell, E., Leventhal, A., Rohrbaugh, T., & Ray, L. A. (2014). The relationship between methamphetamine and alcohol use in a community sample of methamphetamine users. Drug and alcohol dependence, 142, 127–132. https://doi.org/10.1016/j.drugalcdep.2014.06.004

Anglin MD, Almog IJ, Fisher DG, Peters KR. Alcohol use by heroin addicts: evidence for an inverse relationship. A study of methadone maintenance and drug-free treatment samples. Am J Drug Alcohol Abuse. 1989;15(2):191-207. doi:10.3109/00952998909092720, https://pubmed.ncbi.nlm.nih.gov/2729226/

Food and Drug Administration (2017). Prescription Drugs and Over-the-Counter (OTC) Drugs: Questions and Answers. FDA https://www.fda.gov/drugs/questions-answers/prescription-drugs-and-over-counter-otc-drugs-questions-and-answers

National Institute of Alcohol Addiction and Alcoholism (2020). Harmful Interactions. NIAAA https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines

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