AlcoholRehabHelp Logo
AlcoholRehabHelp Logo
Alcohol & Health
Helping Alcoholics
Where Does My Call Go?
Updated on October 27, 2023
10 min read

Drugs that Interact with Alcohol

If you’ve ever taken prescription drugs, you’ve seen warning labels advising you not to mix them with alcohol. But what about illegal street drugs, over-the-counter medications, and herbal supplements? 

Mixing any drug or medication with alcohol consumption is dangerous. 

Certain mixtures can lead to:

  • Irreversible changes in brain chemistry
  • Negative mental health effects
  • Severe health complications
  • Legal issues
  • Financial issues
  • Increased risk of injuries
  • Overdosing
  • Death 

Alcohol and Substance Abuse: Common Drugs and How They Interact with Alcohol

While not all mixtures are fatal, it’s risky to combine any drug with alcohol. A range of effects can occur depending on how the substances interact.

Most FDA-regulated substances interact, on some level, with alcohol. Each type interacts differently with alcohol. So, it’s essential to understand the potential effects of each drug alone and in combination with alcohol consumption.

Which Drugs Show Synergistic Effects with Alcohol?

All controlled substances have the potential to interact with alcohol, but those that fall into the lower-level classifications (except Schedule IV sedatives) tend to be more dangerous. 

The danger comes from a higher potential for abuse and addiction and more intense psychological and physical effects that alcohol can exacerbate.

In the case of Schedule I substances, the danger increases because there isn’t any form of regulation. Many street drugs contain additives like fentanyl that can increase the likelihood of overdose and unknown adverse effects in combination with alcohol.


Online Therapy Can Help

Over 3 million people use BetterHelp. Their services are:

  • Professional and effective
  • Affordable and convenient
  • Personalized and discreet
  • Easy to start
Find a Therapist

Answer a few questions to get started

online consultation

Controlled Substances in the U.S.

Currently, the FDA classifies controlled substances into five categories (Schedule I to V). It categorizes each substance based on the risk for abuse and the potential for psychological or physical dependence. 

Schedule I substances are flat-out illegal on a federal level. Schedule II through V drugs may be legal with a doctor’s prescription.

Schedule I Controlled Substances

According to U.S. law, a drug under Schedule I has the highest potential for abuse and isn’t federally legal for medical use. Street drugs and tribally-recognized medicine fall into this category.

Some of the most well-known Schedule I substances include:

  • Cannabis (marijuana)
  • Heroin
  • Lysergic Acid Diethylamide (LSD)
  • 3,4-methylenedioxymethamphetamine (MDMA, ecstasy, or molly)
  • Peyote

Many “club drugs,” hallucinogens, and dissociative drugs are Schedule I substances. All of the drugs in this category are illegal on a federal level, although some are legal on a state level. 

These drugs can be 

  • Smoked
  • Swallowed
  • Snorted
  • Injected 

They can create extreme effects, from hallucinogenic and out-of-body experiences to lowering inhibition and severe sedation.

Schedule II Controlled Substances

Most opioid pain medications and stimulants are Schedule II controlled substances, according to U.S. law. They have a high potential for creating psychological or physical dependence.

Many drugs in this classification, with a few exceptions, are legal with a medical prescription but illegal recreationally, including:

  • Methamphetamine (i.e., Desoxyn)
  • Combination medications that include less than 15 mg of hydrocodone per dosage unit (i.e., Vicodin)
  • Methadone
  • Fentanyl
  • Adderall
  • Ritalin
  • Oxycodone
  • Morphine
  • Opium
  • Cocaine

On the street, these drugs can be injected, swallowed, or snorted. They create intense psychological effects, including: 

  • A sense of euphoria
  • Drowsiness
  • Severe impairment

Schedule III Controlled Substances

The law deems Schedule III substances at moderate to low risk for creating physiological or physical dependence. 

Some common Schedule III substances include:

  • Ketamine
  • Tylenol with codeine
  • Anabolic steroids (like testosterone)

These drugs can create mood changes ranging from sedation and drowsiness to increased energy and loss of inhibition.

Schedule IV Controlled Substances

Schedule IV substances are usually less likely to create psychological or physical dependence. Some of these include:

  • Xanax
  • Valium
  • Tramadol
  • Klonopin
  • Lorazepam

Many of this category’s drugs are sedatives and extremely dangerous to mix with alcohol.

How Prescription Drugs (Schedule II to IV) Interact with Alcohol

Prescription medication (Category II, III, or IV) requires a written medical prescription from a doctor. While the FDA regulates these drugs, abuse is a growing problem and can happen in several ways.

Abuse occurs when a person with a prescription takes a drug in a way that differs from its intended medical use. Alternatively, it happens when someone without a prescription illegally obtains a medication for personal use, usually from a street dealer.

Drug interactions that are problematic and severe can occur, even after a small amount of alcohol consumption.

Below are some of the most serious alcohol and medication interactions.

Mixing Alcohol and Xanax

Both Xanax and alcohol are depressants with sedative effects. When taken together, they can cause: 

  • Fatigue
  • Drowsiness
  • Loss of muscle control, coordination, and balance
  • Mood and behavioral effects
  • Memory impairments
  • Other physical side effects, such as headaches, low blood pressure, blurry vision
  • Gastrointestinal symptoms like nausea, vomiting, and diarrhea

Mixing Xanax and alcohol is serious and potentially fatal. They both slow down the central nervous system, doubling the effect when you take them together. This can even lead to death due to:

  • Respiratory depression
  • Oxygen deprivation
  • Coma

Combining Alcohol and Opioids

Combining alcohol with opioid pain medications can be extremely dangerous. Mixing these substances can lead to: 

  • Nausea
  • Vomiting
  • Low Blood Pressure
  • Rapid heartbeat
  • Dizziness
  • Impaired motor control
  • Loss of consciousness
  • Organ and liver damage
  • Coma 
  • Death

Mixing Alcohol and Antidepressants

Consuming alcohol while taking antidepressants can cause unwanted side effects, including:

  • Drowsiness
  • Dizziness
  • Decreased coordination

Interactions aside, alcohol consumption also has the potential to deepen depression.

Combining Alcohol and Other Prescription Medications 

Drinking alcohol while on these drugs is not advised, as they can lead to dangerous interactions with alcohol:


BetterHelp can Help

They’ll connect you to an addiction and mental health counselor

Find a Therapist

Answer a few questions to get started

Better Help Logo

Recreational Street Drugs and Their Interaction With Alcohol

Generally speaking, it’s a bad idea to mix any substance that alters your mental or physical state with alcohol consumption. This is true regardless of whether a person obtains the drug legally or illegally. 

Recreational drugs often produce more significant and unpredictable changes in brain chemistry than pharmaceuticals, over-the-counter medications, or herbal supplements. 

They also don’t go through any regulatory process, making them even more dangerous because you won’t know what you’re ingesting.

Alcohol and Cocaine

When taken together, alcohol and cocaine mix to form a substance called “cocaethylene.” Cocaethylene is more problematic to the body, particularly the liver, than either drug on its own.

Aside from liver damage, mixing these drugs causes dehydration more than alcohol consumption or cocaine ingestion alone. The damages can cause further issues such as heat stroke or bad comedowns.

Alcohol and Heroin

Both heroin and alcohol are depressants. Combining two depressants causes a stronger and often overwhelming intoxication.

A fatal heroin overdose becomes more likely when a sedative or other depressant, such as alcohol, is present in the bloodstream.

Together, they interact in a way that causes the central nervous system to slow down. This can cause respiratory depression and even lead to death.

Alcohol and Methamphetamine 

Taking methamphetamine (which is a type of stimulant) and alcohol together can lead to:

  • Adverse changes in mood
  • Rapid heart rate
  • Severely impaired physiological abilities

Mixing these substances can also alter levels of certain neurotransmitters in the brain. These changes affect signals in the brain that help regulate critical functions.

Alcohol and Ecstasy/MDMA/Molly

Ecstasy, also known as MDMA or “molly,” is one of the most common party drugs in the world and can produce hazardous side effects. Additional problems arise with alcohol, as it can overburden the liver. Ingesting alcohol can slow the liver’s removal of MDMA. 

This leads to potential adverse effects such as:

  • Confusion
  • Muscle spasms
  • Elevated heart rate
  • High blood pressure
  • Liver damage

Thinking about Getting Help?

BetterHelp offers affordable mental health care via phone, video, or live-chat.

Find a Therapist

Answer a few questions to get started

Better Help Logo

How Over-The-Counter Medications Interact with Alcohol

People don’t need a doctor’s prescription to buy over-the-counter (OTC) drugs. Most of these medications can also be found in pharmacy aisles, not just behind the pharmacist counter. They’re generally considered safer than illicit drugs, and the FDA regulates them.

Some common examples of OTCs include:

  • Dramamine: Motion sickness medication
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDS like acetaminophen, ibuprofen, salicylic acid): Pain relievers
  • Loratadine: Seasonal allergy medication
  • Bismuth subsalicylate: Upset stomach and heartburn medications
  • Hydroxycut: Weight loss pills

Is It Safe to Mix OTCs with Alcohol?

Combining OTCs with alcohol use is often seen as less problematic than mixing other drugs with alcohol. However, that doesn’t mean risks are absent. 

Depending on the amount of OTC medication and alcohol consumed, there could be serious consequences, including 

  • Stomach bleeding (in the case of NSAIDS)
  • Liver damage
  • Heart complications
  • Death

There’s enough medicine in excessive ibuprofen or acetaminophen to seriously harm an adult, including causing death. Consuming alcohol alongside OTC medication carries an increased risk of serious damage.

Alcohol Interactions with Other Mind-Altering Substances

Generally, you shouldn’t consume alcohol with any substance that alters brain chemistry.

Mixing Alcohol with Caffeine

Drinking alcohol with caffeine can hide the effects of alcohol. As a result, a person may lose awareness of their mental and physical impairment level.

It can cause rapid heartbeat, which can strain a person’s heart. Other over-the-counter items or caffeine supplements may contain untested ingredients that don’t mix with alcohol use.

Alcohol Interactions with Energy Drinks

Many energy drinks have chemicals that can increase energy levels and hide the effects of alcohol. These chemicals include:

  • Guarana
  • Taurine
  • Ginseng
  • Sugar

They can also have high levels of caffeine. A person who combines energy drinks and alcohol is likely to experience a higher energy level and lower inhibition. The person is then more likely to engage in high-risk behaviors.

Mixing Alcohol with Herbal Supplements

OTC herbal supplements have become famous for supposedly treating various health issues. Many claim to treat a selection of health problems, including 

  • Weight gain
  • Cosmetic problems
  • Mood issues

Herbal supplements that market as mood enhancers may also combine dangerously with alcohol. Some users have reported blacking out or experiencing seizures after drinking alcohol with 5-HTP, a supplement that may improve depression. 

Be careful when you drink alcohol with herbal supplements, and always follow the directions on the label.

If you take any supplement, even if it’s natural, speak with your doctor before drinking alcohol.

Mixing Alcohol with Diet Pills

Many diet pills are addictive. In combination with alcohol, they can lead to many health issues.

Symptoms of an interaction between alcohol and certain medications meant for weight loss include:

  • Dizziness
  • Depression
  • Rapid heartbeat
  • Seizures
  • Problems with concentration, memory, and judgment

What Drugs Cannot Mix with Alcohol?

Some substances are worse to mix with alcohol than others. Here are the ones that tend to cause the most harmful interactions:

  • Alcohol and benzodiazepines: Xanax, Valium, and Ativan
  • Alcohol and opiates: Heroin and prescription opioids like Norco and hydrocodone
  • Alcohol and stimulants: Cocaine, methamphetamine, Adderall, and Ritalin

What is Polysubstance Abuse?

When someone regularly abuses more than one drug, they’re prone to developing polysubstance abuse.

People who chronically combine different drugs may worsen physical dependence on one or more drugs; they may develop a substance use disorder.

Polysubstance abuse may lead to:

  • Developing a physical dependence on several drugs
  • Problems with relationships in personal life and at work
  • Using drugs in places and situations where it is dangerous to do so
  • Failing to fulfill obligations (e.g., problems with parenting, fulfilling work responsibilities, and sustaining relationships)

Chronic polysubstance abuse problems typically lead to significant emotional, cognitive, and physical issues.

Polysubstance Abuse and Alcohol Use Disorder

Polysubstance abuse can be challenging to treat for various reasons. Clinicians may accidentally miss or overlook a person’s alcohol abuse and instead focus on their drug use.

People need treatment for all their issues with alcohol use disorder and polysubstance abuse simultaneously. Treatment focusing on only one substance abuse disorder is unlikely to be successful.

Updated on October 27, 2023
6 sources cited
Updated on October 27, 2023
All Alcoholrehabhelp content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies.
  1. Bujarski et al. “The relationship between methamphetamine and alcohol use in a community sample of methamphetamine users.” Drug and Alcohol Dependence, 2014.
  2. Anglin et al. “Alcohol use by heroin addicts: evidence for an inverse relationship. A study of methadone maintenance and drug-free treatment samples.” The American Journal of Drug and Alcohol Abuse, 1989.
  3. Prescription Drugs and Over-the-Counter (OTC) Drugs: Questions and Answers.” U.S. Food and Drug Administration, 2017. 
  4. U.S. Department of Health and Human Services. Harmful Interactions. National Institute of Alcohol Addiction and Alcoholism, 2014. 
  5. Moore et al. “Risks of combined alcohol/medication use in older adults.” The American Journal of Geriatric Pharmacotherapy, 2014.
  6. Martin, C.S. “Timing of alcohol and other drug use.” Alcohol Research & Health, 2008.
AlcoholRehabHelp Logo
All content created by Alcohol Rehab Help is sourced from current scientific research and fact-checked by an addiction counseling expert. However, the information provided by Alcohol Rehab Help is not a substitute for professional treatment advice.
© 2024 by Treatment Pathway LLC. All rights reserved.
Back to top icon
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram