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Cocaine + Alcohol

We recommend avoiding this combination. No numeric safety recommendation possible.

review pending

Content is undergoing medical and legal review. Changes possible.

Substances involved

Risk profile

Forms cocaethylene in the body — a metabolite with a longer duration of action and higher cardiac toxicity than cocaine alone. One of the most common substance-related causes of death in Western countries, often in young people who appear to have healthy hearts.

Acute emergency scenarios

When cocaine and alcohol are in the body at the same time, the liver produces cocaethylene — an ethyl ester of cocaine. Cocaethylene has:

  • A longer half-life than cocaine (about twice as long)
  • Higher cardiac toxicity — coronary vasoconstriction, sudden arrhythmias, heart attacks in young people
  • Stronger euphoric effects — which encourages a higher dose
  • Prolonged aggression and risk-taking — relevant for the risk of violence and accidents

Cocaethylene is the presumed reason why cocaine + alcohol is the most common substance-related cause of death in the US CDC dataset. In Berlin, too, sudden heart attacks or aortic dissections in young people on this combination keep happening.

We recommend avoiding this combination. If you do use it: low cocaine dose, minimal alcohol, no redosing, and call 112 immediately if you have chest pain or shortness of breath.

Repeated use of this combination is a matter for cardiac screening — even without acute symptoms, a check-up makes sense.