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medical emergency

Mixing Cocaine + Alcohol

When When someone has combined cocaine and alcohol and shows chest pain, racing heart, nausea, dizziness or confusion.

review pending

Content is undergoing medical and legal review. Changes possible.

Emergency

Call 112. Calling for help is required by law (German Criminal Code § 323c). levelll cannot promise immunity from criminal or administrative consequences.

Immediate

  1. 1. With chest pain, tightness, shortness of breath or tachycardia over 150/min: 112.
  2. 2. Calm the person, sit them down, no more stimulants, no more alcohol.
  3. 3. Water in small sips, quiet surroundings. Keep watching.

Don't do

  • Don't 'top up' with alcohol or cocaine to balance out the mix — that makes the toxicity worse.
  • No sedatives without medical instruction.
  • Don't leave the person alone until symptoms subside or medical care arrives.

Cocaine + alcohol form cocaethylene in the body, a metabolite with:

  • A longer duration of action than cocaine (~2× the half-life)
  • Higher cardiac toxicity (heart attacks in young people are more common under cocaethylene than under cocaine alone)
  • Enhanced euphoric effect — which encourages higher amounts of use

Cocaethylene is the suspected reason why cocaine + alcohol is one of the most common substance-related causes of death in Western countries.

Clinically relevant complications:

  • Acute myocardial infarction
  • Aortic dissection
  • Arrhythmias
  • Cerebral hemorrhage
  • Liver strain

With repeated use of this combination, a cardiac work-up later on (days afterwards) is also part of the picture — symptoms like chest pain, shortness of breath or syncope should not be dismissed as a “hangover”.