Combining cocaine and alcohol produces cocaethylene, a toxic and potentially deadly substance. Learn the risks and side effects of mixing these drugs.

Cocaine and alcohol are both dangerous substances when consumed on their own, particularly if consumed in large amounts or abused frequently. However, the individual dangers of cocaine and alcohol are significantly greater when the two drugs are taken together.

When combined, cocaine and alcohol can produce chemical reactions in the body that produce a substance called cocaethylene — a byproduct of cocaine. Cocaethylene can increase the power of the effects and the risks of each substance – and can cause an overdose or death.

What is Cocaethylene?

When alcohol and cocaine are ingested together, a chemical reaction occurs to produce a new substance, cocaethylene, which can have a toxic effect on the body. Cocaethylene is the substance that is produced once the cocaine metabolizes in the body.

Cocaethylene can stay in the body for much longer than cocaine. Risks of cocaethylene buildup include liver damage, immune system damage and seizures.

What are the risks of cocaethylene buildup?
  • Cocaethylene is one of the reasons pairing alcohol and coke can lead to alcohol poisoning and death.
  • Cocaethylene is toxic to the liver, and it’s often a contributing factor when heart attacks occur in young people. The production of this substance is what leads to the risk of a spontaneous heart attack when you combine alcohol and cocaine.
  • Not only can cocaethylene be produced when you use alcohol and coke only once together, but it also has the potential to build up in the body over time.
Why do people mix alcohol & coke?

Cocaine and alcohol are often consumed together because they are frequently present together at parties or clubs. Mixing alcohol and coke is also common because people often want to amplify their feelings of intoxication, and they may believe that mixing the two will intensify the cocaine high they experience. There’s also some belief that combining alcohol and coke can help alleviate the negative side effects of coming down from the cocaine.
Unfortunately, the risks of mixing alcohol with cocaine are incredibly dangerous and deadly.

The risk of dying when you combine alcohol and coke is 20 times higher than it if you just use cocaine alone. 

When you mix alcohol and coke, there is no way to know how you’ll be affected by this combination of substances. The combination will likely make you feel less intoxicated than you really are, which can increase the chances of alcohol poisoning or drug overdose.

Many people who frequently abuse these substances will start to develop a tolerance for either one or both of the substances, and they will want to move onto something that will give them a more intense high.

Research has shown that more than half of the people who are dependent on cocaine are also dependent on alcohol, and there is a very significant link between these two substances.

Side Effects of Cocaethylene

As a stimulant, cocaine has different effects on the body than alcohol (a depressant) does. Taking cocaine on its own causes a rush of energy, a high or feelings of euphoria. Although alcohol usually slows the body down, taking cocaine and alcohol together can make the effects and risks of cocaine more severe.

Cocaethylene has similar effects to cocaine, but the risk of toxicity is greater. Alcohol also prevents cocaine from being eliminated from the body, which can be toxic.

Other common side effects:
  • An increased risk of stroke
  • Chest pain or cardiac depression 
  • Increased heart rate
  • Sedation or coma
  • Increased perceived level of intoxication
  • Cocaethylene can cause damage to veins, arteries and nerve tissue, which can cause serious long-term effects or death.

Overdose Risks

Overdose is a serious risk when mixing alcohol and cocaine. Cocaethylene can also prevent adequate oxygen to the brain or bleeding of the brain. High levels of cocaethylene can cause various toxicity symptoms. The toxic effects of cocaethylene can cause long-term, irreversible damage to the heart and brain which can result in death.

Common symptoms of an overdose:
  • Irregular heartbeat
  • Seizures
  • High body temperature
  • Trouble breathing
  • Agitation
  • Anxiety

How Long Does Cocaethylene Stay In Your System?

How long cocaethylene stays in your system depends on various factors from overall health conditions to the frequency of drug use. If drug use is chronic, it may take longer for these substances to clear your system completely.

In general, however, cocaine has a relatively short half-life. The elimination half-life of cocaine metabolites like cocaethylene can range from 14.6 to 52.4 hours. This means it can take over a week for cocaethylene to leave one’s system completely.

The individual variability can also affect if cocaethylene shows up on a drug test and can depend on the method of testing.

Testing Hair for Cocaethylene

Cocaethylene traces can be detected in hair. Generally, a 1.5-inch hair sample can detect use within the previous 90 days.

Testing Urine for Cocaethylene

Cocaethylene can be found in urine. Although little data exist on how long it stays in urine, it is detectable for at least several days.

Testing Blood for Cocaethylene

The half-life of cocaethylene in plasma, or the liquid portion of blood, is about two hours. Since it takes five half-lives to completely rid the body of a drug, cocaethylene can be detectable in plasma for up to 10 hours after the last use of cocaine.

Testing Saliva for Cocaethylene

Cocaethylene can be found in saliva, although studies have been limited to detecting it on the same day as cocaine use. As a result, it’s unclear how long cocaethylene can remain in saliva.

These are estimates, and cocaethylene may be detectable much longer if cocaine and alcohol are used frequently or in very high doses.

Finding Help for Addiction

Addiction to alcohol and cocaine can mean that cocaethylene is often present in the body. There is a serious risk that cocaethylene can permanently damage the heart or brain, causing long-term disability or even death. These risks are present every time you mix the two substances.

If you’re abusing alcohol and cocaine, or you’re addicted to both substances, it’s important that you seek the right kind of treatment. The consequences of continuing to mix alcohol and cocaine can be extremely damaging to your physical and mental health.

The kind of treatment that’s best suited to alcohol and cocaine addiction is one that can treat polysubstance abuse problems. Dual diagnosis care may also be beneficial. Seeking this care level means that you receive treatment for both your alcohol and cocaine use and any underlying mental disorders related to your addictions. Detoxing from alcohol and cocaine can allow cocaethylene to leave the system completely, which can ensure your safety through the recovery process.

a man with a beard wearing glasses and a hoodie.
Editor – Thomas Christiansen
With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more
a woman standing in front of a clock on a building.
Medically Reviewed By – Dr. Sarah Dash, PHD
Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more

Farooq, Muhammad; Bhatt, Archit; Patel, Mehul.”Neurotoxic and Cardiotoxic Effects of Cocaine and Ethanol.” Journal of Medical Toxicology, September 2009. Accessed August 22, 2019.

Mackey-Bojack, Shannon; Kioss, Julie; Apple, Fred. “Cocaine, Cocaine Metabolite, and Ethanol[…] and Vitreous Humor.” February 2000. Accessed August 22, 2019.

Laizure, S. Casey; et al. “Cocaethylene metabolism and interaction with cocaine and ethanol.” Drug Metabolism and Disposition, January 2003. Accessed August 22, 2019.

Treadwell, Sean; Tom, Robinson. “Cocaine use and stroke.” Postgraduate Medical Journal, 2007. Accessed August 24, 2019.

Pennings, Ed; et al. “Effects of concurrent use of alcohol and cocaine.” Addiction, 2002. Accessed August 24, 2019.

National Institute on Drug Abuse. “Cocaine.” July 2018. Accessed August 24, 2019.

Fettiplace, Michael; et al. “Cardiac Depression Induced by Cocaine or Cocaethylene Is Alleviated by Lipid Emulsion More Effectively Than by Sulfobutyletherb-cyclodextrin.” Academic Emergency Medicine, May 2015. Accessed August 24, 2019.

Schwartz Bryan; et al. “Cardiovascular Effects of Cocaine.” Circulation, December 2010. Accessed August 24, 2019.

Jones, AW. “Forensic Drug Profile: Cocaethylene.” Journal of Analytical Toxicology, April 1, 2019. Accessed February 22, 2022.

Hallare, J; Gerriets, V. “Half Life.” StatPearls, August 23, 2021. Accessed February 22, 2022.

Gryczynski, J; Schwartz, RP; et al. “Hair Drug Testing Results and Self-repor[…]isk Illicit Drug Use.” Drug and Alcohol Dependence, May 17, 2014. Accessed February 22, 2022.

Moore, C; Coulter, C; et al. “Determination of Cocaine, Benzoylecgonin[…]ctrometric Detection.” Agilent Technologies, September 27, 2007. Accessed February 22, 2022.

Clauwaert, K; Decaestecker, T; et al. “The determination of cocaine, benzoylecg[…]ht mass spectrometry.” Journal of Analytical Toxicology, November. Accessed February 22, 2022.

Menotti, VS; Scanferla, TP; et al. “Validation of a method for simultaneous […]hy-mass spectrometry.” Brazilian Journal of Pharmaceutical Sciences, 2020. Accessed February 22, 2022.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.