Alcohol is a CNS depressant that acts through the GABAₐ receptor, and is one of the most common strong psychoactives used by humans. It has a long history of use and its intoxicating effects are well-studied and documented. It remains legal in most parts of the world.
⚠️ Alcohol consumption should be spread out over a few hours and ideally separated by water breaks. Check the label on alcohol for unit content
These combinations are considered extremely harmful and should always be avoided.
benzodiazepines: Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.
dextromethorphan: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place the affected individual in the recovery position to prevent vomit aspiration from excess. Additionally, CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.
ghb/gbl: Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.
ketamine: Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.
mxe: There is a high risk of memory loss, vomiting and severe ataxia from this combination.
opioids: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place the affected individual in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely
tramadol: Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place the affected individual in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.
There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.
cocaine: Cocaine can decrease some of the intoxicating effects of alcohol, causing some people to drink more than they otherwise would, which leads to greater behavioral and physical health risks. There is also some debate about cocaethylene, a metabolite produced when combining alcohol and cocaine, with some researchers positing that it is more cardiotoxic than cocaine on its own. Use moderation when combining these substances.
maois: Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.
pcp: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.
These combinations are not usually physically harmful, but may produce undesirable effects.
amphetamines: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.
amt: aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable
mdma: The combination of MDMA and alcohol may increase strain on the cardiovascular system and lead to increased alcohol consumption. MDMA may also impair one's ability to recognize their level of drunkenness, leading to increased alcohol consumption and poor decision-making. Alcohol may also increase the risk of dehydration and hyperthermia (increased body temperature) when combined with MDMA.
nitrous: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.
ssris: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
These drugs work together to cause an effect greater than the sum of their parts.
cannabis: In excess, this combination can cause nausea.
Effects are subtractive. The combination is unlikely to cause any adverse or undesirable reaction.
2c-t-x: Both these classes of compound can interact unpredictably. Caution should be exercised.
dox: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.