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Combining Codeine & Alcohol: What Are the Dangers & Risks?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Sep 19, 2023 • 10 cited sources

Codeine and alcohol are both central nervous system (CNS) depressants, which slow brain activity, breathing rate, and heart rate. Combining these two depressants can have dangerous consequences, including an increased risk of overdose.[1] 

Unfortunately, mixing alcohol and codeine cough syrup—a drink known as “lean” or “sizzurp”—is popular among young people, and they may not know just how dangerous this combination can be.

Can You Mix Codeine and Alcohol?

Quick Answer

Mixing codeine and alcohol is very dangerous since both of these substances are central nervous system (CNS) depressants that slow your breathing and heart rate. Combining these drugs can cause severe respiratory depression and increase the risk of overdose and life-threatening consequences.

Side Effects of Codeine

Codeine is an opioid medication (which acts as a sedative) most commonly prescribed to manage pain or treat cough, though it may sometimes be used to treat chronic diarrhea or restless leg syndrome.[1] Because codeine is an opioid, it shares many of the same side effects with prescription painkillers like Vicodin and OxyContin, including: [1]

  • Constipation
  • Nausea and vomiting
  • Sedation
  • Inattention
  • Sexual dysfunction
  • Fatigue
  • Decreased libido
  • Blurred vision
  • Tremors
  • Stomach cramps
  • Inability to fully empty the bladder
  • Itchiness
  • Wheezing
  • Respiratory depression

Some of these codeine adverse effects can be dangerous—it’s important to take this medication exactly as directed by your doctor. And if you experience any troubling effects, contact your provider immediately or call 911 if it’s a medical emergency.

Side Effects of Alcohol

Alcohol is a central nervous system depressant or sedative and can cause many adverse effects, such as: [2], [3]

  • Mood swings
  • Impaired judgment, increasing the risk of accidents
  • Aggressive behavior
  • Slurred speech
  • Coordination problems, leading to accidents or injuries
  • Memory and attention issues
  • Stupor
  • Coma

Generally, the more a person drinks, the more likely they are to experience dangerous side effects from alcohol, such as respiratory depression or coma. And the risks increase significantly when mixing alcohol with other sedatives like codeine.

Dangers of Mixing Alcohol and Codeine

More than half of people who misuse prescription painkillers like codeine also misuse alcohol.[4] Many people mix these drugs and are unaware of just how risky and potentially life-threatening this practice is. 

In reality, combining two sedative drugs like codeine and alcohol compounds the dangers of each substance. Some of the risks of combining alcohol and codeine syrup include:[1],[2]

  • Severe drowsiness
  • Dangerously slowed or stopped breathing
  • Dangerously slowed or stopped heartbeat
  • Loss of consciousness or coma
  • Death

In one study, researchers found that mixing one type of opioid with a moderate amount of alcohol causes life-threatening respiratory distress.[5] This complication is most common in the elderly, but it could happen to anyone.

Researchers also found that in 2017, one in seven deaths involving opioids also involved drinking alcohol.[6]

Overdose and Severe Respiratory Depression

The most dangerous complication of mixing codeine with alcohol is the potential for life-threatening respiratory depression. Respiratory depression involves slow and ineffective breathing, which results in too-low oxygen levels and a buildup of carbon dioxide, leading to organ damage, overdose, and even death. 

Signs of an overdose on codeine and alcohol include:[7],[8]

  • Blueish fingernails or lips
  • Pinpoint pupils
  • Limp body
  • Clammy or pale skin
  • Gurgling noises or vomiting
  • Unresponsive
  • Dangerously slowed or stopped pulse or heart rate

If you think someone is overdosing on codeine and alcohol or any other substance, call 911 immediately and stay with the person until first responders arrive. Perform CPR if the person’s pulse or breathing stops. And if you have naloxone (Narcan), the opioid overdose medication, administer it right away—it won’t work on the alcohol but it will treat the codeine overdose. Naloxone rapidly reverses the life-threatening respiratory depression caused by an overdose on an opioid like codeine and can buy the person some time while waiting for medical personnel to arrive.

Chronic Use Can Lead to Alcohol and Codeine Addiction

In addition to the risk of overdose and life-threatening consequences, chronic misuse of codeine and alcohol can increase the risk of developing tolerance, physiological dependence and addiction to both these drugs.

Continued use of these substances can lead to tolerance, which means a person requires increasing doses in order to achieve the desired high; this can contribute to an even higher overdose risk.

Meanwhile, ongoing codeine and alcohol misuse can lead to dependence, which means the brain and body have adapted to the presence of these drugs and needs them to function optimally. If someone is dependent on alcohol and codeine, they will experience unpleasant and potentially fatal withdrawal symptoms when they suddenly stop using them.

Codeine withdrawal symptoms include flu-like symptoms, such as:[2]

  • Nausea and vomiting
  • Diarrhea
  • Fever
  • Sweating
  • Stomach cramping
  • Joint pain
  • Muscle aches
  • Anxiety
  • Runny nose and tearing eyes

Alcohol withdrawal symptoms can be life-threatening and may include: [2]

  • Tremors
  • Anxiety
  • Panic attacks
  • Sweating
  • Rapid pulse
  • Insomnia
  • Nausea and vomiting
  • Hallucinations
  • Seizures

Physiological dependence can lead to a cycle of withdrawal, discomfort, and return to misuse in an effort to alleviate these symptoms—a cycle which can lead to an addiction, known as codeine use disorder and alcohol use disorder (AUD). Once someone is addicted to these drugs, it can be extremely difficult to quit without professional help.

Treatment for Codeine and Alcohol Use Disorder

An estimated 1.1% of Americans have co-occurring alcohol use disorder and another substance use disorder.[9] While it’s more complicated to treat AUD and opioid use disorder (OUD) together, it’s still very possible. Medication for Addiction Treatment (MAT) programs can help. 

There are FDA-approved medications for the treatment of OUD and AUD. MAT for OUD consists of medications like Suboxone (buprenorphine/naloxone), which alleviates codeine withdrawal symptoms and cravings while preventing relapse. 

MAT options for AUD may include naltrexone, which works on opioid receptors, blocking the pleasant effects of opioids and alcohol and treating both AUD and OUD. Other options include acamprosate and disulfiram, which are approved to treat AUD only.[10] 

While these medications are a vital part of sustaining recovery from both AUD and OUD, they work best in conjunction with therapy. Counseling is a key component of every MAT program.[10] In therapy, you’ll acquire skills that help you to lead a healthy, balanced life, and you’ll build a support network you can turn to when you’re tempted to relapse back to substance misuse. 

Frequently Asked Questions About Codeine and Alcohol

What Happens if You Mix Codeine and Alcohol?

Mixing codeine and alcohol can lead to dangerous and potentially fatal effects, such as respiratory depression, coma, overdose and death.

Can Codeine and Alcohol Kill You?

Yes, mixing codeine and alcohol can have life-threatening consequences due to the increased risk of overdose. If you suspect you or someone else has overdosed, call 911 immediately.

Can You Mix Alcohol and Tylenol with Codeine?

No, you cannot mix alcohol and codeine because of the risk of over-sedation. Meanwhile, Tylenol on its own can cause liver damage, especially when taken in large amounts—mixing alcohol and Tylenol can increase the risk of harmful liver effects.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Codeine. Stat Pearls. February 2023. Accessed April 2023.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  3. Centers for Disease Control and Prevention. Alcohol Use and Your Health. April 2022.
  4. More Than Half of People Who Misuse Prescription Opioids Also Binge Drink. Centers for Disease Control and Prevention. June 2019. Accessed April 2023.
  5. Mixing Opioids and Alcohol May Increase the Likelihood of Dangerous Respiratory Complication, Especially in the Elderly, Study Finds. American Society of Anesthesiologists. February 2017. Accessed April 2023.
  6. Alcohol and Other Substance Use. Centers for Disease Control and Prevention. July 2022. Accessed April 2023.
  7. Opioid Overdose. Substance Abuse and Mental Health Services Administration. March 2023. Accessed August 2023.
  8. Save a Life from a Prescription Opioid Overdose. Centers for Disease Control and Prevention. July 2020. Accessed August 2023.
  9. Treatment of Co-Occurring Alcohol and Other Drug Use Disorders. Alcohol Research and Health. 2008. Accessed April 2023.
  10. Evidence-Based Pharmacotherapies for Alcohol Use Disorder: Clinical Pearls. Mayo Clinic Proceedings. September 2020. Accessed April 2023.

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