The Risks of Mixing Alcohol and Codeine

You’re at a friend’s party, and they offer you a drink. But wait. You were up all night coughing last night and took some cough medicine in the middle of the night. Is it okay to drink if you had cough medicine only a few hours earlier? In fact, you might even take another dose tonight just to be safe. Should you take the drink or opt for water?

In this article, we’ll discuss all the reasons why the answer is water. 

What Is Codeine?

Codeine is an opiate painkiller used in hospitals to treat pain, but it is also used as an ingredient in some cough suppressants. Codeine is a Schedule 3 drug, meaning it is highly addictive and therefore a controlled substance. It works by suppressing the area of the brain that makes us cough, thereby reducing the number of times we cough. Codeine is also a central nervous system depressant. 

Due to growing fears of opioid addiction, codeine is available by prescription only in the U.S. (e.g., Phenergan with Codeine or Robitussin AC). The codeine in many U.S. cough syrups has been replaced with dextromethorphan (DXM), which is synthetically produced and similar to codeine in its effects on the brain and its risk of abuse.

What’s in Cough Syrup?

Cough syrup typically has 15 mg of codeine in a 5-mL spoonful. A serving size of cough syrup is typically around 10 mL (30 mg codeine) taken every few hours or 24 hours, depending on the brand. Most cough syrup brands also contain about 10% alcohol, which is used as a solvent or preservative.

Because of the effects of codeine or dextromethorphan on the brain, taking large amounts of cough syrup can actually make you feel drunk. 


Side Effects of Codeine

When used as intended, cough syrup won’t hurt you. However, ingesting more than prescribed means we are ingesting more codeine than we’re supposed to, which can have some pretty nasty side effects. Let’s take a look at some of the common ones:

• Dizziness
• Distorted Awareness and Space/Time Perception
• Fainting
• Confusion
• Hallucinations

Ingesting more codeine (or DXM) than prescribed increases the risk of overdose, but how much do we need to take to see these effects? Well, a safe dose is considered no more than 30 mg over 24 hours, and ingesting anything over 300 mg is overdose territory.

But what happens if we take the correct amount and have alcohol with it? Can we mix codeine and alcohol? 

Risks of Mixing Codeine With Alcohol

It is best to avoid alcohol while taking cough medicine that contains codeine or DXM. For one thing, if you’re coughing, you’re probably sick, which means you should avoid alcohol for the time being anyway. If you combine both substances, it can lead to some adverse health effects:

• Liver damage. Ingesting codeine long term can cause pancreatitis and liver damage, and since alcohol also affects the liver, the combination damages the liver even more if ingested regularly. 

• Nausea and vomiting. Not only is this uncomfortable, but it can result in dehydration.

• Effects on the brain. Since codeine affects the brain by suppressing cough and pain mechanisms, mixing it with alcohol (which also affects the brain) can lead to dizziness, poor motor function, impaired cognitive functions, and trouble concentrating.

• Effects on the heart and lungs. As a central nervous system (CNS) depressant, codeine can slow our breathing and reduce our heart rate. Adding alcohol intensifies these effects and can potentially cause fatal respiratory arrest.

If you or anyone you know has ingested this combination and has any of these side effects, seek medical attention.

Now, let’s go back to our friend’s party. Has it been long enough since we took the cough medicine, or should we wait? The half-life of codeine in the body is around three hours, so it takes around half a day for it to be out of our system. That said, it is best to wait at least 24 hours before consuming alcohol. Better yet, wait until your cough is completely gone, and opt for a mocktail while you wait! 

What About “Drinking/Sipping Lean”?

Now that we’ve unpacked the effects of alcohol while taking cough syrup, let’s look at what happens if we mix them on purpose. Unfortunately, mixing codeine or DXM cough syrup with alcohol has become popular in the past couple of decades, especially among young people, who have nicknamed the mixture “Lean,” “Purple Drank,” or “Sizzurp.” Let’s take a closer look at the dangers.

Why Do People Drink Lean?

Now that we’re equipped with all our new slang, let’s unpack it a bit more. Drinking or sipping Lean is basically a way for people to use cough syrup as a recreational drug – they drink Purple Drank with the intent to get high. Remember how we said ingesting anything over 300 mg is getting into overdose territory? Well, that’s how much codeine or DXM cough syrup it takes to get high. That means we’d need to ingest ten times the serving size in 24 hours to get “drunk” off cough syrup.

But why drink Lean? Why not just do shots or a beer bong? The rising popularity of it is largely because it gets people “high” (rather than just drunk) in a more accessible way than other opioids like morphine or illegal drugs like heroin. It’s much easier, cheaper, and safer to purchase cough syrup at the pharmacy than to purchase from a dealer in a dark alley. Plus, it’s much less conspicuous. 

Dangers of Drinking Lean

We’ve said drinking Lean is dangerous, but what’s so bad about it? Let’s take a look:

• High potential for addiction and overdose. The combination of codeine and alcohol is extremely addictive and can lead to overdose, more so than taking each separately. Plus, because it is used by younger crowds and at dance parties, it is often consumed in dangerously high quantities. 

• Psychosis. High doses of Lean can produce an out-of-body experience similar to the effects of taking PCP. Users get a “high” that makes them deluded and disoriented, which is not only bad for the body but can also result in dangerous situations.

• Brain damage. Abusing this combo can result in seizures as well as brain changes that cause behavioral problems. In severe cases, it can even lead to memory loss or permanent psychosis.

With these effects in mind, it’s important to note that ingesting Lean can be fatal. If you or a friend has ingested Lean, call poison control at 800-222-1222 (in the U.S.).

What About Cough Drops and Alcohol?

What about cough drops? Do the same dangers apply? The good news is that most cough drop brands contain menthol as their active ingredient (which is not dangerous when mixed with alcohol). Some brands, however, contain DXM (not codeine), so it’s important to check the ingredients or ask your doctor about any possible interactions. But we can’t stress this enough: if you’re coughing or have a sore throat, it’s best to avoid alcohol anyway.

Tips To Stay Safe While Sick

Now that we’ve investigated alcohol and codeine, DXM, and cough syrup from various angles, let’s talk about some things we can do to stay safe.

• Avoid alcohol while taking cough syrup. As we said, you should avoid alcohol if you’re sick anyway, as it will only delay recovery and compromise the immune system further.

• Avoid any drinks you don’t know. If someone offers you a drink, make sure you know what’s in it and are familiar with slang terms for drugs and substance combinations. When in doubt, a “No, thank you” is a good way to go, and remove yourself from the situation if it gets out of hand. Also check out this list of slang terms for DXM and list of additional terms for Lean. If you see these on the menu at a house party, leave or call for a ride home.

• Read the labels. Be sure to take the correct dose of cough syrup if you’re sick, and wait long enough before taking another dose.

• Don’t overuse it. If you still have a cough after a week, it may be time to consult your doctor and see what else is going on. You shouldn’t need it for more than seven days in a row. 

• Try an alternative cough suppressant. There are plenty of options out there for cough syrups that don’t contain codeine or alcohol, but if you want to avoid the syrup altogether, try a product with eucalyptus or menthol, especially if you know you’re going to be drinking or taking other medications. Don’t be afraid to ask your doctor about different brands of cough medicine. Your health comes first, and being honest about any plans to drink alcohol will only keep you safer in the long run. 

• Try herbal remedies. There are several teas and herbal remedies on the market that can help soothe a sore throat. You can even add honey and lemon to warm water. A salt water gargle can also provide relief.

Coughing Up Some Parting Words

Whether intentional or accidental, mixing cough medicine and alcohol is dangerous. Understanding these dangers and being vigilant about medication labels and cocktail mixes will help keep us safe. No drink is worth the horrible side effects caused by mixing with codeine or DXM, and our body deserves better, especially when we’re sick.