DXM And Alcohol: Is it Safe To Mix?

Last Updated: June 3, 2020

The use of dextromethorphan as a recreational drug has caused many users to decide to combine it with other substances. Mixing DXM with alcohol is one of the most popular combinations as the person looks for more potent DXM high effects. People tend to combine both because dextromethorphan medicine is sold over the counter, and alcohol is also easily accessible. Furthermore, DXM duration of action and its effects can be prolonged using alcohol after DXM ingestion. However, there’s a question regarding if it’s bad to mix alcohol and DXM. Considering that both drugs have adverse effects on their own, their combination could affect a person’s well-being.

Is The Combination Of DXM And Alcohol Safe?

According to the Drug Abuse Warning Network, ethanol is the drug that is more commonly used with dextromethorphan, surpassing by far the use of DXM and Xanax. But is DXM and alcohol use safe? The Network also reported that a majority of the cases that presented with major side effects were those in which there was a DXM-alcohol co-ingestion. Furthermore, the National Institute of Alcohol Abuse and Alcoholism has warned about the interaction of these two substances. Therefore, there are additional risks when taking dextromethorphan drug class medication as well as a drink containing ethanol, and the combination can affect a person’s health.
is it safe to mix dxm with alcohol?

Effects Of Mixing DXM And Alcohol

Both the dextromethorphan powder and liquid forms, in amounts over the therapeutic ones, cause certain degrees of high, which can be affected by ethanol concomitant consumption. There are four different plateaus, and mixing alcohol and DXM can change the effects felt at each of these different levels.

  1. Alcohol and a small DXM dose (100-200 mg) together can cause a decrease in the normal euphoric effect of taking DXM alone. This is due to the depressive impact that alcohol has on the Central Nervous System (CNS). This could cause the person to take a higher amount of dextromethorphan-alcohol combination.
  2. A dose of 200-400 mg of dextromethorphan with alcohol: the person is more likely to have hallucinations. However, when using dextromethorphan alone, these hallucinations are more likely to present at the third plateau.
  3. Higher doses of DXM and alcohol at 300-600 mg can cause a great loss of motor coordination as well as very manifest visual impairment. The person can stumble, and fall and walking will be increasingly difficult.
  4. Higher dextromethorphan-alcohol consumption at 500-1500 mg: at this stage, a person consuming both substances is likely to present sedation. Ethanol’s action in the Central Nervous System increases the sedating effect on breathing, slowing it down. A person taking DXM from cough syrup and alcohol is more likely to die from respiratory failure.

At the gastrointestinal level, the combination of alcohol and DXM can cause diarrhea. Furthermore, taking alcohol and dextromethorphan can increase the risk of a DXM overdose. In the case of breastfeeding mothers, it’s not recommended to take even a low dose of alcohol and dextromethorphan in breastfeeding.

Risks Of Mixing Alcohol With DXM

Adverse outcomes due to the use of these two drugs can cause long-term effects, especially with chronic use. These effects can affect at a social, physical, and mental level:

  1. Loss of job opportunities. People have wondered does DXM show up on a drug test? It does, just like alcohol, which could affect hiring decisions at the workplace.
  2. Dependence on alcohol has been reported with more frequency in patients abusing DXM.
  3. Car accidents or falls from a dangerous height: the combined effects of these substances on the CNS can lead to seizures while driving.
  4. Panic: due to intense hallucinations, which might cause the person to attack someone else due to the alcohol and DXM combination.
  5. Withdrawal symptoms: the use of both substances could cause a DXM tolerance reset; however, adverse symptoms might ensue.
  6. Liver damage: a known consequence of ethanol abuse, which DXM can worsen.
  7. Mental health: abusing dextromethorphan and ethanol simultaneously increases the risk of developing both insomnia and anxiety. Furthermore, the chronic use of dextromethorphan and ethanol could lead to DXM depression, which ethanol might exacerbate.
  8. Death: when wondering how much dextromethorphan is too much, remember that this combination potentiates the risk of respiratory dysfunction, which can be fatal. Higher intake of dextromethorphan increases this risk.

death after mixing dxm with alcohol

Treating The Effects Of DXM And Alcohol Combination

The use of two depressants of the CNS can have fatal consequences. Dextromethorphan and ethanol can also lead to adverse events, which highlights the importance of preventing these negative outcomes. Taking only the amounts recommended of cough syrup containing dextromethorphan and avoiding concomitant drinking are instrumentals in preventing these alarming consequences.

It’s important for people addicted to these substances to recognize the need to look for substance abuse treatment programs. This way, there is a chance of recovering a healthy life, free of addiction to any of these substances. Dextromethorphan detox, as well as alcohol detox, are the first steps to take during treatment of this type. Drug abuse rehabilitation centers have qualified medical professionals that can be instrumental during this process. There are options for both inpatient and outpatient protocols, depending on the severity of the case and what the person desires. In both cases, group therapy and individual therapy are recommended. Family therapy might also be part of the rehabilitation approach. It’s essential to have professional supervision, especially during the initial stages of the treatment. The underlying causes for the ingestion of both substances should be addressed, to promote a profound understanding of the disease and increase the chances of recovery.

Page Sources

  1. Substance Abuse & Mental Health Administration Study. Drug Abuse Warning Network (DAWN-2006). 2006. https://www.datafiles.samhsa.gov/study/drug-abuse-warning-network-dawn-2006-nid13603
  2. National Institute on Alcohol Abuse and Alcoholism. Brochures and Fact Sheets. Mixing Alcohol With Medicines. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines

Published on: August 6th, 2019

Updated on: June 3rd, 2020

About Author

Peter J. Grinspoon, MD

Dr. Peter Grinspoon is an experienced physician with long-term clinical practice experience. As a former analgesic addict, Dr. Grinspoon knows precisely how important it is to provide patients with effective treatment and support. Medical writing for him is the way to communicate with people and inform them about their health.


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