Cocaine alone adversely affects the heart and drinking alcohol with it adds to that risk. While common, the combination of cocaine and alcohol together or even within a few hours of one another can be extremely risky because it increases heart rate and blood pressure, which further heightens the risk of a heart attack. 

Cocaine and alcohol also react within the liver to form a chemical known as cocaethylene, which has toxic effects on the heart, liver and other organs. This can happen even if cocaine and alcohol are used separately on consecutive days. 

Heroin and Other Opioids

Sometimes known as a “speedball,” the use of heroin and cocaine together can pose serious, potentially fatal risks to the user. Heroin and cocaine have opposing effects on the central nervous system –heroin depresses it and cocaine stimulates it. Both heroin and cocaine can cause breathing difficulties and the use of them together can adversely affect a person’s heart rate. 

Learn more about heroin.


As cocaine and MDMA are both stimulants, taking them together can exacerbate the effects of both, including increased heart rate and body temperature, and can sometimes be fatal. 

Learn more about MDMA


Using antidepressants (such as Prozac, Zoloft, Tofranil, etc.) with cocaine can increase the risk of “serotonin syndrome” — a condition when the brain is overloaded with serotonin. This can lead to excessive sweating, tremors, increased heartbeat and could also lead to seizures, shaking and shivering and sometimes death.

See the fact sheet for more information and sources.