What happens if I consume alcohol while taking benzodiazepines (BZDs), such as diazepam (Valium) or lorazepam (Ativan)?

Combining Alcohol with Benzodiazepines: Dangerous and Potentially Fatal

Taking alcohol with benzodiazepines can cause severe drowsiness, breathing problems (respiratory depression), coma, and death. This combination significantly increases the risk of overdose and should be avoided completely 1.

Mechanisms of Interaction

Benzodiazepines and alcohol both act as central nervous system (CNS) depressants, but through different mechanisms that produce additive effects:

• Benzodiazepines enhance GABA activity at the GABA-A receptor
• Alcohol affects the same GABA-benzodiazepine-chloride ionophore complex
• When combined, they produce synergistic depression of brain and respiratory function 2

Specific Risks of Combined Use

1. Respiratory Depression

   • The combination can severely suppress breathing
   • Risk of hypoxemia and hypercarbia leading to tissue injury 3
   • Can progress to respiratory arrest

2. CNS Depression

   • Excessive sedation and impaired consciousness
   • Cognitive impairment and memory problems
   • Increased risk of falls and accidents

3. Overdose Risk

   • Fatal overdose is much more likely when benzodiazepines are combined with alcohol 4
   • Even therapeutic doses of benzodiazepines can become dangerous with alcohol

4. Impaired Functioning

   • Severely impaired ability to operate vehicles or machinery
   • Impaired judgment and decision-making
   • Increased risk of accidents and injuries 3

High-Risk Populations

Certain groups face even greater dangers when mixing these substances:

• Patients with liver disease: Impaired metabolism of both substances leads to prolonged effects 3
• Elderly patients: Increased sensitivity to CNS depressants 5
• Those with respiratory conditions: Higher risk of respiratory depression 5
• Patients with sleep apnea: Significantly increased risk of respiratory arrest 3

Emergency Management of Combined Overdose

If someone has taken both substances and shows signs of overdose:

• Seek emergency medical help immediately
• Monitor vital signs closely
• Supportive care is the mainstay of treatment
• In hospital settings, the benzodiazepine antagonist flumazenil may be considered, though it carries its own risks 1

Prevention Strategies

• Never combine benzodiazepines with alcohol under any circumstances
• Patients prescribed benzodiazepines should completely abstain from alcohol
• Healthcare providers should screen for alcohol use before prescribing benzodiazepines
• Patients with substance use disorders should generally not be prescribed benzodiazepines 6

Warning Signs of Overdose

Seek emergency help immediately if you observe:

• Shallow or slowed breathing
• Breathing stops
• Excessive sleepiness or difficulty waking
• Blue-tinged lips or fingernails
• Loss of consciousness

The FDA medication guide for benzodiazepines explicitly warns that taking benzodiazepines with alcohol or other CNS depressants can cause severe drowsiness, breathing problems, coma, and death 1. This is not a theoretical concern but a well-documented risk that has resulted in numerous fatalities.

Remember that this dangerous interaction occurs regardless of whether the benzodiazepine was prescribed legitimately or obtained illicitly. The physiological effects of the combination remain the same.