
Mixing alcohol with cough syrup is dangerous and can lead to serious health complications. This combination is called by various names, including lean, purple drank, syrup, sizzurp, and screw, among others. Lean is a polysubstance drink used as a recreational drug, typically consisting of prescription-grade cough syrup containing opioids and antihistamines mixed with soda and hard candy. The drink is known to produce euphoric side effects, but also carries risks of addiction, respiratory depression, respiratory arrest, and cardiac arrest. Mixing alcohol with cough syrup can amplify the effects of both substances, increasing the likelihood of dangerous outcomes such as overdose and death.
| Characteristics | Values |
|---|---|
| Names | Lean, purple drank, syrup, sizzurp, screw, jelly, Tussin/Tuss', barre, Wock', Act', Texas tea, mud, dirty Sprite, tsikuni |
| Ingredients | Cough syrup, soda, hard candy, alcohol, promethazine, codeine, DXM, hydrocodone, chlorphenamine, APAP, homatropine, guaifenasin, dextromethorphan |
| Effects | Euphoria, sleepiness, drowsiness, lethargy, dissociative feelings, mild "euphoric side effects", hallucinations, psychosis, heat stroke, liver damage, respiratory depression, respiratory arrest, cardiac arrest, tooth decay, internal bleeding, heart problems, difficulties in breathing, loss of coordination, nausea, vomiting, headaches, fainting, lightheadedness, trouble concentrating, loss of motor skills, dehydration, weakened immune system, risk of overdose, addiction, death |
| Risks | Increased chance of respiratory depression, dangerous outcomes, unpredictable or more severe side effects, overdose, addiction, death |
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What You'll Learn

The dangers of mixing alcohol and cough syrup
Mixing alcohol and cough syrup is extremely dangerous and can lead to severe adverse effects, including death. This combination is sometimes referred to as "lean", "purple drank", "sizzurp", or "screw", and its popularity is partly due to its glorification in pop culture.
Firstly, it is important to note that some cough syrups already contain a small amount of alcohol. Therefore, mixing them with additional alcohol can amplify the effects of both substances, increasing the risk of dangerous outcomes. This is because both alcohol and dextromethorphan (DXM), a common ingredient in cough syrups, are central nervous system (CNS) depressants. When mixed, they can cause enhanced relaxation, sleepiness, and euphoria, which can be dangerous when experienced to an extreme degree.
The combination of alcohol and cough syrup can lead to unpredictable and severe side effects, including increased dizziness, drowsiness, impaired coordination, and even respiratory depression or irregular breathing. Additionally, this mixture can cause profound sedation, coma, and death. The risk of overdose is also heightened when mixing these substances. Furthermore, consuming alcohol while sick can worsen symptoms, cause dehydration, and weaken the immune system, hindering the recovery process.
The dangers of mixing alcohol with cough syrup are particularly prominent among adolescents, who are more likely to abuse this combination and experience negative consequences. The mixture can also lead to dental problems due to the high sugar content, and the use of opioids like codeine can contribute to dry mouth, increasing the risk of harmful bacteria in the mouth.
In conclusion, mixing alcohol and cough syrup is highly dangerous and can lead to severe side effects, including overdose and death. It is crucial to heed the warnings on medication labels and avoid mixing alcohol with any medication, including cough syrup, to prevent harmful and potentially fatal outcomes.
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Lean, purple drank, sizzurp, and other names for the mixture
Lean, also known by the popular street name "purple drank", is an illicit substance made with codeine-based cough syrup, soda, hard candy, and occasionally alcohol and promethazine. The drink is called "lean" because users tend to slouch or lean to one side the more they consume the substance. "Purple drank" references its typically purple hue, as the cough syrups used are often purple. The drink originated in Houston, Texas, in the 1960s or 90s, and is popular in hip-hop culture, especially within the Southern United States.
The cocktail is known by various other names, including sizzurp, syrup, screw, jelly, Tussin/Tuss', barre, Wock', Act', Texas tea, mud, dirty Sprite, and tsikuni. In areas where lean had not yet been introduced, codeine-based cough syrup mixed with pills was called "juice and beans". Lean is sometimes referred to by its colour in slang, usually purple (or purp'), but can also be red, green, or yellow based on the ingredients used.
The practice of mixing alcohol and medicines can be harmful and can lead to dangerous reactions. Alcohol can cause the medication to become less effective or even useless, or it may make the medication harmful or toxic to the body. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, loss of coordination, internal bleeding, heart problems, and difficulties in breathing. Cough syrup and laxatives may have some of the highest alcohol concentrations.
The ingredients used to make lean are legal when prescribed by a doctor, but it is important to note that lean is not safe to drink under any circumstances. Codeine is listed as a Schedule II drug in the Controlled Substances Act, meaning it has a high potential for abuse and addiction and is only intended for prescribed medical uses. Lean is especially dangerous when consumed with alcohol. The super-sweet combination of soda, cough syrup, and hard candy provides a pleasing flavour and mouthfeel that lingers on the user's tongue for an extended duration, which can be appealing to first-time users.
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The increased risk of overdose and other side effects
The combination of cough syrup and alcohol is called by various names, including "lean", "purple drank", "sizzurp", and "screw", among others. This mixture is extremely dangerous and can lead to severe side effects and an increased risk of overdose.
Firstly, it is important to note that alcohol is one of the most widely abused intoxicating substances globally, and its use alongside other drugs can have unpredictable and amplified effects. Mixing alcohol with cough syrup can lead to a range of adverse side effects, including nausea, vomiting, headaches, drowsiness, fainting, loss of coordination, internal bleeding, heart problems, and difficulties in breathing. These side effects can be unpredictable and more severe when combining intoxicating substances.
Secondly, cough syrups often contain central nervous system (CNS) depressants such as dextromethorphan and codeine, which cause relaxation, sleepiness, and euphoria. When mixed with alcohol, a CNS depressant itself, the effects of both substances are amplified, increasing the risk of overdose. Dextromethorphan, in particular, is a widely abused drug that can cause intoxication, overdose, and addiction when used in large doses. The combination of these substances can lead to profound sedation, respiratory depression, coma, and even death.
Additionally, consuming alcohol while sick can worsen symptoms, cause dehydration, interfere with sleep, and weaken the immune system. This is true even when cough syrups contain guaifenesin, an expectorant that does not directly interact with alcohol. Alcohol can also make medications less effective or even harmful to the body, and it may interact negatively with other ingredients in cough syrups, such as narcotics like hydrocodone or codeine. These narcotic medications carry a black box warning from the FDA due to their high potential for abuse, dependence, and overdose when taken alone or in combination with alcohol.
Furthermore, the practice of mixing cough syrup and alcohol has led to addiction and overdose in many individuals, especially teens and young adults. The sweet taste and prevalence of this combination in pop culture have contributed to its misuse. The risk of overdose is heightened when alcohol is mixed with codeine-based cough syrups, as alcohol can cause a rapid release of the narcotic pain reliever, resulting in amplified euphoric effects and high alcohol blood content levels.
In conclusion, the combination of cough syrup and alcohol significantly increases the risk of overdose and adverse side effects. It is essential to heed the warnings on medication bottles and avoid mixing these substances under any circumstances.
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How to identify if someone is abusing this combination
Cough syrup abuse, particularly when combined with alcohol, poses a significant risk to both teens and adults. Dextromethorphan (DXM) is a common ingredient in many over-the-counter cough medicines, and its misuse can lead to harmful effects and even addiction.
- Behavioural changes and secretiveness: While it is normal for teenagers to exhibit mood swings, changes in sleep patterns, and increased secretiveness during adolescence, these behaviours could also indicate drug abuse. Keeping an eye on your child's internet usage and being aware of any websites they visit that discuss drug abuse or provide instructions on how to extract DXM from cough syrup is crucial.
- Physical symptoms and psychological effects: Common symptoms of cough syrup abuse, especially when combined with alcohol, include loss of coordination, numbness, nausea, excitability, vision changes, and lack of oxygen to the brain, which can lead to brain damage. Long-term abuse of DXM can result in cognitive impairments, memory loss, emotional instability, liver damage, respiratory depression, and cardiovascular problems. Additionally, the dissociative and hallucinogenic effects of DXM can cause individuals to injure themselves or experience severe sickness and rapid heart rate during a "bad trip."
- Combining cough syrup with alcohol or other drugs: Mixing cough syrup with alcohol or other drugs, such as MDMA, significantly increases the risk of severe and potentially fatal outcomes. The combination can lead to high blood pressure and an increased risk of heart attacks. Additionally, the likelihood of life-threatening conditions, such as liver damage, respiratory depression, and chemical psychosis, is heightened when DXM is mixed with other substances.
- High doses and frequency of use: People who abuse cough syrup often consume 10-40 times the recommended dose at once. They may also exhibit signs of frequent use, such as always appearing drowsy or impaired.
- Slang and cultural references : Being aware of slang terms and cultural references related to cough syrup abuse can help identify potential abuse. For example, terms like "Robo," "Skittles," "Vitamin D," and "Purple Drank" are commonly used to refer to cough syrup abuse. References to "tripping" or "syrup head" may also indicate abuse.
- Evidence in their possession : Checking your medicine cabinet regularly and keeping track of what's in it can help identify if any medications are missing or being used without your knowledge. Additionally, finding empty or hidden bottles of cough syrup or alcohol in their possession may be a red flag.
If you suspect someone is abusing this combination, it is important to approach the situation calmly and gather evidence to support your concerns. Offer support and guidance, and consider seeking professional help if needed.
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Alcohol-free cough syrup alternatives
Combining cough syrup and alcohol is extremely dangerous and can lead to overdose and even death. This combination is known by various names, including lean, purple drank, syrup, sizzurp, and screw. The cocktail typically includes cough syrup, soda, alcohol, and hard candy.
To avoid the dangers of mixing cough syrup and alcohol, it is recommended to opt for alcohol-free cough syrup alternatives. Here are some options:
Alcohol-Free Formulations
Most pharmacies carry alcohol-free cough syrups, such as Tussin-DM or Safe-Tussin DM. These formulations are designed to relieve cough and cold symptoms without the presence of alcohol. Always check the labels and consult your pharmacist to ensure the product is alcohol-free and suitable for your needs.
Daytime Cough Syrups
If you prefer non-drowsy formulas, daytime cough syrups are typically alcohol-free. These formulations help alleviate cough and cold symptoms during the day without causing drowsiness.
Alcohol-Free NyQuil
Vicks offers an alcohol-free version of its popular NyQuil product, which provides relief from cough, cold, and flu symptoms without the presence of alcohol. This option is ideal for those seeking relief from multiple symptoms without the potential negative effects of alcohol.
Tablet or Capsule Products
Tablet or capsule products, such as Sudafed PE Daytime/Nighttime, are usually alcohol-free. These alternatives are convenient for on-the-go relief and can be easier to swallow for adults who do not prefer syrups.
Children's Cold Medicine
If you are seeking options for children, alcohol-free children's cold medicine products, such as NyQuil Kids Cold & Cough, are available. These formulations help keep children comfortable while fighting off cold and cough symptoms.
It is important to remember that even though these alternatives do not contain alcohol, they may still have side effects. Always read the labels, follow the dosage instructions, and consult a healthcare professional if you have any concerns or underlying health conditions.
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Frequently asked questions
Mixing alcohol and cough syrup is called "polydrug use". This combination is dangerous and can lead to unpredictable or more severe side effects, including overdose and death.
Some common names for the mixture of alcohol and cough syrup include "lean", "purple drank", "sizzurp", "screw", "jelly", "Texas tea", and "dirty sprite".
Mixing alcohol and cough syrup can lead to a range of dangerous side effects, including:
- Respiratory depression
- Respiratory arrest
- Cardiac arrest
- Nausea and vomiting
- Headaches
- Drowsiness
- Fainting
- Loss of coordination
- Internal bleeding
- Heart problems
- Difficulty breathing
Alcohol and cough syrup are both central nervous system (CNS) depressants, which means they cause relaxation, sleepiness, and a euphoric feeling. When combined, they amplify each other's effects, increasing the risk of dangerous outcomes. Additionally, alcohol can make a medication less effective or even harmful to the body.
Abuse or addiction to the mixture of alcohol and cough syrup may exhibit some of the following signs:
- Tooth decay
- Dry mouth
- Hallucinations
- Motor-skill impairment
- Lethargy
- Dissociative feelings
- Lightheadedness
- Sleepiness
- Nervousness
- Restlessness
- Nausea
- Vomiting
- Stomach upset











































