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Caffeine, Energy Drinks and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 3, 2019.

Caffeine is the most consumed drug on the planet. So it’s no surprise that energy drinks are the second most popular dietary supplement in the U.S., second only to vitamins.

Energy drinks are non-alcoholic beverages that contain caffeine, along with other ingredients such as amino acids, other stimulating dietary supplements, herbals, and vitamins. Annual sales of energy drinks number in the billions of dollars worldwide. In 2018, energy drink sales in the US alone reached $3.14 billion. Effective marketing has skyrocketed the sales of these products, including popular brand names of energy drinks such as:

  • Red Bull
  • Amp Energy
  • Monster
  • Rockstar
  • NOS
  • 5-Hour Energy 

Caffeine is the main ingredient in most energy drinks, and a 24-oz energy drink may contain from 80 mg to 500 mg of caffeine (similar to four or five cups of coffee). The FDA requires energy drink labels to list if the product contains caffeine, but the FDA does not require a caffeine limit or reporting of the actual level of caffeine from the manufacturer.

Energy drinks may also contain guarana (a plant-based source of caffeine also called Brazilian cocoa). One gram of guarana is equal to 40 to 50 mg of caffeine, and although it may be listed as an ingredient in some energy drink labels, it’s added caffeine content often is not noted on the label.

Other ingredients may include taurine, B vitamins, sugar, ginseng, artificial sweeteners, or artificial preservatives and colors.

What does caffeine do?

  • stimulates the central nervous system (for example, the brain)
  • imparts a temporary sense of alertness
  • dilates blood vessels
  • elevates heart rate and blood pressure
  • can lead to dehydration
  • leads to withdrawal symptoms

While caffeine is usually used responsibly and safely, some people misuse energy drinks by combining them with alcohol to boost a sense of intoxication. Combining alcohol with energy drinks that are high in caffeine or guarana has become popular among the younger crowd, including college students. Males between the ages of 18 and 34 years consume the most energy drinks, and about 30% of teens drink them on a regular basis.

  • A 2019 study found that consumption of energy drinks grew substantially between 2003 and 2016. Researchers found that these drinks are a major source of caffeine among those who consume them. The increase in consumption in young adults increased from 0.5% to 5.5%.
  • A study in the journal Pediatrics found that 54% of 496 surveyed college students reported mixing energy drinks with alcohol, and 49% drank three or more energy drinks mixed with alcohol at one setting.
  • The U.S. Centers for Disease Control and Prevention (CDC) reports that in 2011, almost 1,500 adolescents aged 12 to 17 years went to the emergency room for an energy drink related emergency.

Is it safe to mix alcohol with energy drinks?

Caffeine is a stimulant when consumed alone. When used with alcohol, a CNS depressant, it can block the sensory cues used by people to know they are getting intoxicated. They may drink more and more alcohol, which will worsen their impairment and increase the risk of an alcohol-linked injury.

Some people believe caffeine will counteract the alcohol effect, but that is not true. Caffeine cannot “sober up” someone up who has been drinking alcohol. Their judgement, coordination, and reaction times are still adversely affected.

Injury or death can occur because people are more likely to engage in risky and hazardous activities. Studies have shown alcohol poisoning, unprotected sex, sexual assault, and riding with an intoxicated driver occur more frequently.

For some people, excessive amounts of caffeine can lead to health issues such as:

  • heart problems (fast heart rate, altered heart rhythm, increased blood pressure)
  • headaches
  • anxiety
  • sleep problems (insomnia)
  • dehydration
  • agitation.

Many caffeinated drinks contain 25 to 50 grams of sugar. When added to additional calories from alcohol, patients with diabetes may run into issues with blood sugar control and weight gain.

As reported by the National Institutes of Health (NIH), 42% of all energy-drink related emergency department visits involved combining these beverages with alcohol or drugs (including illicit drugs like cocaine, stimulants like Ritalin or Adderall, or marijuana).

Warnings 

The American Academy of Pediatrics (AAP) reports that caffeine has been linked to a number of harmful health effects in children, including effects on the developing neurologic (brain) and cardiovascular (heart) systems. They do not recommend caffeine for children. Most energy drinks are labeled to be avoided in children, as well.

If you have an underlying condition such as heart disease or high blood pressure, ask your doctor if energy drinks may cause complications.

Women who are pregnant or breastfeeding should avoid or limit consumption of these beverages and caffeine in general.

Bottom line

A daily cup of coffee or two is a ritual for many adults, and for the most part is very safe. However, energy drinks, which can be exceptionally high in caffeine, should be used with discretion and should be avoided with certain health risks. If you have a heart condition or high blood pressure, are pregnant or breastfeeding, are a teen or a parent of a child drinking these products, discuss with your doctor if caffeine-boosted energy drinks are wise for your health, or your child's health.

Energy drinks may temporarily enhance alertness, but the individual effect when adding alcohol to an energy drink can be problematic.

  • Young adults who combine caffeinated energy drinks with alcohol may not be able to judge their level of intoxication.
  • Sleep can be disrupted and risky behaviors may seem harmless, leading to injury.
  • Weight gain and altered blood sugar can be problematic, especially in patients with diabetes.

Avoid regularly mixing alcohol with caffeine. If you feel run down or fatigued, consider healthier ways to boost your energy, such as adequate sleep, a normal bedtime and awakening schedule, daily exercise, adequate non-alcoholic fluids (like water) and a healthier diet.

Health care providers and parents should discuss the use of caffeine and alcohol with adolescents and young adults and educate them on the potential risks of both, either alone or mixed together.

Other Alcohol Interactions

Sources

  1. Vercammen K, Koma J, Bleich S. Trends in Energy Drink Consumption Among U.S. Adolescents and Adults, 2003–2016. Am J Prev Med. 2019;56:827-833. doi: 10.1016/j.amepre.2018.12.007
  2. Center for Behavioral Health Statistics and Quality. The DAWN Report: Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.
  3. CDC Healthy Schools: The Buzz on Energy Drinks. US Centers for Disease Control and Prevention (CDC). Accessed Nov. 3, 2019 https://www.cdc.gov/healthyschools/nutrition/energy.htm
  4. Energy drink sales in the United States from 2015 to 2018. Statista.
  5. Fact Sheets - Alcohol and Caffeine. US Centers for Disease Control and Prevention (CDC). Accessed Dec. 3, 2019 at https://www.cdc.gov/alcohol/fact-sheets/caffeine-and-alcohol.htm
  6. Seifert S, Schaechter J, Hershorin E, et al. Health Effects of Energy Drinks on Children, Adolescents, and Young Adults. Pediatrics March 2011; 27: 511-528. Accessed May 21, 2019 at DOI: https://doi.org/10.1542/peds.2009-3592
  7. Roemer A. Stockwell T. Alcohol Mixed With Energy Drinks and Risk of Injury: A Systematic Review. J Stud Alcohol Drugs. 2017 Mar;78(2):175-183. Accessed November 11, 2019.
  8. Energy drinks: Do they really boost energy? Drugs.com. Accessed November 11, 2019 at https://www.drugs.com/mcf/energy-drinks-do-they-really-boost-energy
  9. Kids Should Not Consume Energy Drinks, and Rarely Need Sports Drinks, Says AAP. American Academy of Pediatrics (AAP). Accessed April. 28, 2020 at https://healthychildren.org/English/news/Pages/Kids-Should-Not-Consume-Energy-Drinks-and-Rarely-Need-Sports-Drinks-Says-AAP.aspx
  10. Brown University Health Promotion. Energy Drinks. Accessed Nov. 3, 2019 at  https://www.brown.edu/campus-life/health/services/promotion/alcohol-other-drugs-other-drugs/energy-drinks
  11. Young Adults Flocking to Energy Drinks. Drugss.com. Accessed Dec. 3, 2019 at drugs.com/news/young-adults-flocking-energy-drinks-82136.html

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.