When cocaine and ethanol coexist in one's blood a unique chemical reaction occurs in the liver. When both substances are metabolized it produces a byproduct called cocaethylene (ethylbenzoylecgonine).

When cocaine is ingested and reaches the liver it needs to metabolize. A special enzyme in the liver (carboxylesterase) provokes the hydrolysis of cocaine. As a result of the chemical reaction two inactive metabolites known as benzoylecgonine and ecgonine methyl ester are produced.

If ethanol is present during this metabolic process a portion of the cocaine will be metabolized differently than the it typically would. Hydrolysis is interrupted and replaced with a different reaction entirely to create a different byproduct, an active metabolite called cocaethylene.

Cocaine and cocaethylene are very similar chemically and even metabolize into the same structure. Being two different esters of the same metabolite makes them chemical cousins; cocaine being the methyl ester of benzoylecgonine and cocaethylene is the ethyl ester of the same metabolite.
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