Tumescent liposuction. Are there any contradictions with the tumescent fluid and patient taking antidepressants?

Certain medications can compete with the degradation of lidocaine in the liver through something called a P450 enzyme system. That enzyme can have a bottleneck affect when competing drugs are added giving one, or the other or both drugs and potentially longer half-life. some plastic surgeons take this into consideration when doing liposuction as an awake procedure when calculating the safe dose of lidocaine to be used.

Other than this potential lengthened half-life of lidocaine because of P4 50 enzyme inhibition I don’t know of any other potential issues.

Many many different types of drugs are broken down through that enzymatic pathway in the liver.

I personally do not differentiate on how much lidocaine I use when doing liposuction as an a week procedure for patients to take medications similar to around. I routinely use up to 50 mg per kilogram in tumescent solution.

If the procedure is done under general anesthesia and the need for large volumes of lidocaine is a non-issue.

I certainly wouldn’t let that stop you from having a liposuction. Have a few in person consultations to see if you’re a good candidate for the procedure. This really only is the potential issue when the procedure is done as an awake procedure.

Even then this is more theoretical than it is a real problem. Going up to 50 mg per kilogram of lidocaine even on patients who take antidepressants has never once cost me to have patience report lidocaine toxicity symptoms. as one of my anesthesiology friends once noted there is a long distance between having the first signs of lidocaine toxicity and having a serious negative outcome.

Best,

Mats Hagstrom MD