Lidocaine toxicity with tumescent liposuction. A case report of probable drug interactions.

When two or three drugs are each substrates for the same enzyme, there is a possibility for an adverse drug reaction when used simultaneously. Lidocaine is rapidly and almost exclusively eliminated by CYP3A4. The newer antidepressant selective serotonin reuptake inhibitors (SSRI) such as sertraline are metabolized by the hepatic enzymes CYP3A4 and CYP2D6. The benzodiazepines such as midazolam (Versed) and diazepam (Valium) are also metabolized by the CYP 3A4 isoenzymes. The specific cytochrome P450 enzyme responsible for the metabolism of flurazepam has not been identified.