with lidocaine with epinephrine and sodium bicarbonate should enhance adipolysis via two distinct mechanisms, with DCA causing cytolysis (adipolysis) via destruction of the cell membrane and the epinephrine stimulating the lipolytic pathway, given that the pH impact of epinephrine is addressed to avoid undermining one of these mechanisms.
Further research is required to determine if the addition of epinephrine could net enhance the adipolytic effects of DCA via the aforementioned mechanisms in clinical studies, particularly if measures are taken to neutralize its impact on the pH of the solution. This experimental model suggests the possibility of dilutions of DCA (2 mL), lidocaine with epinephrine (1 mL), and bicarbonate (0.2 mL) that could maintain a neutral/ alkaline pH while mitigating injection pain, allowing product to be used effectively over larger surface areas, and potentially augmenting the efficacy of injectable DCA.
Further research is required to determine if the addition of epinephrine could net enhance the adipolytic effects of DCA via the aforementioned mechanisms in clinical studies, particularly if measures are taken to neutralize its impact on the pH of the solution. This experimental model suggests the possibility of dilutions of DCA (2 mL), lidocaine with epinephrine (1 mL), and bicarbonate (0.2 mL) that could maintain a neutral/ alkaline pH while mitigating injection pain, allowing product to be used effectively over larger surface areas, and potentially augmenting the efficacy of injectable DCA.
DISCLOSURES
The authors have no conflicts to report.
REFERENCES
1. Sung CT, Lee A, Choi F, Juhasz M, Mesinkovska NA. Non-submental applications of injectable deoxycholic acid: a systematic review. J Drugs Dermatol. 2019;18(7):675-680.
2. Kybella [package insert]. Westlake Village, CA: Kythera Biopharmaceuticals Inc; 2015.
3. Pollock S, Nathan NR, Costa RD, Kourosh AS. A novel injection technique for the use of deoxycholic acid to mitigate pain while maintaining efficacy [published online ahead of print, 2020 Jul 21]. J Am Acad Dermatol. 2020;S0190-9622(20)32261-1. doi:10.1016/j.jaad.2020.07.061
4. Chernick SS, Spooner PM, Garrison MM, Scow RO. Effect of epinephrine and other lipolytic agents on intracellular lipolysis and lipoprotein lipase activity in 3T3-L1 adipocytes. J Lipid Res. 1986;27(3):286-294.
2. Kybella [package insert]. Westlake Village, CA: Kythera Biopharmaceuticals Inc; 2015.
3. Pollock S, Nathan NR, Costa RD, Kourosh AS. A novel injection technique for the use of deoxycholic acid to mitigate pain while maintaining efficacy [published online ahead of print, 2020 Jul 21]. J Am Acad Dermatol. 2020;S0190-9622(20)32261-1. doi:10.1016/j.jaad.2020.07.061
4. Chernick SS, Spooner PM, Garrison MM, Scow RO. Effect of epinephrine and other lipolytic agents on intracellular lipolysis and lipoprotein lipase activity in 3T3-L1 adipocytes. J Lipid Res. 1986;27(3):286-294.
AUTHOR CORRESPONDENCE
Arianne Shadi Kourosh MD MPH shadi@mail.harvard.edu
