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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17958
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I've been on nortryptyline months, now on 100 mg

Customer Question

I've been on nortryptyline for several months, now on 100 mg for migraines. I have also gained over 20 lbs in spite of increased exercising and having significantly decreased appetite (in last several days no appetite and nausea), acid reflux, bloating, fluid retention everywhere, distended stomach, stomach pain in right side, malaise, symptoms of IBS, and fatigue. I started to see an acupuncturist to help with the weight gain and he said I showed signs of liver damage. I was shocked because I only drink socially and that's infrequently. It took me a week to realize I needed to look at my medications. This one is metabolized by the liver and associated with liver issues and weight gain - should I be concerned because these are pretty significant signs of liver disease? Is this an emergency? I know I can't stop cold turkey... what should I do? I'm afraid to sleep. Unfortunately my doctor doesn't have an answering service...
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.
Are you having any significant vomiting?
How severe is the abdominal pain?
Has there been any blood tests of liver function?
Expert:  Dr. D. Love replied 1 year ago.
I had asked for some further information and have not heard back.
It is appropriate to be concerned about the possibility of liver disease.
For the vast majority of people, this would not be an emergency. The only times that this would be an emergency would be if there were more severe symptoms, particularly severe vomiting or abdominal pain.
If there are no severe symptoms, then this can be evaluated as an out-patient. The first step, if not already done, would be to check blood tests of liver function, along with other screening blood tests, such as electrolytes, kidney function tests, and a thyroid profile.
If there are no severe symptoms, then it would be fine to wait to get these tests done once your doctor's office opens.
Your doctor can also discuss tapering off the nortriptyline, which would usually be done over several weeks, and also should occur in the context of a discussion of using an alternative for the migraines.
If I can provide any clarification, please let me know.
Customer: replied 1 year ago.
Thank you. The pain is constant but not unbearable (occasionally it is sharp and I'll need to lie down - I don't have an appendix or gall blasts so I know it's nothing like this). I have not actually vomited yet but yesterday I thought I might while driving but somehow got through it. I was also incredibly dizzy a couple of times (when I was doing hot yoga and then I was in a very hot room). I have not had blood tests yet - I tried calling my doctor last night and she has no answering service and I called again this morning and tried to explain to someone and they made me leave a message. So I'm waiting to hear. I'm glad to hear that I'm not on death's doorstep and I have a little time. I also have another appointment with the acupuncturist this evening so he is helping as well. He is the one who tipped me off about the liver. I think you're right about tapering and trying something else. I appreciate it. Is the weight gain associated with nortriptyline reversible once you stop taking it? Are there other medications (other than topamax which I'm also taking) that work for migraine that will reverse this weight gain (which might me just fluid retention - I look like Fat Elvis and nothing fits). The distended stomach doesn't help. Thank you!
Expert:  Dr. D. Love replied 1 year ago.
Yes, the weight gain associated with the nortriptyline will reverse once the drug is stopped. There are many other choices for migraine, and while they do not specifically oriented towards reversing the weight gain, the fact that the nortriptyline is stopped will reverse the weight gain.