Argh. I looked up nortiptyline and is said something like an accidental overdose is easy to do. Yep, there's that liver warning for Cymbalta. Ghee this is tough b/c my doc will know I've done my homework. I've used bupropion for years, but it's lost it's effectiveness on me (10 years) and doesn't help with NP. 6 of 10 of my nerves in my lower legs are unresponsive-but I still walk (have a service dog for artificial lighting areas where I have most balance problems). Otherwise I hike, etc. I used to suffer from awful panic attacks in my 20's, so I have been to many, many years of counseling. I go weekly now. The docs thought I had borderline personality disorder for many years before the tumor was found! Lol - not.

I don't want liver problems (who does), but I want a life too. No one on this thread said anything too worriesome about Cymbalta (except the blowout) and I'm wondering if I can have my liver function tested regularly to be sure I'm not causing damage. Weight gain was listed on both; I lost 10 pounds when I quit Lyrica.

My NP is excruciating burning on the bottom of my feet, especially on the balls and for good measure stabbing pain occasionally, if I'm as active as a normal person (actually more active - I can't seem to stop if I get on a roll) or if I wear the same shoes all day (no high heels of course). I live in slippers at home. Sometimes the burning/stabbing is so bad, I cry. I have oxycodone I take regularly to prevent most breakthrough pain.

I really appreciate the responses and read each one with gratitude.

I'm glad I found you guys and hope to be of help to others as well.

The doses used for nortriptyline are much lower (sometimes only 10%) than the antidepressant doses.

At the low end therefore there is not much risk of overdosing unless one takes a whole bottle of them.

The tricyclics when used for depression were used 100mg + a day (up to 200-300mg a day). At that dose, and when mixed with other drugs that affect liver enzyme metabolism, THEN, an QT event may be triggered.
When tricyclics first came out on the market for depression, these liver enzymes had NOT been discovered yet. And suicide attempts with them were often fatal because they affect the heart rhythm in high doses.

Today there is alot of research on QT events, because this was happening with a common antihistamine called Seldane --which was taken off the market. Seldane used with erythromycin or antifungal drugs caused the heart to stop.

There is a research organization now for this topic:
https://www.crediblemeds.org/

Now, the issue with Cymbalta is different. This drug is not used in tiny doses for PN.... it is used in HIGH doses right from the beginning. So the liver toxicity is much much higher in potential than with nortriptyline.(or amitriptyline). Cymbalta caused some deaths even during its clinical trials. None of the other SSRI/SNRI drugs have that history either. People who drink or who already have liver damage, are most at risk for liver damage with Cymbalta. But damage has occurred in patients who do not drink alcohol at all.

Therefore Cymbalta is not for everyone.

If you put your daily dose(s) in a daily pillbox once a week, like I do, it's pretty hard for this senior citizen to take too many capsules of Nortriptyline, unless you are trying to do yourself in. 50 mg of it daily has also greatly reduced my need for a benzo for panic/anxiety.