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My doctor started me on two doses daily (am and pm) in August, 2011. The second day on it, I was on a camping trip and developed an itchy rash on my lower arms and hands, and my lower legs. I didnt connect it to the spiriva so I went to my regular doctor and my dermatologist. The dermatologist told me to stop taking the spiriva and wait for my my cardiologist to come back in town. As it turned out I was having a "sun sensitivity" to the medicine. He cut my dosage to once at night and I have not had any more problems with a rash. However, a month or so after I started taking the medicine, I started having "shaking episodes". I did tell my cardiologist the last time I saw him. It is mainly my hands shaking. by SIDNEY from North East, MD
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