Atimos modulite (Formoterol)

How does it work?

Atimos modulite CFC-free aerosol inhaler contains the active ingredient formoterol (previously known as eformoterol in the UK), which is a type of medicine called a long-acting beta 2 agonist. (NB. Formoterol inhalers are also available without a brand name, ie as the generic medicine.)

Formoterol works by acting on receptors in the lungs called beta 2 receptors. When formoterol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open.

In conditions where there is narrowing of the airways, such as asthma or chronic obstructive pulmonary disease (COPD, eg emphysema and chronic bronchitis), it is difficult for air to get in and out of the lungs. By opening the airways, formoterol makes it easier to breathe.

Formoterol is taken using an inhaler device. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it were taken by mouth.

Formoterol starts to work in one to three minutes and its effects last for about 12 hours. Due to its long-lasting effect, it is taken regularly twice a day (morning and evening) to help keep the airways open and prevent asthma attacks, wheezing, chest tightness or shortness of breath, for example before exercise or at night.

As formoterol starts to work quickly, it will work to relieve an asthma attack. However, current asthma management guidelines recommend that formoterol is only used as a preventer (ie on a regular basis) and that short-acting beta 2 agonists such as salbutamol or terbutaline (relievers) should used when required to relieve shortness of breath.

What is it used for?

  • Asthma.

In people whose asthma is not controlled with short-acting bronchodilators (eg salbutamol) and regular inhaled corticosteroids (eg beclometasone, budesonide, fluticasone), this medicine is used as an additional regular inhaler to help keep the airways open. It is taken regularly twice a day and is particularly useful for preventing shortness of breath caused by exercise, and to prevent shortness of breath that is worse at night.

  • Chronic obstructive pulmonary disease (COPD).

This medicine is used as a regular inhaler taken twice daily to help keep the airways open.


  • You should make sure you know how to use this inhaler properly (instructions will be provided inside the box). You can ask your doctor, nurse or pharmacist for help if you are unsure about anything.
  • Your symptoms are likely to improve once you have started using this medicine regularly. However, it is important that you don't reduce your dose of corticosteroid medicine (eg beclometasone, budesonide, fluticasone), as this will make your symptoms get worse again.
  • Do not exceed the dose of formoterol that your doctor has prescribed you to use.
  • If this inhaler does not seem to work as well or for as long as usual, or if you find you need to use your reliever inhaler (eg salbutamol or terbutaline) more often than normal, you should consult your doctor as soon as possible. It may be that your asthma is getting worse and your doctor might need to give you another medicine.
  • Inhalers may cause an unexpected increase in wheezing (paradoxical bronchospasm) straight after using them. If this happens, stop using the inhaler immediately and consult your doctor. The medicine should be stopped and an alternative treatment found.
  • People with severe asthma should have regular blood tests to monitor the amount of potassium in their blood. This is because low oxygen levels in the blood (hypoxia) and various asthma medicines, including this one, can lower blood potassium levels.

Use with caution in

  • Heart disease caused by inadequate blood flow to the heart (ischaemic heart disease, eg angina).
  • Heart disease characterised by thickening of the internal heart muscle and a blockage inside the heart (hypertrophic obstructive cardiomyopathy).
  • People with an irregular heartbeat (arrhythmia), or an abnormal heart rhythm seen as a 'prolonged QT interval' on a heart monitoring trace or ECG.
  • People taking other medicines that can cause a 'prolonged QT interval' (see end of factsheet for examples).
  • People with a serious defect in the heart's electrical message pathways resulting in decreased function of the heart (3rd degree heart block).
  • People with narrowing of the tract through which blood is pumped out of the heart (idiopathic subvalvular aortic stenosis).
  • Severe heart failure.
  • High blood pressure (hypertension).
  • Severe cirrhosis of the liver.
  • Overactive thyroid gland (thyrotoxicosis).
  • Tumour of the adrenal gland (phaeochromocytoma).
  • Diabetes. It is recommended that people with diabetes should monitor their blood sugar more carefully when starting treatment with this medicine, as it may increase blood sugar levels. If your diabetes treatment becomes less effective, ie your blood sugar levels are harder to control, you should consult your doctor.

Not to be used in

  • Known sensitivity or allergy to any ingredient.
  • Atimos modulite inhaler is not recommended for children under twelve years of age.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • It is important that asthma is well controlled in pregnant women. Wherever possible, asthma medications should be taken by inhaler, as this minimises the amount of medicine that enters the bloodstream and crosses the placenta. The safety of this medicine for use during pregnancy has not been established by the manufacturer, and they state that it should only be used during pregnancy if the potential benefits outweigh any risks to the developing baby. It is important to get medical advice from your doctor on how to control your asthma during pregnancy.
  • It is not known whether this medicine passes into breast milk. The manufacturer states that it should be used with caution in women who are breastfeeding. However, in general, asthma inhalers can be used as normal during breastfeeding, because the amount of medicine that passes into the breast milk after using an inhaler is negligable and unlikely to harm the baby. Seek further medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common (affect between 1 in 10 and 1 in 100 people)

  • Shaking, usually of the hands (tremor).
  • Headache.
  • Awareness of your heart beat (heart palpitations).
  • Cough.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

  • Dizziness.
  • Faster than normal heart beat (tachycardia).
  • Difficulty sleeping (insomnia).
  • Restlessness or agitation.
  • Throat irritation.
  • Muscle cramps.
  • Feeling sick.
  • Taste disturbances.
  • High blood sugar levels (hyperglycaemia).

Rare (affect between 1 in 1000 and 1 in 10,000 people)

  • Unexpected narrowing of the airways (paradoxical bronchospasm) - see warning section above.
  • Low blood potassium level (hypokalaemia).
  • Irregular heartbeats (arrhythmias).
  • Change in blood pressure.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

This medicine should not be taken with beta-blockers, such as atenolol, propranolol or timolol. This is because beta-blockers have an opposite action to this medicine and cause the airways to narrow. This can result in breathing difficulties for people with asthma or COPD. This problem has sometimes been seen with eye drops containing beta-blockers, eg used for glaucoma.

Formoterol can potentially cause a serious decrease in the levels of potassium in the blood (hypokalaemia), which may result in adverse effects. This effect can be increased by the following medicines, which can also lower potassium in the blood:

  • acetazolamide
  • xanthine derivates, such as theophylline or aminophylline
  • corticosteroids, such as beclometasone and prednisolone
  • other beta 2 agonists, such as salbutamol
  • diuretics, such as bendroflumethiazide and furosemide.

This is why people with severe asthma or COPD, who may be taking several of these medicines, should have their blood potassium levels monitored regularly.

There may be an increased risk of abnormal heart rhythms (prolonged QT interval on the heart monitoring trace or ECG) if this medicine is taken in combination with other medicines that can have this effect, such as the following:

  • certain antihistamines (terfenadine, astemizole, mizolastine)
  • certain medicines for abnormal heartbeats (antiarrhythmics, eg quinidine, disopyramide, procainamide)
  • certain antidepressants, eg amitriptyline, imipramine, maprotiline
  • certain antipsychotics, eg thioridazine, chlorpromazine, sertindole, haloperidol
  • certain antimalarials, eg halofantrine, chloroquine, quinine
  • erythromycin.

Other medicines containing the same active ingredient

Foradil breath actuated inhaler Oxis turbohaler

Formoterol inhalers are also available without a brand name, ie as the generic medicine.