Lincolnshire Prescribing and Clinical Effectiveness Forum (PACEF) was founded in 2007. It is the current strategic advisory network to NHS Lincolnshire CCG. PACEF has the responsibility for ensuring the cost-effective use of medicines and other healthcare interventions and their functional integration into healthcare delivery across Lincolnshire.

Representation on the group is comprised of leading professionals from the Lincolnshire Clinical Commissioning Group, primary care, the local Acute Trusts (United Lincolnshire Hospitals Trust and Lincolnshire Partnership Foundation Trust), Lincolnshire Community Health Services, Local Medical Council and Local Pharmaceutical Council. 

PACEF Bulletins

Title
PACE Bulletin Vol 8 No 23 Dec14 Lipid Modification

Description

Review of Lincolnshire lipid modification guidance in response to the new NICE clinical guideline.

PACE Bulletin Vol 8 No 22 Dec Antibiotic Prescribing Winter 2014-15

Description

Prescribing Advice - Lincolnshire guidelines for the treatment of commonly occurring infections in primary care: Winter 2014/15.

PACE Bulletin Vol 8 No 21 Dec14 Stroke Prevention in AF

Description

Treatment selection: Newly diagnosed Atrial Fibrillation patients (CHA2DS2-VASc score > 1) requiring oral anticoagulant stroke thromboprophylaxis.

Treatment selection: Existing patients diagnosed with AF (CHA2DS2-VASc score > 1) currently taking a vitamin K antagonist.

NICE Technology Appraisal 249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (March 2012).

NICE Technology Appraisal 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation (May 2012).

NICE Technology Appraisal 275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation (February 2013).

NICE Clinical Guideline 180: Atrial fibrillation: the management of atrial fibrillation (June 2014).

Guidance on switching: Dabigatran, rivaroxaban or apixaban to warfarin Licensed doses for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation.

Guidance on switching: Warfarin to dabigatran, rivaroxaban or apixaban.

NICE Diagnostic Guidance 14: Atrial fibrillation and heart valve disease: self-monitoring coagulation status using point of care coagulometers (CoaguChek XS system and INRatio 2 PT/INR monitor) (September 2014).

PACE Bulletin Vol 8 No 20 Dec14

Description

New Drug Assessment: Sodium hyaluronate 0.1% and dexpanthenol 2% eye drops (Hylo-Care).

New Drug Assessment: Budesonide/ formoterol fumarate breath actuated dry powder inhaler 160microgram/4.5microgram and 320microgram/9microgram (DuoResp Spiromax).

Rapid Drug Assessment: Beclometasone/ formoterol dry powder inhaler 100microgram/ 6microgram (Fostair NEXThaler).

Rapid Drug Assessment: Canagliflozin/metformin 50mg/850mg and 50mg/1000mg tablets (Vokanamet).

Rapid Device Assessment: Freestyle Libre glucose monitoring system.

New Device Assessment: Otovent autoinflation device for glue ear.

NICE Technology Appraisal 317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndrome (July 2014).

European Medicines Agency: PRAC recommends strengthening the restrictions on the use of valproate in women and girls.

Medicines and Healthcare products Regulatory Agency: Drug Safety Update (October 2014): Interferon-beta: Risk of thrombotic microangiopathy and risk of nephrotic syndrome; Dexamethasone 4mg/ml injection (Organon Laboratories Ltd): Reformulation with changes in name, concentration, storage conditions and presentation; Drugs and driving.

PACE Bulletin Vol 8 No 19 Dec14

Description

Review: Needles for Pre-Filled and Reusable Pen Injectors.

Product Recall: Aciclovir 3% eye ointment (Zovirax).

New Drug Assessment: Calcium acetate capsules (PhosLo).

New Drug Assessment: Tocilizumab subcutaneous injection (RoActemra) for rheumatoid arthritis.

Rapid Drug Assessment: Polyethylene glycol 0.6% eye drops (Systane Balance).

New Device Assessment: Levonorgestrel 13.5mg intrauterine delivery system (Jaydess).

Specialised Services Circular: Primary care responsibilities in relation to the prescribing and monitoring of hormone therapy for patients undergoing or having undergone gender dysphoria treatments (March 2014).

NICE Technology Appraisal 320: Dimethyl fumarate for treating relapsing-remitting multiple sclerosis (August 2014).

Rapid Cost Comparison: Lower cost galantamine formulations.

PACE Bulletin Vol 8 No 18 Oct14

Description

New Trial Assessment: Does daily aspirin reduce cancer risk?

New Drug Assessment: Alprostadil 300microgram in 100mg cream (Vitaros).

New Formulation Assessment: Methotrexate pre-filled pen for subcutaneous injection (Metoject).

Formulary Update: Finasteride 5mg tablets; Prochlorperazine 5mg in 5ml liquid (generic); Discontinuation of Ortho-Gynest (estriol) pessaries; Ibuprofen 10% gel (Fenbid).

NICE Technology Appraisal 316: Enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen (July 2014).

NICE Technology Appraisal 319: Ipilimumab for previously untreated advanced (unresectable or metastatic) melanoma (July 2014).

Medicines and Healthcare Products Regulatory Agency, Drug Safety Update (August 2014): Levonorgestrel and ulipristal remain suitable emergency contraceptives for all women, regardless of body weight or body mass index.

Shared care update: Denosumab injection (Prolia) for Peterborough patients.

Medicines and Healthcare Products Regulatory Agency, Drug Safety Update (September 2014): Denosumab – Minimising the risk of osteonecrosis of the jaw; Nitrofurantoin now contraindicated in most patients with an estimated Glomerular Filtration Rate of less than 45ml/min; Domperidone – Risk of cardiac side effects – No longer available without prescription.

PACE Bulletin Vol 8 No 17 Oct14 Smoking Cessation

Description

Prescribing Advice - guidance on the prescirbing of smoking cessation therapy.

PACE Bulletin Vol 8 No 16 Sep14

Description

Rapid Drug Assessment: Ropinirole 2mg, 4mg, 8mg sustained release tablets (Repinex XL).

Rapid Drug Assessment: Lecicarbon A suppositories.

Rapid Drug Assessment: Fluoxetine dispersible tablets 20mg (Olena).

NICE Technology Appraisal 308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody associated vasculitis (March 2014).

NICE Technology Appraisal 309: Pemetrexed maintenance treatment following induction therapy with pemetrexed and cisplatin for non-squamous non-small-cell lung cancer (April 2014).

NICE Technology Appraisal 310: Afatinib for treating epidermal growth factor receptor mutation-positive locally advanced or metastatic non-small-cell lung cancer (April 2014).

NICE Technology Appraisal 311: Bortezomib for induction therapy in multiple myeloma before high dose chemotherapy and autologous stem cell transplantation (April 2014).

NICE Technology Appraisal 313: Ustekinumab for the treatment of psoriatic arthritis (May 2014).

Medicines and Healthcare Products Regulatory Agency: Drug Safety Update (June 2014): Combination use of medicines from different classes of renin-angiotensin system blocking agents; Ivabradine – emerging evidence of increased cardiovascular risk.

European Medicines Agency, Levonorgestrel and ulipristal remain suitable emergency contraceptives for all women, regardless of bodyweight (July 2014).

Medicines and Healthcare Products Regulatory Agency: Drug Safety Update (July 2014): Drugs and driving – Blood concentration limits to be set for certain controlled drugs in new legal offence; Transdermal fentanyl patches – Reminder of potential life-threatening harm from accidental exposure particularly in children.

PACE Bulletin Vol 8 No 15 Aug14

Description

Review: Oxycodone preparations.

Rapid Drug Assessment: Buprenorphine patches (BuTrans and Transtec).

Product Discontinued: Fusidic acid 1% gel eye drops (Fucithalmic).

Rapid Cost Comparison: Ondansetron 4mg and 8mg oral film (Setofilm).

PACE Bulletin Vol 8 No 14 Aug14

Description

Generic sildenafil tablets removed from the selected list scheme.

NICE Technology Appraisal 315: Canagliflozin in combination therapy for treating type 2 diabetes (June 2014).

Review of Prescribable Medical Devices: Silk garments for eczema/atopic dermatitis.

Rapid Drug Assessment: Fexofenadine 120mg and 180mg tablets.

Rapid Drug Assessment: Dapagliflozin/metformin 5mg/850mg and 5mg/1000mg tablets (Xigduo).

PACE Bulletin Vol 8 No 13 Jul14

Description

New Drug Assessment: Brimonidine tartrate 3mg/g gel (Mirvaso) for facial erythema of rosacea.

Rapid Drug Assessment: Sodium chloride 5% preservative free eye drops (PF Drops and NaCl 5%).

Review: Melatonin prolonged-release 2mg tablets (Circadin).

Medicines and Healthcare products Regulatory Agency, Drug Safety Update (May 2014): Voriconazole – Reminder of risk of liver toxicity, phototoxicity and squamous cell carcinoma; Adrenaline Auto-injector – Advice for patients; Statins – Benefits and risks.

PACE Bulletin Vol 8 No 12 Jun14

Description

Drug Safety Advice: Domperidone - risk of cardiac side effects.

Rapid Drug Re-Assessment: Sildenafil chewable tablets 25mg, 50mg and 100mg (Nipatra).

Rapid Drug Assessment: Avanafil 50mg, 100mg and 200mg tablets (Spedra).

Rapid Review: Resource ThickenUp Clear.

Rapid Re-Assessment: Omnitest 3 meter and blood glucose testing strips.

Review of expiry dates of blood glucose testing strips.

NICE Technology Appraisal 304: Total hip replacement and resurfacing arthroplasty for end-stage arthritis of the hip (February 2014).

NICE Technology Appraisal 305: Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion (February 2014).

NICE Technology Appraisal 306: Pixantrone monotherapy for treating multiply relapsed or refractory aggressive non-Hodgkin’s B-cell lymphoma (February 2014).

Medicines and Healthcare products Regulatory Agency, Drug Safety Update (April 2014): Tumour Necrosis Factor Alpha Inhibitors: Risk of tuberculosis.

NICE Technology Appraisal 307 Aflibercept in combination with irinotecan and fluorouracil-based therapy for treating metastatic colorectal cancer that has progressed following prior oxaliplatin-based chemotherapy (March 2014).

PACE Bulletin Vol 8 No 11 Jun14

Description

Changes to controlled drug legal classifications: tramadol, lisdexamfetamine, zopiclone and zaleplon.

New Device Assessment: Vibro-Pulse and Vibro-Pulse cycloidal vibration accessories.

New Drug Assessment: Fluticasone furoate/vilanterol inhalation powder (Relvar Ellipta).

Rapid Cost Comparison: Prescribe low cost generic triptans preferentially for migraine.

Rapid Wound Management Product Review: Coban 2 and Coban 2 Lite multi-layer compression bandage kit.

Prescribe nystatin oral suspension as Nystan.

PACE Bulletin Vol 8 No 10 May14

Description

New Drug Assessment: Alogliptin 6.25mg, 12.5mg and 25mg tablets (Vipidia) and alogliptin/metformin 12.5mg/1g tablets (Vipdomet).

New Drug Assessment: Tamsulosin 400 microgram/ solifenacin 6mg modified release tablet (Vesomni).

Rapid Drug Assessment: Captopril oral solution 5mg in 5ml and 25mg in 5ml (Noyada).

Rapid Drug Assessment: Metolazone tablets 5mg and 10mg (unlicensed).

New Indication Assessment: Colesevelam 625mg capsules.

(Cholestagel) for the treatment of bile acid malabsorption.

Formulary Amendment: Sevelamer hydrochloride 800mg tablets (Renagel) to be removed from the Formulary.

Medicines and Healthcare Regulatory Agency: Drug Safety Update (March 2014) – Orlistat: theoretical interaction with antiretroviral medicines; St John’s wort: interaction with hormonal contraceptives; Strontium ranelate: cardiovascular risk; Methysergide serious fibrotic reactions; Dorzolamide hydrochloride/timolol maleate (Cosopt) preservative free eye drops: new pipette design; Combined hormonal contraceptives: risk of venous thromboembolism – clarification of advice.

PACE Bulletin Vol 8 No 9 May14

Description

Rapid Cost Comparison: New lower cost oral contraceptives.

Rapid Cost Comparison: Levonorgestrel 1.5mg tablet (Upostelle).

Lincolnshire Audit of Waste Medicines: summary of results.

Supply Difficulties: Naftidrofuryl 100mg capsules – cilostazol 50mg and 100mg tablets are the preferred alternative.

Product Withdrawal: Metformin oral powder 500mg and 1g (Glucophage).

PACE Bulletin Vol 8 No 8 May14 ONS

Description

Prescribing Advice - Guidance on the prescribing of Oral Nutritional Supplements (ONS).

PACE Bulletin Vol 8 No 7 Apr14

Description

Increased risk of tuberculosis with anti-TNF alpha treatments.

New Drug Assessment: Nalmefene tablets 18mg (Selincro).

Alcohol Use Disorders Identification Test (AUDIT): Interview Questions.

Rapid Drug Assessment: Inactivated quadrivalent influenza vaccine (Fluarix Tetra).

Rapid Assessment: Accu-Chek Active blood glucose testing meter and strips.

Rapid Drug Assessment: Granisetron transdermal patch 3.1mg in 24 hours (Sancuso).

Monitoring patients prescribed lithium.

Policy Relating to the Prescribing, Supply, Storage and Disposal of Controlled Drugs in Primary Care (March 2014).

MHRA: Drug Safety Update (February 2014): Combined hormonal contraceptives and venous thromboembolism.

PACE Bulletin Vol 8 No 6 Mar14

Description

Goodbye to minocycline?

New Formulation Assessment: Aripiprazole prolonged-release suspension for injection (Abilify Maintena).

Update on revised commissioning arrangements for depot antipsychotic drugs.

New Trial Assessments: Gout increasing but urate lowering therapies still under-used; Oral direct thrombin inhibitors and the risk of myocardial infarction.

Medicines and Healthcare Products Regulatory Agency: Drug Safety Update (January 2014): Prasugrel (Efient) – Increased risk of bleeding – information on timing of loading dose; Ofatumumab – screen for hepatitis B virus before treatment; Temozolomide – Risk of hepatic injury, including fatal hepatic failure – updated warnings and monitoring guidance; Capecitabine – Risk of severe skin reactions – discontinue treatment.

PACE Bulletin Vol 8 No 5 Mar14

Description

Antiepileptic drugs – new advice on switching between different manufacturers’ products for a particular drug.

New Drug Assessment: Imiquimod 5% cream (Aldara).

Rapid Cost Comparison: Oxycodone standard release capsules (OxyNorm vs Lynlor vs Shortec).

Management of constipation.

New Drug Assessment: Lubiprostone 24 microgram capsules (Amitiza).

PACE Bulletin Vol 8 No 4 Feb14

Description

New Drug Assessment: Meningococcal group B vaccine (Bexzero).

Rapid Drug Assessment: Bimatoprost/timolol 300microgram/5mg per ml unit dose eye drops (Ganfort UD).

Rapid Drug Assessment: Colecalciferol 20,000 IU tablets (SunVit D3).

Lincolnshire Joint Formulary Update – Venlafaxine modified release; Fentanyl patches; Ibandronate 150mg tablets.

New Trial Assessment: Anastrozole for the prevention of breast cancer in high-risk post-menopausal women.

Medicines and Healthcare Products Regulatory Agency: Drug Safety Update (November 2013): Mefloquine – strengthened warnings on neuropsychiatric side effects; Sodium valproate – risk of neurodevelopment delay in children following maternal use; Risperidone and paliperidone – risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery.

NICE Technology Appraisal 302: Canakinumab for treating systemic juvenile idiopathic arthritis (November 2013).

NICE Technology Appraisal 301: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy (November 2013).

Medicines and Healthcare Products Regulatory Agency: Drug Safety Update (December 2013): Rituximab – screen for hepatitis B virus before treatment; Clopidogrel – risk of acquired haemophilia; Dorzolamide hydrochloride/timolol (Cosopt) preservative free single dose eye drops – reports of eye injury.