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

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PACE Bulletin Vol 4 No 21 Dec10

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INFLUENZA OUTBREAK 2010/11 AND ANTIVIRAL SUPPLY

PACE Bulletin Vol 4 No 20 Nov10

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Review: Agomelatine 25mg tablets (Valdoxan) remains RED. All prescribing should be handled by specialists in mental health; GPs are not expected to prescribe

Rapid Drug Assessment:

Rupatadine 10mg tablets (Rupafin) Licensed for the symptomatic treatment of allergic rhinitis and chronic idiopathic urticaria (CIU) in adults and adolescents classified RED-RED

Sevelamer carbonate powder (Renvela) Licensed for the control of hyperphosphataemia in adult patients (1) receiving haemodialysis or peritoneal dialysis or (2) with Chronic Kidney Disease (CKD) not on dialysis with a serum phosphate greater than or equal to 1.78 mmol/l. Classified AMBER

NICE TA198: Tocilizumab for the treatment of rheumatoid arthritis (August 2010)

NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (August 2010)

New Trials in Brief: Antipsychotics in early psychosis; Ivabradine in heart failure; Bisphosphonates and cancer risk

Guidelines for the treatment of commonly occurring infections in Lincolnshire primary care (Winter 2010/11)

PACE Bulletin Vol 4 No 19 Nov10

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NATIONAL PATIENT SAFETY AGENCY (NPSA) PATIENT SAFETY ALERT: ACTIONS THAT CAN MAKE ANTICOAGULANT THERAPY SAFER (MARCH 2007)

PACE Bulletin Vol 4 No 18 Oct10

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New Drug Assessment:

Indacaterol (Onbrez Breezhaler) Licensed for maintenance bronchodilator treatment of airflow obstruction in adult patients with chronic obstructive pulmonary disease (COPD) classified RED-RED

Dutasteride capsules (Avodart) and Dustasteride/Tamsulosin capsules (Combodart) Licensed for benign prostatic hypertrophy classified RED-RED

Sativex Oromucosal Spray Licensed as an add-on treatment for symptom improvement in patients with moderate to severe spasticity due to multiple sclerosis (MS) who have not responded adequately to other anti-spasticity medication. Classified RED-RED

Review: Modified Release Oral Morphine Preparations. All prescribing of modified release morphine preparations should be by brand name; preferred brands are Morphgesic SR and Zomorph

NICE TA191: Capecitabine for the treatment of advanced gastric cancer (July 2010)

NICE TA192: Gefitinib for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer (July 2010)

NICE TA193: Rituximab for the treatment of relapsed or refractory chronic lymphocytic leukaemia (July 2010)

NICE TA194: Denosumab for the treatment of therapy-induced bone loss in non-metastatic prostate cancer (terminated appraisal) (July 2010)

NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor (August 2010)

NICE TA196: Imatinib for the adjuvant treatment of gastrointestinal stromal tumours (August 2010)

New Trials in Brief: BMJ meta-analysis of calcium supplements and risk of MI and CV events

MHRA, Drug Safety Update (August 2010): Modafinil; Topical ketoprofen - reminder on risk of photosensitivity reactions

PACE Bulletin Vol 4 No 17 Nov10

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USE OF UNLICENSED PHARMACEUTICAL ‘SPECIALS’

PACE Bulletin Vol 4 No 16 Oct10

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DISCONTINUATION OF MIXTARD 30 INSULIN PRODUCTS

PACE Bulletin Vol 4 No 15 Sep10

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SUSPENSION OF MARKETING AUTHORISATION OF ROSIGLITAZONE

PACE Bulletin Vol 4 No 14 Sep10

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Rapid Drug Assessment: Bimatoprost 0.01% eye drops (Lumigan) As monotherapy or as an adjunct to beta-blockers (BBs) in chronic open angle glaucoma (COAG) or ocular hypertension (OHT) classified RED-RED

NICE TA187: Infliximab (review) and adalimumab for the treatment of Crohn’s disease (May 2010)

NICE TA188: Human growth hormone (somatropin) for the treatment of growth failure in children (May 2010)

NICE TA189: Sorafenib for the treatment of advanced hepatocellular carcinoma (May 2010)

NICE TA190: Pemetrexed for the maintenance treatment of non-small-cell lung cancer (June 2010)

New Trials in Brief: Proton Pump Inhibitors (PPIs) and the risk of Clostridium difficile infection: Antibiotic resistance; Side effects and unintended benefits of statin therapy; Angiotensin 2 receptor antagonists (A2RAs) and cancer risk; Non-Steroidal Anti-inflammatory Drugs and cardiovascular risk

MHRA, Drug Safety Update (July 2010): Orciprenaline sulphate (Alupent) reminder of withdrawal from the market

National Patient Safety Agency: Rapid Response Report – Safer Administration of Insulin (June 2010)

PACE Bulletin Vol 4 No 13 Aug10

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REVIEW OF LIPID MODIFICATION GUIDELINES

PACE Bulletin Vol 4 No 12 Aug10

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Rapid Review: Oxycodone/Naloxone prolonged release tablets (Targinact) Licensed for the treatment of severe pain. Classified RED-RED

Rapid Drug Assessment:

Degarelix acetate injection (Firmagon) Licensed for the treatment of advanced hormone dependent prostate cancer Classified RED-RED

Sitagliptin/Metformin 50mg/1000mg tablets (Janumet) Licensed as an adjunct to diet and exercise to improve glycaemic control in patients with type 2 diabetes mellitus inadequately controlled on their maximal dose of metformin alone or those already being treated with the combination of sitagliptin and metformin. Licensed for triple therapy in combination with either a sulphonylurea or thiazolidinedione (glitazone); also licensed for use with insulin. Classifed GREEN

Review of glucosamine. Prescribers are reminded that all glucosamine and glucosamine/chondroitin preparations are not recommended for prescribing

MHRA, Drug Safety Update (June 2010): Rivastigmine (Exelon) transdermal patch - risk of medication errors; Quinine not to be used routinely for nocturnal leg cramps; Bevacizumab (Avastin) - hypersentivity and infusion reactions

PACE Bulletin Vol 4 No 11 Aug10

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MHRA DRUG SAFETY UPDATE: SIMVASTATIN 80MG AND MYOPATHY

PACE Bulletin Vol 4 No 10 Jul10

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RENIN ANGIOTENSIN SYSTEM DRUGS: THE CASE FOR FIRST LINE ANGIOTENSIN CONVERTING ENZYME INHIBITORS

PACE Bulletin Vol 4 No 9 Jun10

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Rapid Drug Assessment:

Doxycycline 40mg modified release capsules (Efracea) Licensed to reduce papulopustular lesions in adult patients with facial rosacea without ocular involvement. Classified RED-RED

Febuxostat tablets (Adenuric) Licensed for chronic hyperuricaemia where deposition has occurred. Classified GREEN

Sulphamethoxypyridazine 500mg tablets (unlicensedUsed for IgA related bullous diseases in patients intolerant of dapsone. Classified RED

New Drug Assessment:

Lacosamide tablets, syrup and infusion (Vimpat)

Ranolazine modified release tablets (Ranexa)

Rapid Review: Prasugrel 5mg tablets (Efient)

NICE CG95: Chest pain of recent onset (March 2010)

MHRA, Drug Safety Update (May 2010): SSRIs and SNRIs - risk of persistent pulmonary hypertension in the new born; Antidepressants - risk of fractures; Oral tacrolimus products - measures to reduce risk of medication errors

PACE Bulletin Vol 4 No 8 May08

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NATIONAL PATIENT SAFETY AGENCY (NPSA) RAPID RESPONSE REPORT 012 – REDUCING RISK OF HARM FROM ORAL BOWEL CLEANSING SOLUTIONS

PACE Bulletin Vol 4 No 7 May10

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Rapid Drug Assessment:

Paracetamol 1g tablets (Panadol OA) Licensed for the relief of pyrexia and mild to moderate pain including that associated with osteoarthritis Classified RED-RED

Pramipexole prolonged release tablets (Mirapexin Prolonged Release) Licensed for monotherapy or in combination with levodopa in the treatment of Parkinson’s disease classified RED-RED

NICE CG92: Venous thromboembolism: Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital (January 2010)

NICE CG94: Unstable Angina and NSTEMI - The early management of unstable angina and non-ST-segment-elevation myocardial infarction (March 2010)

New Trials in Brief: Antipsychotic use in elderly patients; Blood pressure control in type 2 diabetes; Compliance with bisphosphonates; Non-Steroidal Anti-Inflammatory Drugs and cardiovascular risk

MHRA, Drug Safety Update (April 2010): Yasmin: update on the risk of venous thromboembolism (VTE); Clopidogrel and proton pump inhibitors: updated advice; Intravenous zoledronic acid; adverse effects on renal function

PACE Bulletin Vol 4 No 6 May10

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Review of Glaucoma Treatments

NICE TA185: Trabectedin for the treatment of advanced soft tissue sarcoma (February 2010)

NICE TA186: Certolizumab pegol for the treatment of rheumatoid arthritis (February 2010)

New Trials in Brief: Insulin glargine/ insulin determir and diabetic ketoacidosis; Do statins increase the risk of developing diabetes?

MHRA, Drug Safety Update (March 2010): Natalizumab (Tysabri) and progressive multifocal leukoencephalopathy; Fluoxetine and congenital cardiac defects

PACE Bulletin Vol 4 No 5 May10

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CLINICAL GUIDELINES FOR ANTIDEPRESSANT USE IN PRIMARY AND SECONDARY CARE

PACE Bulletin Vol 4 No 4 Apr10

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PRESCRIBING GUIDANCE FOR HAY FEVER: SPRING / SUMMER 2010

PACE Bulletin Vol 4 No 3 Mar10

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New Drug Assessment: Liraglutide injection (Victoza) has been approved for use in type 2 diabetes mellitus. It should only be used as an alternative to exenatide where exenatide is either not tolerated or inappropriate

Rapid Drug Assessment: Fentanyl nasal spray (Instanyl) Licensed for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain. Classified RED-RED

Final withdrawal of beclometasone CFC containing metered dose inhalers, remaining patients should be switched to CFC free equivalents

New Trials in Brief: Improving statins adherance; Survival as a function of HbA1c in people with type 2 diabetes mellitus; Motor vehicle crashes in diabetic patients with tight blood glucose control

MHRA, Drug Safety Update (February 2010): Tacrolimus granules for oral suspension (Modigraf) - formulations are not interchangeable without careful therapeutic monitoring; Orlistat (alli) safety update

Department of Health Alert: The use of medicines in care homes for older people (January 2010)

National Patient Safety Agency Rapid Response Report: Vaccine Cold Storage (February 2010)

PACE Bulletin Vol 4 No 2 Mar10

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New Drug Assessment: Nicotinic acid/ laropiprant modified release tablets (Tredaptive)

Clarification of the role of ezetimibe (Ezetrol)

New Drug Assessment: Saxagliptin 5mg tablets (Onglyza) is not approved for the treatment of type 2 diabetes mellitus

Rapid Drug Assessment: Ketoprofen/ omeprazole modified release capsules (Axorid)

New Trials in Brief: Efficacy and safety of varenicline for smoking cessation in patients with cardiovascular disease; Does higher usage of low cost statins correlate with poorer achievement in cholesterol quality markers for secondary prevention?

MHRA, Drug Safety Update (January 2010): Risk of Stevens Johnson syndrome with phenytoin; New patient information with methylphenidate