Lincolnshire Prescribing and Clinical Effectiveness Forum (PACEF) was founded in 2007. It is the current strategic advisory network to NHS Lincolnshire Integrated Care Board (ICB). 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 NHS Lincolnshire Integrated Care Board, primary care, the local acute trust United Lincolnshire Hospitals NHS Trust, Lincolnshire Partnership NHS Trust, Lincolnshire Community Health Services NHS Trust, Lincolnshire LMC and Community Pharmacy Lincolnshire.
PLEASE NOTE: The publication of PACEF bulletins is currently suspended. We will provide a brief update of formulary decisions and updates following PACEF meetings in the LICB Medicines Optimisation Newsletter and also listed below.
Please allow time for the Lincolnshire Joint Formulary to be updated.
PACEF and Formulary Meeting Updates
PACEF September 2024
Stiripentol - PACEF approved the change of formulary classification to Amber 2, restricting it’s use for the treatment of epilepsy, within its licensed indication, only at the request of an epilepsy specialist from a tertiary centre. In these circumstances Stiripentol is approved for ongoing prescribing in primary care, following approval of a named patient requests. Stiripentol remains as RED/RED for all other uses.
Phytomenadione (unlicensed) – PACEF approved this due to the shortage of Menadiol tablets, which may necessitate the use of unlicensed Phytomenadione. This has been added onto the formulary as a second-line treatment option and will state unlicensed on the formulary too.
Tadalafil (Daily dose) – Following the change in NHSE advice PACEF has approved tadalafil once daily, 5mg and 2.5mg, as a treatment option for those where use of a daily dose is considered clinically appropriate. 2.5mg strength are significantly more expensive than the 5mg strengths and should only be used when 5mg dose is not suitable. Cialis brand should not be used as significantly more expensive than the generic equivalent. Tadalafil remains as second line treatment for erectile dysfunction after sildenafil for patients that meet the SLS criteria.
Formulary meeting August 2024
- Doxazocin is more cost effective to prescribe 2 x 4mg tablets rather than 1 x 8mg tablet. This reflects what is issued at ULHT.
- Removal of Eloquis brand from Apixaban formulary entry as no longer the most cost-effective brand. Removal of Xarelto brand from Rivaroxaban as no longer the most cost-effective brand. Formulary section clarifies to ensure clarity over full course supply issued on discharge from ULHT.
- Nitrofurantoin 50mg/5ml discontinued. 25mg/5ml remains available.
PACEF Bulletins
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| PACE Bulletin Vol 7 No 21 Dec13 | |
DescriptionMetoclopramide – Risk of neurological adverse effects. Review of gonadorelin analogues. Rapid Drug Assessments: Unlicensed clopidogrel oral solution 75mg in 5ml and clopidogrel oral suspension 75mg in 5ml. Generic montelukast preparations are now available. New Trial Assessment: New safety data on dapagliflozin (Forxiga). NICE Technology Appraisal 297: Ocriplasmin for treating vitreomacular traction (October 2013). NICE Technology Appraisal 296: Crizotinib for previously treated non-small-cell lung cancer associated with an anaplastic lymphoma kinase fusion gene (September 2013). |
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| PACE Bulletin Vol 7 No 20 Dec13 | |
DescriptionNew Drug Assessment: Degarelix injection (Firmagon). Rapid Drug Assessment: Medroxyprogesterone acetate 104mg/0.65ml (Sayana Press). Rapid Drug Assessment: Sildenafil chewable tablets 25mg/50mg/100mg (Nipatra). Lincolnshire Community Health Services: Clinical Guideline for the Diagnosis and Management of Heart Failure in Lincolnshire (September 2013). Infant Feeding Formulary – For Cows’ Milk Protein Allergy and Lactose Intolerance (October 2013). New Trial Assessment: Community associated Clostridium difficile infection and antibiotics – a meta-analysis. Product Discontinuation: Ketoconazole 200mg tablets (Nizoral). Contra-indications and drug interactions with varicella zoster virus vaccine (Zostavax). NICE Technology Appraisal 295: Everolimus in combination with exemestane for treating advanced HER2-negative hormone-receptor positive breast cancer after endocrine therapy (August 2013). NICE Technology Appraisal 292: Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar disorder (July 2013). NICE Technology Appraisal 293: Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura (review of technology appraisal 205 (July 2013). MHRA Drug Safety Update: New oral anticoagulants apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) – Risk of serious haemorrhage – clarified contraindications apply to all three medicines. |
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| PACE Bulletin Vol 7 No 18 Oct13 | |
DescriptionProduct Relaunch: Oxybutynin 2.5mg in 5ml elixir (Ditropan Elixir). Medicines and Healthcare Products Regulatory Agency: Drug Safety Update (August 2013): Oral ketoconazole – risk of liver injury outweighs benefits; Metoclopramide – risk of neurological adverse effects. Medicines and Healthcare Products Regulatory Agency: Drug Safety Update (September 2013): Filgrastim and pegfilgrastim – risk of potentially life threatening capillary leak syndrome. New Trial Assessment: Tiotropium Spiriva Respimat inhaler and the risk of death in chronic obstructive pulmonary disease; Saxagliptin and cardiovascular outcomes in patients with type 2 diabetres mellitus. NICE Technology Appraisal 289: Ruxolitinib for disease-related splenomegaly or symptoms in adults with myelofibrosis (June 2013). NICE Technology Appraisal 291: Pegloticase for treating severe debilitating chronic tophaceous gout (June 2013). Guidance on the use of the salbutamol metered dose inhaler with a spacer device. NICE Technology Appraisal 294: Aflibercept solution for injection for treating wet aged-related macular degeneration (July 2013). |
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| PACE Bulletin Vol 7 No 17 Oct13 | |
DescriptionNew Drug Assessment: Linaclotide 290 microgram capsules (Constella). New Drug Assessment: Perampanel tablets (Fycompa). New Drug Assessment: Naloxone 2mg in 2ml intramuscular injection (Prenoxad). Rapid Drug Assessment: Renavit water soluble vitamin tablets. Rapid Drug Assessments: Desogestrel 75 microgram tablets (Aizea/Cerazette/Cerelle/Zelleta). Rapid Drug Assessment: Ethinylestradiol 30 microgram/desogestrel 150 microgram tablets (Cimizt). NICE Clinical Guideline 164: Familial breast cancer (June 2013). Updated Rapid Drug Assessment: Latanoprost 50 microgram/ml (0.005%) preservative-free single dose eye drops (Monoprost) and bimatoprost 300 microgram per ml (0.03%) preservative-free single dose eye drops (Lumigan). |
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| PACE Bulletin Vol 7 No 14 Aug13 | |
DescriptionNew Drug Assessment: Ingenol mebutate gel (Picato). Rapid Drug Assessment: Estradiol hemihydrate 1.5mg / nomegestreol acetate 2.5mg combined oral contraceptive pill (Zoely). Rapid Drug Assessment: Latanoprost 50 microgram/ml (0.005%) preservative-free single dose eye drops (Monoprost) and bimatoprost 300 microgram per ml (0.03%) preservative-free single dose eye drops (Lumigan). NICE Technology Appraisal 283: Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion (May 2013). NICE Technology Appraisal 284: Bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer (May 2013). NICE Technology Appraisal 285: Bevacizumab in combination with gemcitabine and carboplatin for treating the first recurrence of platinum-sensitive advanced ovarian cancer (May 2013). NICE Technology Appraisal 286: Loxapine inhalation for treating acute agitation and disturbed behaviours associated with schizophrenia and bipolar disorder (terminated appraisal) (May 2013). MHRA Drug Safety Update (July 2013): Codeine for analgesia: restricted use in children because of reports if morphine toxicity; Retigabine (Trobalt): indication restricted to last-line use and new monitoring requirements after reports of pigment changes in ocular tissue, skin, lips or nails. NICE Technology Appraisal 290: Mirabegron (Betmiga) for treating symptoms of overactive bladder (June 2013). MHRA Drug Safety Update (June 2013): Diclofenac: new contraindications and warnings after a European-wide review of cardiovascular safety; Cyproterone acetate with ethinyloestradiol (co-cyprindiol) – balance of benefits and risks remains positive; Oral retinoids: pregnancy prevention – reminder of measure to minimise teratogenic risk. NICE Technology Appraisal 288: Dapagliflozin in combination therapy for treating type 2 diabetes (June 2013). |
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| PACE Bulletin Vol 7 No 12 Jun13 | |
DescriptionNew Drug Assessment: Fluticasone propionate/ azelastine hydrochloride 50 microgram/ 137 microgram nasal spray (Dymista). Prescribe midazolam oromucosal solution by brand. Shared Care Guidelines: Methylphenidate, atomoxetine, dexamfetamine and lisdexamfetamine in the management of Attention Deficit Hyperactivity Disorder (ADHD). Use of memantine and acetylcholinesterase inhibitor combination therapy in the treatment of Alzheimer’s disease. NICE Technology Appraisal 278: Omalizumab for the treating severe persistent allergic asthma (April 2013). NICE Technology Appraisal 279: Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures (April 2013). NICE Technology Appraisal 280: Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (April 2013). NICE Technology Appraisal 281: Canakinumab for treating gouty arthritis attacks and reducing the frequency of subsequent attacks (terminated appraisal) (April 2013). General Medical Council, Good Practice in Prescribing and Managing Medicines and Devices (February 2013). MHRA Drug Safety Update (May 2013): Tolvaptan (Samsca) - risk of liver injury; Thalidomide - risk of second primary malignancies; Liothyronine 20 microgram tablets - continuity of supply and potential need for patient monitoring. NICE Technology Appraisal 282: Pirfenidone for treating idiopathic pulmonary fibrosis (April 2013). |
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| PACE Bulletin Vol 7 No 11 Jul13 | |
DescriptionRapid Drug Assessment: Eplerenone 25mg and 50mg tablets for left ventricular dysfunction and heart failure. New Drug Assessment: Nepafenac 1mg/ml eye drops (Nevanac). New Drug Assessment: Racecadotril sachets and capsules (Hidrasec). New Drug Assessment: Lisdexamfetamine capsules (Elvanse). New Drug Assessment: Lixisenatide 10microgram/20microgram injection (Lyxumia). NICE Technology Appraisal 276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis (March 2013). NICE Technology Appraisal 277: Methynaltrexone for treating opioid-induced bowel dysfunction in people with advanced illness receiving palliative care (terminated appraisal) (March 2013). New Treatment Algorithm: Flutter oscillating positive expiratory pressure (PEP) device. MHRA Drug Safety Update (April 2013): Cilostazol (Pletal) - risk of cardiovascular and bleeding events; Strontium ranelate (Protelos) risk of serious cardiac disorders; Recent drug name confusion. New Treatment Algorithm: Flutter oscillating positive expiratory pressure (PEP) device. |
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| PACE Bulletin Vol 7 No 10 Apr13 | |
DescriptionPatent Expiry: Sildenafil 25mg, 50mg and 100mg tablets. Review: Pioglitazone 15mg / Metformin 850mg tablets (Competact). Review: Tapentadol prolonged release tablets (Palexia SR). New Drug Assessment: Rifaximin tablets 550mg (Targaxan). Shared Care Guidelines: Midodrine for the treatment of Orthostatic Hypotension and Vasovagal Syncope (March 2013); Erythropoiesis Stimulating Agents (ESA’s) in the treatment of Anaemia of Chronic Kidney Disease (March 2013). NICE Technology Appraisal 271: Fluocinolone acetonide intravitreal implant for the treatment of chronic diabetic macular oedema after an inadequate response to prior therapy (January 2013). NICE Technology Appraisal 272: Vinflunine for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract (January 2013). NICE Technology Appraisal 273: Tadalafil for the treatment of symptoms associated with benign prostatic hyperplasia (terminated appraisal) (January 2013). NICE Technology Appraisal 274: Ranibizumab for treating diabetic macular oedema (February 2013). NICE Technology Appraisal 275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation (February 2013). PACEF guidance on primary care rebate schemes. MHRA Drug Safety Update Reminder: Quinine for the management of nocturnal leg cramps Gout Treatment Algorithm. MHRA: Drug Safety Update (March 2013): Dabigatran (Pradaxa) is now contraindicated in patients with prosthetic heart valves requiring anti-coagulant treatment; Aqueous cream - risk of skin irritation, particularly in children, due to sodium lauryl sulfate content. Gout Treatment Algorithm |
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| PACE Bulletin Vol 7 No 9 Jun13 Oral Anti-Platelet Agents | |
DescriptionGuidance on the prescribing of aspirin, clopidogrel, prasugrel and ticagrelor for the prevention of a atherothrombotic event in patients with acute coronary syndromes. |
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| PACE Bulletin Vol 7 No 8 Jun13 Insulin Analogues | |
DescriptionGuidance on the choice of insulin regimens for people with Type 2 diabetes mellitus. |
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| PACE Bulletin Vol 7 No 7 Mar13 | |
DescriptionJoint Formulary Now Published. Accessing PACEF information through the NHS Lincolnshire website. Changes to the national immunisation programme in 2013-14. Lincolnshire Clinical Commissioning Groups: Statement in support of 28 day prescribin g. Improving the use of medicines for better outcomes and reduced waste. New Drug Assessment: Hydrocortisone modified release 5mg and 20mg tablets (Plenadren). New Drug Assessment: Argatroban infusion (Exembrol). Rapid Drug Assessment: Efavirenz, emtricitabine and tenofovir tablets (Atripla). Rapid Review: Oxycodone prolonged release tablets (Longtec). MHRA: Drug Safety Update (February 2013) - Denosumab 60mg (Prolia): rare cases of atypical femoral fracture with long term use. MHRA: Drug Safety Update (January 2013) - Fingolimod (Gilenya) - bradycardia and heart block; Lenalidomide (Revlimid) risk of serious hepatic adverse drug reactions; Roflumilast (Daxas) - risk of suicidal behaviour. |
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| PACE Bulletin Vol 7 No 5 Feb13 | |
DescriptionManaging the temazepam 10mg and 20mg tablet supply problem. Managing the isosorbide mononitrate standard release 10mg, 20mg and 40mg tablet supply problem. New Drug Assessment: Saxagliptin/metformin tablets 2.5mg/850mg and 2.5mg/1000mg tablets (Komboglyze). New Drug Assessment: Glycopyrronium bromide inhaler (Seebri Breezhaler). New Drug Assessment: Zonisamide capsules (Zonegran). New Trial Assessments: Risk of dementia with benzodiazepines; Effectiveness of non-benzodiazepine hypnotics in the treatment of adult insomnia; Increased risk of NSAID induced acute kidney injury in patients taking concurrent diuretic and ACE Inhibitor/Angiotensin Receptor Blocker Therapy. NICE Technology Appraisal 261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (July 2012). NICE Technology Appraisal 264: Alteplase for treating acute ischaemic stroke (September 2012). NICE Technology Appraisal 265: Bone metastases from solid tumours – denosumab (October 2012). NICE Technology Appraisal 266: Mannitol dry powder for inhalation for treating cystic fibrosis (November 2012). NICE Technology Appraisal 267: Ivabradine for treating chronic heart failure (November 2012). NICE Technology Appraisal 268: Ipilimumab for previously treated advanced (unresectable or metastatic) melanoma (December 2012). NICE Technology Appraisal 270: Decitabine for the treatment of acute myeloid leukaemia (terminated appraisal) (December 2012). NICE Technology Appraisal 269: Vemurafenib for treating locally advanced or metastatic BRAF V600 mutation-positive malignant melanoma (December 2012). |
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| PACE Bulletin Vol 7 No 4 Jan13 | |
DescriptionReview: Oral mesalazine products for the management of inflammatory bowel disease. New Device Assessment: Flutter oscillating positive expiratory pressure device. New Drug Assessment: Colecalciferol tablets 800iu (Desunin). European Medicines Agency and MHRA review of the safety of Tredaptive. MHRA review levothyroxine tablet supply issues. NICE Technology Appraisal 262: Adalimumab for the treatment of moderate to severe ulcerative colitis (July 2012). MHRA Drug Safety Update (December 2012): Codeine containing pain relief for children. NICE Technology Appraisal 263: Bevacizumab in combination with copecitabine for the first line treatment of metastatic breast cancer (August 2012). |
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| PACE Bulletin Vol 7 No 2 Jan13 | |
DescriptionReview: Varicella zoster virus vaccine (Zostavax). New Drug Assessment: Fidaxomicin 200mg tablets (Dificlir). Updated New Drug Assessment: Doxycycline 40mg modified release capsules (MR) (Efracea). New Drug Assessment: Ulipristal acetate 5mg tablets (Esmya). New Drug Assessment: Aclidinium bromide dry powder inhaler (Eklira Genuair). Mounting concerns over the safety of tiotropium bromide (Spiriva Respimat). New Drug Assessment: Fluticasone/formoterol metered dose inhaler (Flutiform). NICE Technology Appraisal 257: Lapatinib or Trastuzumab in combination with an aromatase inhibitor for the first-line treatment of metastatic hormone receptor-positive breast cancer that overexpresses HER2 (June 2012). NICE Technology Appraisal 258: Erlotinib for the first-line treatment of locally advanced or metastatic EGFR-TK mutation-positive non-small cell lung cancer (June 2012). NICE Technology Appraisal 259: Abiraterone for castration resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen (June 2012). MHRA Drug Safety Update (September to November 2012): Oseltamivir (Tamiflu) - changed concentration and dosing dispenser of oral suspension; Dipeptidylpeptidase–4 inhibitors - risk of acute pancreatitis; Agomelatine – risk of dose related hepatotoxicity and liver failure; Denosumab - fatal cases of severe symptomatic hypocalcaemia and risk of hypocalcaemia; Further evidence that the cardiovascular risk of diclofenac is higher than other non-selective NSAIDs and similar to the selective COX-2 inhibitors. |
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The current form to request a non-formulary medicine can be viewed here:
Are you a member of our PACEF committee?
If so, please see the forthcoming dates for 2025:
2025 Meeting Dates
Wednesday 22nd January 2025 - 1.15pm start
Wednesday 19th March 2025 - 1.15pm start
Wednesday 21st May 2025 - 1.15pm start
Wednesday 16th July 2025 - 1.15pm start
Wednesday 17th September 2025 - 1.15pm start
Wednesday 19th November 2025 - 1.15pm start
