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.



The current form to request a non-formulary medicine can be viewed here:

PACEF Bulletins

PACE Bulletin Vol 2 No 19 Dec08


Rapid Assessment:

Dexibuprofen tablets (Seractil) Osteoarthritis, dysmenorrhoea, mild to moderate pain and dental pain. Classified RED-RED

Dexketoprofen tablets (Keral) Musculoskeletal pain, dysmenorrhoea, dental pain Classified RED-RED

Clopidogrel tablets 300mg (Plavix) For use as a loading dose in patients with non-ST segment elevation acute coronary syndrome (i.e. unstable angina or non-Q-wave myocardial infarction (MI)) and ST segment elevation acute MI classified RED

Update on Clostridium difficile

NICE TA160: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (October 2008)

NICE CG71: Familial hypercholesterolaemia – Identification and management of familial hypercholesterolaemia (August 2008)

PACE Bulletin Vol 2 No 18 Nov08


MHRA imposes restrictions on the import of unlicensed melatonin

Rapid Assessment:

Bimatoprost/ timolol eye drops (Ganfort) Ocular hypertension or open angle glaucoma insufficiently responsive to beta blockers or prostaglandin analogues. Classified GREEN

Glycopyrrolate 0.5% lotion Unlicensed topical antimuscarinic agent used in the treatment of facial hyperhidrosis and diabetic gustatory sweating. Classified AMBER

NICE TA153: Entecavir for the treatment of chronic hepatitis B (August 2008)

NICE TA154: Telbivudine for the treatment of chronic hepatitis B (August 2008)

NICE TA155: Ranibizumab and pegaptanib for the treatment of age-related macular degeneration (August 2008)

NICE TA156: Routine antenatal anti-D prophylaxis for women who are rhesus D negative (August 2008)

NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults (September 2008)

NICE TA158: Oseltamivir, amantadine and zanamivir for the prophylaxis of influenza (September 2008)

MHRA Safety Update: Fentanyl Patches; Human Papillomavirus Vaccine; Antiepileptic Drugs

Shortage of prednisolone suppositories: advice to prescribers

PACE Bulletin Vol 2 No 17 Oct08



PACE Bulletin Vol 2 No 16 Oct08


Antibiotic Awareness Campaign

NICE CG 69: Respiratory tract infections – antibiotic prescribing (July 2008)

Guidelines for the Treatment of Commonly Occurring Infections in Primary Care: Winter 2008/08 – Summary table

PACE Bulletin Vol 2 No 15 Nov08


New Drug Assessment: Fesoterodine (Toviaz) For the treatment of the symptoms of overactive bladder syndrome (OAB) (urinary frequency and/ or urgency and/or urgency incontinence). Classified RED-RED

Rapid Assessment: Sodium Hyaluronate eye drops (Oxyal) for dry eyes Classified RED-RED

In the News: Human Papillomavirus Vaccination Programme: Further Developments

NICE TA151:Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (July 2008)

NICE TA152: Drug-eluting stents for the treatment of coronary artery disease (July 2008)

NICE CG 68: Stroke – Diagnosis and initial management of acute stroke and transient ischaemic attack (July 2008)

NICE CG 70: Induction of labour (July 2008)

New Wound Management Formulary

Safety Alert: Opiates and Snoring or Sleep Apnoea

PACE Bulletin Vol 2 No 13 Aug08


New Drug Assessment:

Melatonin Prolonged Release Tablets (Circadin)

NICE TA144: Rimonabant for the treatment of overweight and obese adults (June 2008)

NICE TA145: Cetuximab for the treatment of locally advanced squamous cell cancer of the head and neck (June 2008)

NICE TA146: Adalimumab for the treatment of adults with psoriasis (June 2008)

NICE TA147: Bevacizumab for the first-line treatment of metastatic breast cancer (terminated appraisal) (June 2008)

NICE TA148: Bevacizumab for the treatment of non-small-cell lung cancer (terminated appraisal) (June 2008)

NICE TA149: Carmustine implants for the treatment of recurrent glioblastoma multiforme (terminated appraisal) (June 2008)

NICE TA150: Cetuximab for the treatment of metastatic colorectal cancer following failure of oxaliplatin containing chemotherapy (Terminated Appraisal) (June 2008)

MHRA Safety Update:

Varenicline – Suicidal Thoughts and Behaviour

Bisphosphonates and Atrial Fibrillation

Rotigitine patches – new prescribing and storage requirements

National Patient Safety Agency: Rapid Response Report – Risks of Incorrect Dosing of Oral Anti-Cancer Medicines (January 2008)

PACE Bulletin Vol 2 No 12 Jul08


New Drug Assessment:

Paricalcitol capsules (Zemplar) Licensed for the prevention and treatment of secondary hyperparathyroidism (SHPT) associated with chronic renal insufficiency (chronic kidney disease Stages 3 and 4) and chronic renal failure (chronic kidney disease Stage 5) in patients on haemodialysis or peritoneal dialysis Classified RED-RED

Ropinirole prolonged release tablets (Requip XL)

New Indication Assessment: Venlafaxine (Efexor XL) for Generalised Anxiety Disorder (GAD) and Social Phobia

Introduction of Human Papillomavirus (HPV) Vaccine into the National Immunisation Programme

NICE TA142: Epoetin alfa, epoetin beta and darbepoetin alfa for cancer treatment-induced anaemia (May 2008)

NICE TA143: Adalimumab, etanercept and infliximab for ankylosing spondylitis (May 2008)

MHRA Safety Update: Nicorandil (Ikorel) (June 2008)

PACE Bulletin Vol 2 No 11 Jul08


NICE CG67: Lipid Modification (May 2008)

NICE TA32: Ezetimibe for the treatment of primary (heterozygous familial and non-familial) hypercholesterolaemia (November 2007)

PACE Bulletin Vol 2 No 10 Jul08


Omacor Review

New Drug Assessment:

Vildagliptin (Galvus) and Vildagliptin/Metformin (Eucreas)

NICE TA140: Infliximab for the subacute manifestations of ulcerative colitis (April 2008)

NICE TA141: Abatacept for the treatment of rheumatoid arthritis (April 2008)

NICE Public Health Programme Guidance 11: Maternal and child nutrition (March 2008)

NICE CG62: Antenatal care – Routine care for the healthy pregnant woman (March 2008)

NICE CG63: Diabetes in pregnancy – Management of diabetes and its complications from pre-conception to the postnatal period (March 2008)

MHRA Safety Update: Rimonabant – New advice on depressive reactions; Exenatide – Risk of acute pancreatitis (May 2008)

Reporting Incidents to the National Patient Safety Agency

PACE Bulletin Vol 2 No 9 Jun08


Exenatide (Byetta) Review GREEN Treatment should primarily be initiated by a diabetologist or a GP with a Specialist Interest in diabetes (GPSI), although the GREEN status allows for broader GP initiation. Exenatide should only be considered within the context of the draft NICE initiation criteria (see below)

Further Advice on Glitazone Use

Rapid Assessment: Cocois scalp ointment (Sebco) Licensed as an adjunctive treatment of common scaly scalp disorders such as psoriasis, eczema, seborrhoeic dermatitis and dandruff. Classified GREEN

NICE TA138: Inhaled corticosteroids for the treatment of chronic asthma in adults and children aged 12 years and over (March 2008)

NICE TA139: Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome (March 2008)

NICE CG60: Surgical management of otitis media with effusion in children (February 2008)

NICE CG61: Irritable bowel syndrome in adults – Diagnosis and management of IBS in primary care (February 2008)

Addendum: Calcium and Vitamin D Supplementation

PACE Bulletin Vol 2 No 7 May08


NICE CG59: Osteoarthritis - The care and management of osteoarthritis in adults (Feb 2008)

Reducing Pharmaceutical Waste Campaign 2008

PACE Bulletin Vol 2 No 6 May08


Rapid Assessment:

Retapamulin Ointment 1% (Altargo) is an expensive agents in comparison to alternatives. Classified RED-RED

Actonel Combi for treatment of postmenopausal osteoporosis in assessed patients for whom the amount of calcium and vitamin D3 included is considered to provide adequate supplementation. Classified RED-RED

Calcium and Vitamin D Supplementation

Cozaar Comp for hypertension in patients whose BP is not controlled by hydrochlorothiazide or losartan monotherapy. Reduction in risk of stroke in hypertensive patients (except black patients) with left ventricular hypertrophy Classified RED-RED

U-500 Insulin (Humulin R) unlicensed RED

NICE TA136: Structural neuroimaging in first-episode psychosis

NICE TA137: Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma

NICE CG58: Prostate Cancer - Diagnosis and treatment

MHRA Safety Update: Ketoconazole and Modafinil

PACE Bulletin Vol 2 No 5 Apr08



PACE Bulletin Vol 2 No 4 Apr08



PACE Bulletin Vol 2 No 3 Apr08


New Drug Assessment: Colesevelam (Cholestagel) Classified RED-RED

Rapid Assessment: Fostair (Beclometasone and Formoterol) Metered Dose Inhaler Classified GREEN

Future Supply of CFC Containing Beclometasone Dipropionate Metered Dose Inhalers

Product Discontinuation: Coversyl and Coversyl Plus

Smoking Cessation and Varenicline

Review of Bicalutamide Traffic Light Classification

NICE TA134: Infliximab for the treatment of adults with psoriasis

NICE TA135: Pemetrexed for the treatment of malignant pleural mesothelioma

MHRA Safety Updates: Carisoprolol and Meprobamate, Rosiglitazone, Statins

Amendment: NICE CG57: Atopic Eczema in Children

PACE Bulletin Vol 2 No 2 Feb08


New Drug Assessment:

Rufinamide (Inovelon) Licensed as an adjunctive therapy in the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 4 years and older. Classified AMBER

Tacrolimus 0.03% ointment and 0.1% ointment (Protopic) Licensed for the second line short term treatment of moderate or severe atopic dermatitis unresponsive or intolerant to topical steroids. For use in adults (0.1% ointment) and children aged 2 and over (0.03% ointment).Classified AMBER

Pimecrolimus 1% cream (Elidel) Licensed for the second line short term treatment of mild or moderate atopic dermatitis where the use of topical steroids is inadvisable or not possible. For use in adults and children aged 2 and over. Classified AMBER

Zoledronic acid infusion (Aclasta) Licensed for the treatment of osteoporosis in postmenopausal women at increased risk of fracture Classified RED-RED

Mesalazine (Mezavant XL) Licensed for the induction and maintenance of remission in patients with mild to moderate active ulcerative colitis. Classified GREEN

NICE CG57: Atopic Eczema in Children

Clostridium difficile reminder

PACE Bulletin Vol 2 No 1 Jan08


New Drug Assessment:

Lenalidomide (Revlimid) for use in combination with dexamethasone for the treatment of multiple myeloma in patients who have received at least one prior therapy. Classified RED-RED

Rivastigmine Transdermal Patch (Exelon) symptomatic treatment of mild to moderately severe Alzheimer’s dementia classified AMBER

Grazax grass pollen induced rhinitis and conjunctivitis diagnosed with a positive skin prick test and/or specific IgE test classified RED-RED

Lantus SoloStar and Apidra SoloStar Insulin Pens both classified GREEN

Product Withdrawals: Co-proxamol Update

NICE TA131: Inhaled corticosteroids for the treatment of chronic asthma in children

NICE TA132: Ezetimibe for the treatment of primary hypercholesterolaemia

NICE TA133: Omalizumab for severe persistent allergic asthma

MHRA Safety Updates: Fibrates and Glitazones


Are you a member of our PACEF committee?

If so, please see the forthcoming dates for 2024:

2024 Meeting Dates

Wednesday 17th January 2024 - 1.15pm start

Wednesday 20th March 2024 - 1.15pm start

Wednesday 15th May 2024 - 1.15pm start

Wednesday 17th July 2024 - 1.15pm start

Wednesday 18th September 2024 - 1.15pm start

Wednesday 20th November 2024 - 1.15pm start