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 Formulary Chapter 19: Oral Nutritional Supplements in Adults - Full Chapter
19  Expand sub section  Oral Nutritional Supplements
 note 

Steps for prescribing nutritional Supplements.

Use ‘MUST’ (Malnutrition Universal Screening Tool) toolkit to identify nutritional risks.Assess underlying cause of malnutrition and consider availability of adequate diet.
Set realistic goals for target weight gain.

Promote 'FOOD FIRST'  high calorie high protein dietary advice -  Use dietary advice sheets

Patient Advice Sheet – Food First

Patient Advice Sheet - Snack Suggestions 100 calorie boosters

 

and promote over the counter products such as Complan sachets, Build-up, Nourishment, Nutriment. 

Prescribing of Oral Nutritional Supplements should only be undertaken if the above steps have failed and should be limited to the formulary choices given below unless advised otherwise by a dietitian.

(Oral Nutritional Supplements (ONS) should only be prescribed to patients who meet the Advisory Committee for Borderline Substances (ACBS) prescribing criteria )


Please note: 'Complan' is an over the counter supplement that is not available on prescription. 'Complan Shake' can be prescribed but is no longer on the formulary. See First choice Milkshake Powder Products

19.01  Expand sub section  Milkshake Powder Products
 note 

Advisory Note - These products should not be prescribed for Home Enterally Fed (HEF) patients

 

Foodlink® Complete
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First Choice
Green
  • 57g powder sachet to be mixed with 200mls whole milk.
  • 7x57g
  • Starter Pack 5x57g sachets of one flavour each.

Flavours available; natural, strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 385 Kcals
  • 18g Protein
 
Aymes ®Shake
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First Choice
Green
  • 57g powder sachet to be mixed with 200mls whole milk.
  • 7x57g
  • Starter Pack 5x57g sachets of one flavour each.

Flavours available; neutral, strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 388 Kcals
  • 16g Protein
 
Ensure Shake
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First Choice
Green
  • 57g powder sachet to be mixed with 200mls whole milk.
  • 7x57g sachets of one flavour.
  • No Starter pack available.

Flavours available; strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 389 Kcals
  • 17g Protein
 
EnergieShake Powder
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First Choice
Green
  • 57g powder sachet to be mixed with 200mls whole milk.
  • 4x57g sachets of one flavour.
  • Starter Pack 5x57g sachets of one flavour each.

Flavours available; neutral, vanilla, chocolate, strawberry or banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 381 Kcals
  • 15.8g Protein
 
Foodlink® Complete with Fibre
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Second Choice
Green

*This is the recommended First Line product for care home residents that are unlikely to manage more than one supplement a day.

For all patients this can be prescribed OD for those unlikely to consume more than one supplement. It has a higher calorie and fibre content than the other first line products.

  • 63g powder sachet to be mixed with 220mls whole milk.
  • 7x63g
  • Starter Pack 5x63g sachets of one flavour each.

Flavours available; natural, strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 421 Kcals
  • 19.7g Protein
  • 4.7g Fibre
 
   
19.02  Expand sub section  Standard Volume Ready to Drink Products
 note 

Advisory Note – Ready Made ONS should only be prescribed if the patient is unable to make up the powder ONS (and does not have family / carers who could to do so)

Aymes Complete®
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Second Choice
Green
  • 200ml Ready to Drink
  • Starter pack available with one of each flavour

Flavours available; vanilla, strawberry, banana and chocolate.

  • Gluten Free

Nutritional Profile

  • 300 Kcals
  • 12g Protein
 
   
Aymes ActaGain 2.4 Complete Maxi
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Second Choice
Green

*This is the recommended First Line product for care home residents that are unlikely to manage more than one supplement a day. For all patients this can be prescribed OD for those unlikely to consume more than one supplement. It has a higher calorie and protein content than the other first line products.

  • 200ml Ready to Drink
  • 4x200ml
  • Flavours available; vanilla, strawberry

Nutritional profile

  • 480kcals
  • 19.2g protein
 
   
Ensure Plus Milkshake Style
(Abbott)
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Second Choice
Green
  •  200ml Ready to Drink

Flavours available; vanilla, strawberry, chocolate, fruits of the forest, banana, raspberry, coffee, peach or neutral.

  • Gluten and Lactose free

Nutritional profile

  • 300kcals
  • 12.5g Protein
 
   
Fortisip
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Second Choice
Green
  • 200ml Ready to Drink
  • Starter pack available with four sample flavours

Flavours available; vanilla, strawberry, chocolate, banana, caramel toffee, orange, tropical fruit or neutral.

  • Gluten and Lactose free

Nutritional profile

  • 300kcals
  • 11.8g Protein
 
   
EnergieShake® Complete 1.5kcal
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Second Choice
Green
  • 200ml Ready To Drink

Flavours available; vanilla, strawberry, chocolate and banana

Nutritional profile

  • 300kcals
  • 12g protein
 
   
19.03  Expand sub section  Juice Style Products
Aymes® Shake Smoothie
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First Choice
Green
  • 66g powder sachet to be mixed with 150ml water
  • 7x66g
  • Starter pack available with one of each flavour
  • For individuals who don’t tolerate or dislike milk based shake.
  • May not be suitable for individuals with Diabetes.

Flavours available; mango, peach, pineapple and strawberry & cranberry.

  • Gluten Free, this product does not contain lactose but is manufactured in a facility that uses lactose so may contain traces.

Nutritional Profile

  • 297 Kcals
  • 11g Protein
 
Ensure ® Plus Juce
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Second Choice
Green
  • 220ml Ready to Drink
  • For individuals who don’t tolerate or dislike milk based shake.
  • May not be suitable for individuals with Diabetes.

Flavours available; strawberry, lemon and lime, apple, orange, fruit punch or peach.

  • Gluten, Lactose and fat free

Nutritional profile

  • 330kcals
  • 10.6g Protein
 
   
19.04  Expand sub section  Compact (Small Volume) Ready to Drink Products - Second Line to top
Aymes Shake Compact
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First Choice
Green
  • 57g powder sachet to be mixed with 100mls whole milk.
  • 7x57g
  • Starter Pack 5x57g sachets of one flavour each.

Flavours available; neutral, strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 320 Kcals
  • 12.4g Protein
 
Ensure Compact
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Second Choice
Green
  •  4x125ml Ready to Drink

Flavours available; vanilla, strawberry, café latte or banana.

  • Gluten Free

Nutritional Profile

  • 300kcals
  • 12.8g protein
 
   
Altraplen Compact
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Second Choice
Green
  • 4x125ml Ready to Drink
  • Starter Pack available (1 of each flavour).

Flavours available; vanilla or strawberry

  • Gluten and Lactose Free

Nutritional Profile

  • 300kcals
  • 12.8g protein
 
   
Fortisip Compact
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Second Choice
Green
  • 4x125ml Ready to Drink.
  • Starter Pack available (x6 mixed flavours).

Flavours available; neutral, vanilla, mocha, banana, apricot, chocolate, forest fruit or strawberry

  • Gluten Free

Nutritional Profile

  • 300kcals
  • 12.8g protein
 
   
19.05  Expand sub section  Specialist Recommendation Only - Milkshake Powder Products
 note 

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See first choice milkshake powder products

Enshake
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Formulary
Blue
  • 96.5g sachet- to be made with 240ml whole milk
  • 6 x 96.5g boxes
  • OD prescription suitable for individuals unable to consume large volumes

Flavours available; banana, chocolate, strawberry, vanilla

Nutritional Profile

  • 600kcals
  • 16g protein
 
   
19.06  Expand sub section  Specialist Recommendation Only - Standard Volume Ready to Drink Products
 note 

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for standard volume ready to drink

Aymes®2kcal
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Formulary
Blue
  • 200ml Ready to Drink
  • 4x200ml

Flavours available; vanilla, strawberry or banana

  • Gluten free

Nutritional profile

  • 400kcals
  • 16g protein

 
To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for standard volume ready to drink

 
   
Ensure®Plus Yoghurt Style
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Formulary
Blue
  • 200ml Ready to Drink
  • Alternative flavours and consistency may help individuals with taste fatigue on regular ONS

Flavours available; orchard peach and strawberry swirl

  • Gluten and lactose free

Nutritional profile

  • 300kcals
  • 12.5g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for standard volume ready to drink

 
   
Aymes®Savoury
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Formulary
Blue
  • 57g sachet to be made with 200ml hot water.

Flavours available; vegetable or chicken

  • Gluten free

Nutritional profile

  • 250kcals
  • 9.2g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for standard volume ready to drink

 
   
Ensure®Plus Savoury
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Formulary
Blue
  • 200ml Ready to Drink (needs to be warmed like a soup for best taste)

Flavours available; Chicken

  • Gluten and Lactose free

Nutritional profile

  • 300kcals
  • 13g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for standard volume ready to drink

 
   
Altraplen Protein
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Formulary
Blue
  • Ready to Drink
  • High Protein
  • Starter Pack available x2 flavours

Flavours available; strawberry or vanilla

  • Gluten Free

Nutritional Profile

  • 300 kcals
  • 20g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for standard volume ready to drink

 
   
Vital®1.5kcal
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Formulary
Blue
  • 200ml Ready to Drink
  • For patients with malabsorption or poor feed tolerance.

Flavours available vanilla, mixed berry or café latte

  • Gluten free and lactose free.

Nutritional profile

  • 300 kcals
  • 13.5g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for standard volume ready to drink

 
   
Fresubin®2 kcal
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Formulary
Blue
  • 200ml
 
   
Fresubin®2 kcal fibre
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Formulary
Blue
  • 200ml
 
   
Fortisip®2 kcal
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Formulary
Blue

Liquid GF 200ml, vanilla - strawberry

for HOME Enteral feeding patients with FREKA-PEG-J

FREKA-PEG-J is a narrow lumen and similar products Fortisip compact are too viscous to go down the lumen

 
   
19.07  Expand sub section  Specialist Recommendation Only - Compact (Small Volume) Ready to Drink Products
 note 

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for Compact (Small volume) Ready to drink

Fresubin 3.2kcal
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Formulary
Blue
  • 125ml Ready to Drink
  • 4x125ml

Flavours available; Vanilla caramel, hazelnut or mango

  • Gluten and lactose free

Nutritional profile

  • 400 kcals
  • 20g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for Compact (Small volume) Ready to drink

 
   
Fresubin 2kcal Fibre mini
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Formulary
Blue
  • 125ml ready to drink

Flavours available; chocolate, vanilla

  • Gluten and lactose free

Nutritional profile

  • 250 kcals
  • 12.5g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for Compact (Small volume) Ready to drink

 
   
19.08  Expand sub section  Specialist Recommendation Only - Juice Style Products
 note 

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for Juice Style Products

Fortijuce®
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Formulary
Blue
  • 200ml Ready to Drink
  • Starter Pack – 4 different flavours available

Flavours available; lemon and lime, apple, orange, strawberry, tropical, forest fruit, blackcurrant

  • Gluten, lactose and fat free

Nutritional profile

  • 300 kcals
  • 8g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for Juice Style Products

 
   
Fresubin ® Jucy
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Formulary
Blue
  • 200ml Ready to Drink
  • Starter pack 6x200ml (mixed flavours)

Flavours available; orange, apple, pineapple, cherry or blackcurrant

  • Gluten, lactose, fibre and fat free

Nutritional profile

  • 300 kcals
  • 8g protein

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for Juice Style Products

 
   
19.09  Expand sub section  Specialist Recommendation Only - Dessert Style/Pre-Thickened Products to top
 note 

NB these products are relatively low in calories and protein compared to liquid ONS, they should therefore only be used when a patient requires a thickened product and it is not possible to use thickeners on a liquid supplement.

AYMES®Creme
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Formulary
Blue
  • 4 x 125g
  • Gluten free and vegetarian

Flavours available; vanilla and chocolate

Nutritional Profile

  • 188 kcals
  • 9.4g

NB these products are relatively low in calories and protein compared to liquid ONS, they should therefore only be used when there is a specific requirement for them stated.

 
   
Nutricrem
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Formulary
Blue
  • 4 x 125g
  • Gluten free.
  • Nutritionally complete in 5 pots

Flavours available; vanilla, strawberry and chocolate orange

Nutritional profile

  • 225 kcals
  • 12.5g protein

NB these products are relatively low in calories and protein compared to liquid ONS, they should therefore only be used when there is a specific requirement for them stated.

 
   
Slő Milkshakes®
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Formulary
Blue
  • 7x50g sachets
  • Make with 200ml whole milk
  • Gluten Free

Flavours available strawberry or chocolate

Nutritional profile

  • 334 kcals
  • 24g protein

NB these products are relatively low in calories and protein compared to liquid ONS, they should therefore only be used when there is a specific requirement for them stated.

 
   
19.10  Expand sub section  Specialist Recommendation Only - Modular Supplements
 note 

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.

Altrashot
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Formulary
Blue
  • 4x120ml pack
  • 40ml Shot recommended TDS
  • Gluten and lactose Free, (Contains milk protein)

Flavours available; vanilla and strawberry

Starter pack – 2 bottles

Nutritional profile per 40ml shot

  • 140 kcals
  • 2g protein

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.
 

 
   
Calogen®
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Formulary
Blue
  • 200 or 500ml Bottle
  • 30ml Shot recommended TDS

Flavours available; neutral, strawberry or banana

  • Gluten and lactose free

Nutritional profile per 30ml shot

  • 135 kcals
  • 0g protein

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.

 
   
Fresubin® 5 kcal Shot
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Formulary
Blue
  • 120ml Bottle
  • 30ml shot recommended TDS or QDS
  • Lactose and Gluten Free
  • Suitable for vegetarians and vegans

Flavours available neutral or lemon

Nutritional Profile per 30ml shot

  • 150 kcals
  • 0g protein

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.

 
   
Pro-Cal® Powder
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Formulary
Blue
  • 1.5kg Tub
  • 15g TDS recommended to be added as a food fortifier.

Flavour available; Neutral

  • Gluten Free

Nutritional profile per 15g scoop

  • 100kcals
  • 2g protein

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.
 

 
   
Calogen® Extra
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Formulary
Blue
  • Available as pre measured 40ml shots

Flavours available; Strawberry or unflavoured emulsion

  • Gluten and lactose free

Nutritional profile per 40ml shot

  • 160 kcals
  • 2 g protein

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.

 
   
Calogen® Extra Shots
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Formulary
Blue

Requires a dietitian’s assessment or advice before prescribing

  • Supplements containing energy (and protein) only
  • Can be given as small volume ‘shots’ - Do not use alone or in doses less than shown without dietetic advice.

    Shots = 6 x 40ml

    Recommended dose
    40mls TDS
 
   
ProSource Liquid
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Formulary
Blue
  • 30ml sachets, recommended as a shot or as an addition to drinks or tube feeds

Flavours available; Unflavoured, lemon, orange crème or citrus berry

  • Lactose and Gluten free

Nutritional profile per 30ml sachet

  • 100kcal
  • 10g protein

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.

 
   
ProSource Plus
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Formulary
Blue
  • 30ml sachets, recommended as a shot or as an addition to drinks or tube feeds

Flavours available; Unflavoured, orange crème or citrus berry

  • Lactose and Gluten free

Nutritional profile per 30ml sachet

  • 100kcal
  • 15g protein

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.

 
   
19.11  Expand sub section  Thickeners for dysphagia
 note 

Ensure the recommendation to prescribe a thickener has come from an appropriately trained healthcare professional, e.g. a Speech and Language Therapist (SALT) after a diagnosis of dysphagia has been made.

NB. The descriptors for the levels of thickness are changing: previously 'stage' and now 'level'

The consistency of fluid needed is described by new International Dysphagia Diet Standardisation Initiative (IDDSI) descriptors in increasing order of thickness: Level 1 (slightly thick) Level 2 (mildly thick) Level 3 (moderately thick) or Level 4 (extremely thick).

Please see Dysphagia guidance

Advise patients and carers to REFER TO THE INDIVIDUAL PRODUCT TIN for the manufacturer’s instructions to make up each consistency, using the correct number of scoops per volume of fluid, and the correct scoop for the product.

Clear gum-based thickeners are now the preferred choice (over starch-based) as they are the most palatable and safest. https://www.prescqipp.info/thickeners-for-dysphagia/viewcategory/339

The use of tins, not sachets or pre-thickened drinks is preferred as they are more cost-effective.

Instant Carobel®
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Formulary
Blue

Presentation - 135g

Specialist recommendation - assessed by a Speech and Language therapist.

 
   
Nutilis® Powder
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Formulary
Blue

Presentation - 300g tin

Specialist recommendation - assessed by a Speech and Language therapist.

 
   
Resource Thickenup Clear®
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Formulary
Blue

Presentation - 127g tin

Residents with swallowing difficulties to be assessed by a Speech and Language therapist.

 
Link  Dysphagia IDDS guidance
   
Thick & Easy Clear®
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Formulary
Blue

Presentation - 126g tin

Residents with swallowing difficulties to be assessed by a Speech and Language therapist.

 
Link  Dysphagia IDDS guidance
   
Nutilis Clear®
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Formulary
Blue

Presentation - 175g tin

Residents with swallowing difficulties to be assessed by a Speech and Language therapist.

Be aware that in the case of Nutilis Clear the scoop size and the number of scoops needed per drink has changed significantly. Further information can be found on the Nutricia website:   https://tinyurl.com/yacaszh4

 

 
Link  Dysphagia IDDS guidance
   
 ....
 Non Formulary Items
Ensure TwoCal liquid

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Non Formulary
 
Pro-Cal Shot

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Black

Comment : Not to be routinely commissioned (prescribed) in any care setting (primary or secondary care). This may be due to a lack of good clinical evidence, cost effectiveness, concerns over safety or due to the availability of more suitable alternatives. As such, drugs classified as Black should be considered as non-formulary.   

Red

Initiation : Specialist only
Repeat Prescribing : Specialist
Monitoring : Specialist
Comment : Prescribing must be in line with any specific treatment criteria outlined. In exceptional circumstances a GP may be asked to prescribe – the specialist must provide adequate information and support.   

Amber

Initiation : Specialist only
Repeat Prescribing : Primary care OR specialist
Monitoring : Primary care OR specialist
Comment : Monitoring according to Effective Shared Care Agreement (ESCA) for stabilised patients only. GP agreement should be requested by specialist and confirmed/declined by GP on a patient-by-patient basis.   

Blue

Initiation/Recommendation : Specialist only
Repeat Prescribing : Primary care
Monitoring : Primary care
Comment : Should be initiated or recommended by a specialist. Monitoring of either medicine or disease does not require specialist skills or equipment   

Green

Initiation : Primary care or specialist
Repeat Prescribing : Primary care
Monitoring : Primary care
Comment : Suitable for non specialist initiation   

OTC

Patients should be advised to purchase if approriate.  

netFormulary