Oral nutritional supplements & Food first formulary

exp date isn't null, but text field is

Always consider the most cost-effective and clinically appropriate product when recommending oral nutritional supplements (ONS). Prescribers are advised:

 For new patients:

• only consider initiating ONS following 'Food First Advice' dietary intervention and on the recommendation of a Dietitian where available.
• check the BNF for any drug nutrient interactions, eg warfarin.
• prescribe supplements as per table below only for ACBS approved indications and endorse prescriptions ‘ACBS’; social or financial reasons do not qualify for ONS prescription.
• powdered ONS should be used as a first-line product in community settings, unless contraindicated.
• usually prescribe 28 days supply on acute prescription for a maximum of 3 months; further supply should only be on the advice of a Dietitian.
• refer to ’Oral nutritional supplements (MUST)’ guidance for further information.
• anyone requiring ONS as a sole source of nutrition should be referred to a Dietitian.

 For existing patients who have received ONS prescriptions for more than 3 months:

• continue the prescription where a Dietitian has provided a detailed nutritional assessment and is closely following up the patient as detailed in dietetic correspondence.
• review all other patients as per ’Oral nutritional supplements (MUST)’ guidance.

Recommended oral nutritional supplements (ONS)		Pack size
Milk-based
First choice	Aymes® Shake (or Aymes® Complete if dexterity problems)	57g 200mL
Second choice	Enshake®	96.5g
Third choice	Fortisip® Compact	125mL
Milk-based with higher protein content
First choice	Fortisip® 2Kcal	200mL
Second choice	Ensure® TwoCal	200mL
Third choice	Fortisip® Compact Protein	125mL
Fruit juice style
First choice	Fresubin® Jucy Drink	200mL
Second choice	Ensure® Plus Juce	220mL
Others	Fortijuce®	200mL
Feed thickeners – often used in patients with dysphagia. Nutritionally incomplete. To be used under the guidance of a Speech and Language Therapist.

In line with national advice, the products listed below are not usually prescribed in primary care and alternatives are recommended. Exceptionally, prescribing of these listed products should be confined to situations where a Dietitian has provided a detailed nutritional assessment and is closely following up the patient as detailed in dietetic correspondence.

Products not usually prescribed	Recommended alternative
Ensure Plus® Creme Forticreme® Complete	Offer 'Food First Advice' and continue to review weight. If any concerns refer to Dietitians.
Calogen® Calogen® Extra Maxijul® Polycal® Pro-cal® Pro-cal® Shot	Offer 'Food First Advice' and continue to review weight. If any concerns refer to Dietitians. Exceptionally, may be required for paediatrics and specialist patients, eg liver or renal disease, on the advice of a Dietitian.
Respifor®	Start new patients and switch existing patients onto Aymes® Shake (or Aymes® Complete if dexterity problems).
Thick and Easy®	Start new patients and switch existing patients onto Nutilis® Clear amylase free thickener. Feed thickeners – often used in patients with dysphagia. Nutritionally incomplete. To be used under the guidance of a Speech and Language Therapist.