Oral nutritional supplements & Food first formulary

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Food First leaflet

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' 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.

Food First leaflet