Formulary choice oral nutritional supplements

There are two leaflets available to help patients and carers. There is a guide to making the most of your food and advice for patients and carers who are prescribed nutrition drinks (nutritional supplements)

Please refer to guidance on Adult Malnutrition

Oral Nutritional Supplements (ONS) must not be prescribed at NHS expense for nursing home patients who do not meet ACBS criteria as rules state that food items are not prescribable.

For acute hospital, all ONS must be written and authorized on prescription chart by dietitian. On discharge patients should be given 7 days supply and dietitian to contact GP by letter to inform regarding patient's MUST score, nutritional goals, ONS prescribed and plans for review.

Nutritional supplements (non-disease specific)

Powder shakes

Powder milk shakes are not suitable for patients with severe or end stage kidney failure (CKD Stage 4-5), or for patients with Stage 3B CKD who are hyperkalemic. They may not be suitable for patients with poor manual dexterity.

Fresubin® Powder Extra
  • Powder neutral, vanilla, strawberry and chocolate (£0.76 = 62g sachet)
  • One sachet reconstituted with 200ml whole milk provides 397 kcal and protein 17.7g
Complan® Shake
  • Powder original, banana, strawberry, vanilla, chocolate (£0.78 = 57g sachet)
  • One sachet reconstituted with 200ml whole milk provides approximately 387 kcal and protein 15.6g

Ready to drink

More than 1.5kcal/ml milkshake style

Fresubin® 2kcal
  • Liquid (sip feed) neutral, vanilla, apricot-peach, toffee, cappuccino, fruits of the forest (£1.96 = 200ml bottle)
  • 400kcal, protein 20g, carbohydrate 45g, fat 15.6g per 200ml
with fibre

Fibre-containing ONS are useful for those with constipation (not suitable for those requiring a fibre-free diet)

Fresubin® 2kcal fibre
  • Liquid (sip feed) chocolate, lemon, cappuccino, apricot-peach, neutral vanilla (£1.98 = 200ml bottle)
  • 400kcal, protein 20g, carbohydrate 45g, fat 15.6g, fibre 3g (3.2g for chocolate flavour) per 200ml

Standard energy soups

  • For disease related malnutrition
  • For hypoproteinaemia
  • Consider in patients who dislike sweet drinks
Vitasavoury®
  • Powder chicken, leek and potato, golden vegetable, mushroom (£1.90 = 50g sachet)
  • 309.5kcal, protein 6g, carbohydrate 11.25g, fat 26g, fibre 3.2g per 50g
Ensure® Plus Savoury
  • Liquid (sip feed) chicken (£1.40 = 220ml bottle)
  • 300kcal, protein 12.5g, carbohydrate 40.4g, fat 9.84g per 200ml

1.5kcal/ml milkshake style

Ensure® Plus
  • Liquid (sip feed) chocolate, strawberry, vanilla, fruits of the forest, banana, raspberry, orange, coffee, peach, neutral (£1.40 = 220ml bottle)
  • 300kcal, protein 12.5g, carbohydrate 40.4g, fat 9.84g per 200ml
Fresubin® Energy
  • Liquid (sip feed) vanilla, strawberry, chocolate, cappuccino, tropical fruit, blackcurrant, neutral, banana lemon (£1.40 = 200ml bottle)
  • 300kcal, protein 11.2g, carbohydrate 37.6g, fat 11.6g per 200ml
with fibre

Fibre-containing ONS are useful for those with constipation (not suitable for those requiring a fibre-free diet)

Ensure® Plus Fibre
  • Liquid (sip feed) vanilla, chocolate, raspberry, banana, strawberry (£2.02 = 200ml bottle)
  • 310kcal, protein 12.5g, carbohydrate 40.4g, fat 9.84g, dietary fibre 5g per 200ml
Fresubin® Energy Fibre
  • Liquid (sip feed) strawberry, chocolate, caramel, cherry, vanilla, banana (£2.02 = 200ml bottle)
  • 300kcal, protein 11.2g, fat 11.6g, carbohydrate 37.6g, fibre 3g per 200ml

1.5kcal/ml juice style

May be appropriate for patients who dislike milky drinks or for those with fat malabsorption

Fresubin® Jucy
  • Liquid (sip feed) orange, apple, pineapple, cherry, blackcurrant (£1.95 = 200ml)
  • 300kcal, protein 8g, carbohydrate 67g per 200ml
Ensure® Plus Juce
  • Liquid (sip feed) orange, apple, lemon and lime, strawberry, peach, fruit punch (£1.97 = 220ml bottle)
  • 330kcal, protein 10.56g, carbohydrate 71.94g per 220ml

1.5kcal/ml yogurt style

May be useful for patients with taste fatigue from first line sip feeds

Ensure® Plus Yogurt
  • Liquid (sip feed) orchard, peach, strawberry (£1.40 = 220ml bottle)
  • 330kcal, protein 13.75g, carbohydrate 44.44g, fat 10.82g per 220ml
Fortisip® Yogurt Style
  • Liquid (sip feed) raspberry, vanilla and lemon, peach and orange (£2.02 = 200ml bottle)
  • 300kcal, protein 12g, carbohydrate 37.4, fat 11.6g per 200ml

More than 1.5kcal/ml low volume

Fortisip® Compact
  • Liquid (sip feed) neutral, strawberry, vanilla, banana, mocha, apricot, forest fruit, chocolate (£1.45 = 125ml bottle)
  • 300kcal, protein 11.75g, carbohydrate 31.5g, fat 13g, per 125ml
with fibre

Fibre-containing ONS are useful for those with constipation (not suitable for those requiring a fibre-free diet)

Fortisip® Compact Fibre
  • Liquid (sip feed) vanilla, strawberry, mocha (£2.09 = 125ml bottle)
  • 300kcal, protein 11.75g, carbohydrate 31.5g, fat 13g, dietary fibre 5.62g per 125ml

High Protein

Fresubin® Protein Energy
  • Liquid (sip feed) vanilla, chocolate, tropical fruits, cappuccino, wild strawberry (£2.04 = 200ml)
  • 300kcal, protein 20g, carbohydrate 24.8g, fat 13.4g per 200ml
Fortsip® Compact Protein
  • Liquid (sip feed) vanilla, strawberry, banana, peach and mango, mocha (£2.00 = 125ml bottle)
  • 300kcal, protein 18g, carbohydrate 30.5g, fat 11.75g per 125ml

Specialist products for specific clinical conditions

The specialist nutritional products are not listed in priority order. Patient compliance should be paramount in the product choice. Seek guidance from a registered dietitian regarding prescribing the following products.

Semi-solid

Feed thickeners

Indicated for patients with dysphagia, as identified by Speech and Language, who have advised on the stage of thickened fluids.

Thick and Easy
  • Powder (225g tin = £5.21)
Thick and Easy Clear
  • Powder (126g tin = £8.80)

Notes

  1. If a patient is prescribed thickener whilst in hospital, it is important to continue the same product into primary care for clinical continuity and to reduce errors in mixing.
  2. Clear (gum based) products have very specific mixing instructions which must be adhered to, to ensure the product is the correct thickness for patient safety. Please refer to mixing instructions on the tins or seek appropriate advice.
  3. Sachets are significantly more expensive than tins. Sachets do not display mixing instructions and can be cumbersome to use. Routine use of sachets is not recommended.

Number of tins of Thick & Easy (225g) or tins of Thick & Easy Clear (126g) required per month (28 days):

Consistency Thick & Easy Thick & Easy Clear
Stage I 3 tins 2 tins
Stage II 4 tins 3 tins
Stage III 6 tins 4 tins

The above is based on recommended usage of Thick & Easy or Thick & Easy Clear for 500ml fluids per day. Ready reckoners and hydration calculators published by Fresenius-kabi.

The communication from the Speech and Language Therapist should state the consistency to be used. If a different amount is required a clinical reason should be stated.

Dessert

Indicated for patients with dysphagia

Fresubin® 2kcal crème
  • Semi-solid vanilla, wild strawberry, cappuccino, chocolate, praline (£1.93 = 125g)
  • 250kcal, protein 12.5g, carbohydrate 28.12g, fat 9.75g per 125g
Fresubin® Yocrème
  • Semi-solid apricot-peach, biscuit, lemon, raspberry (£2.00 = 125g pot)
  • 187.5kcal, protein 9.37g, carbohydrate 24.37g, fat 5.87g per 125g
Forticrème® Complete
  • Semi-solid vanilla, chocolate, banana, forest fruits (£1.96 = 125g pot)
  • 200kcal, protein 11.87g, carbohydrate 24.12g, fat 6.25g per 125g

Pre-thickened drink

Indicated for patients with dysphagia or disease related malnutrition

Fresubin® Thickened stage 1
  • Lactose free, syrup consistency, vanilla, wild strawberry (£2.31 = 200ml)
  • 300kcal, protein 20g, carbohydrate 24.4g, fat 13.4g per 200ml
Fresubin® Thickened stage 2
  • Lactose free, custard consistency, vanilla, wild strawberry (£2.31 = 200ml)
  • 300kcal, protein 20g, carbohydrate 24g, fat 13.4g per 200ml

Fat based calorie liquid supplement

  • For conditions requiring fortification with a high fat supplement
  • Not to be used as a sole source of nutrition
  • Recommended dose: 30ml three times daily
  • Lactose free, cow's milk protein free
Fresubin® 5kcal Shot
  • Neutral, lemon (£2.80 = 120ml)
  • 600kcal, carbohydrate 4.8g, fat 64.56g, fibre 0.48g per 120ml
Calogen®
  • Unflavoured (£4.36 = 200ml)
  • 900kcal, fat 100g per 200ml

Carbohydrate based calorie powder supplement

  • Use as an energy enhancer in disease related malnutrition
  • Lactose free, fat free
  • Care when used in diabetics
  • Not to be used as a sole source of nutrition
  • Minimum recommended dose: 75g/day
Maxijul® Super Soluble
  • Powder 3.8kcal/g (£2.60 = 200g)
  • Carbohydrate 95g/100g
Polycal®
  • Powder 3.8kcal/g (£4.28 = 400g tin)
  • Carbohydrate 90g/100g

Carbohydrate based calorie liquid supplement

Polycal® Liquid
  • 2.47kcal/ml orange, neutral (£1.72 = 200ml)

Notes

  1. Use as an energy enhancer in disease related malnutrition
  2. Lactose free, fat free

Fat and carbohydrate calorie supplement

Duocal® Super Soluble
  • Powder 5kcal/g (£18.09 = 400g)
  • Carbohydrate 72.7g, fat 22.3g per 100g

Notes

  1. For high energy, low fluid, low electrolyte requirements e.g. renal disease, catabolic states
  2. Suitable for use in infants, children and adults

Protein supplement

  • For hypoproteinaemia
  • Contains residual lactose
Protifar®
  • Powder 3.8kcal and 0.9g protein/g (£8.69 = 225g)

Fat and protein liquid supplement

  • Disease related malnutrition, conditions requiring fortification with fat
  • For hypoproteinaemia
  • 120ml/day in divided doses
Calogen® Extra
  • Emulsion 4kcal and 0.05g protein/ml, strawberry, unflavoured (£4.98 = 200ml bottle)
Pro-cal® Shot
  • 3.3kcal and 0.07g protein/ml neutral, banana, strawberry (£2.41 = 120ml bottle)
MCT Procal
  • Powder 657kcal/100g (£0.79 = 16g, 30 x 16g = £23.76)

Fat, protein and carbohydrate supplement

For hypoproteinaemia

Pro-cal®
  • Powder 667kcal/100g (£14.67 = 510g tub)
  • Protein 13.6g, carbohydrate 28.2g, fat 55.5g per 100g

High Energy Milk Shake Powder

  • For disease related malnutrition
  • For hypoproteinaemia
  • All varieties need to be reconstituted with 240ml full cream milk
  • None are nutritionally complete
Calshake®
  • Powder, vanilla, chocolate, banana 495kcals per 100g (£2.39 = per sachet)
  • Protein 4.3g, fat 24.4g, carbohydrate 65.1g
Enshake®
  • Powder 450kcals per strawberry, vanilla, chocolate, banana (£2.16 = 1 sachet)
  • Protein 8.4g, fat 15.6g, carbohydrate 69.0g per 100g

Special additives for conditions of intolerance

VSL#3®
  • Sachets (£33.89 = 30 sachets)

Indications

  • Maintenance of remission of ileoanal pouchitis induced by antibacterials in adults

Notes

  1. To be initiated by a consultant gastroenterologist
  2. It is recommended to take VSL#3 for at least one month to see the best benefit. In general it takes up to seven days for the bacteria colonies to become established in the gut. By day 20 the maximum concentration of bacteria will have colonised the gut.

Anti-inflammatory (Crohn's disease)

Modulen® IBD
  • Powder 100kcals, 3.6g protein/ 100ml reconstituted powder (£15.06 = 400g)
  • Protein 18g, carbohydrate 54g, fat 23g per 100g

Notes

  1. For Crohn's disease – active phase and in remission if malnourished

Peptide based supplement

Vital 1.5kcal
  • Liquid 150kcals per 100ml (£2.98 = 200ml)
  • Protein 6.75g, carbohydrate 18.4g, fat 5.5g per 100ml

Notes

  1. For malabsorption

 

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