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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 25: A2 - Borderline substances - Full Chapter
Notes:

For specific CCG pathways for Cows Milk allergy and supplentary criteria, please refer to the APC website

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A2.02.01  Expand sub section  Powdered Oral Nutritional Supplements
 note  Powdered ONS which require mixing with 200mls of whole milk are first line in Primary Care. Ready to drink products are used in secondary care due to convenience and cost, but can often be switched to powdered ONS after discharge.

Contraindications to powdered supplements: lactose intolerance, CKD stage 4 and 5, dexterity or cognition problems (not applicable within a care home or patients with carers support).
AYMES Shake®
View adult BNF View SPC online View childrens BNF
First Choice
Amber 3

57g sachet - available in banana, chocolate, neutral, strawberry, vanilla and ginger flavours (Starter pack available containing one of each flavour and a shaker)

 
Ensure® Shake
View adult BNF View SPC online View childrens BNF
First Choice
Amber 3

57g sachet - available in banana, chocolate, strawberry and vanilla flavours

 
AYMES ActaSolve Smoothie® (Juice style)
View adult BNF View SPC online View childrens BNF
First Choice
Amber 3

66g sachet - available in mango, peach, pineapple, strawberry and cranberry flavours (Starter pack available containing one of each flavour and a shaker)

 
AYMES Shake Compact® (Low volume)
View adult BNF View SPC online View childrens BNF
First Choice
Amber 3

57g sachet - available in banana, chocolate, strawberry, vanilla and neutral flavours (Starter pack available containing one of each flavour and a shaker)

 
Foodlink® Complete with Fibre
View adult BNF View SPC online View childrens BNF
Formulary
  • Available in Vanilla, Banana, Chocolate, Natural and Strawberry flavours to be made with 200mls of whole milk
  • On dietician recommendation in secondary care- not stocked at SFH.
     
  •    
    Complan® Shake
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3
  • Available flavours are vanilla, strawberry, original,chocolate and banana in boxes of four sachets.
  • Starter pack available containing 1 of each flavour and a shaker. NOT FOR REPEAT PRESCRIPTION.
  • On dietician advice only in secondary care. 
  •    
    A2.02.01.01  Expand sub section  Milkshake/ Yoghurt Style Sip Feeds
     note 

    • Powdered ONS which require mixing with 200mls full fat milk are first line in Primary Care. Ready to drink products are used in secondary care due to convenience and cost, but can often be switched to powdered ONS after discharge.

    • Contraindications to powdered supplements: lactose intolerance, CKD stage 4 and 5, dexterity or cognition problems (not applicable within a care home or patients with carers support).

    • Patients that require ONS given via an enteral tube should be under the care of the Hospital HEF dieticians and obtain these through Homeward. Prescriptions for these should not be required from Primary Care.

    AYMES Complete® (Milkshake style)
    View adult BNF View SPC online View childrens BNF
    Second Choice
    Amber 3

    200ml ready to drink - available in banana, chocolate, strawberry, and vanilla flavours (Starter pack available containing one of each flavour)

     
       
    Ensure® Plus (Milkshake style)
    View adult BNF View SPC online View childrens BNF
    Second Choice
    Amber 3

    200ml ready to drink - available flavours are banana, chocolate, coffee, fruits of the forest, neutral, orange, peach, raspberry, strawberry and vanilla.

     
       
    Fortisip® Bottle (Milkshake style)
    View adult BNF View SPC online View childrens BNF
    Second Choice
    Amber 3

    200ml ready to drink - available in banana, caramel, chocolate, neutral, orange, strawberry, tropical fruit and vanilla

     

     
       
    AYMES® ActaGain 2.4 Complete Maxi
    View adult BNF View SPC online View childrens BNF
    Second Choice
    Amber 2

    200ml ready to drink - available in strawberry, and vanilla flavours (Starter pack available)

     
       
    Ensure® Plus Yoghurt style
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted

    On dietitian recommendation only

     
       
    Fortini
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    • On Dietician recommendation only
    • Available in strawberry and vanilla flavours
     
       
    Fortini compact multifibre
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Fortini multifibre
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Fortini multifibre 1.0
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Fortini smoothie multifibre
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Infatrini Peptisorb
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Infatrini®
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Fortisip® Yoghurt Style
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    • On dietician recommendation only. Ensure® plus Yoghurt style preferred in primary care.
    • Available in raspberry, peach & orange, and vanilla & lemon flavours in 200ml bottles.
     
       
    A2.02.01.02  Expand sub section  Juice Style Sip Feeds
     note  Juice style are not nutritionally complete and should not be used a sole source of nutrition. They are lower in protein than milk based supplements and are significantly higher in carbohydrate content. They should only be used for diabetes patients if their blood glucose levels can be adequately controlled and monitored.
    Altrajuce®
    View adult BNF View SPC online View childrens BNF
    Third Choice
    Amber 3

    200ml ready to drink - available in orange, apple, strawberry and blackcurrant flavours (Starter pack available containing assorted flavours)

     
       
    Fortijuce®
    View adult BNF View SPC online View childrens BNF
    Third Choice
    Amber 3

    200ml ready to drink - available in forest fruit, lemon, orange, apple, strawberry, blackcurrant and tropical flavours (Starter pack available containing six assorted flavours)

     
       
     ....
     Non Formulary Items
    Ensure Plus Savoury

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Ensure®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ensure® Plus Juce

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Please use formulary alternative. See APC Prescribing Oral Nutritional Supplements in Adults.

     
    Foodlink® Complete

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Please use formulary alternative. See APC Prescribing Oral Nutritional Supplements in Adults

     
    Fortini smoothie

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fresubin Powder Extra

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fresubin® Energy
    (Sip feed)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fresubin® Jucy

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Please use a formulary product, see APC Prescribing Oral Nutritional Supplements in Adults.

     
    Meritene

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Not for prescription. Patients may buy OTC
     
    Nurishment®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Not for prescription. Patients may buy OTC.
     
    Paediasure Plus

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Paediasure Plus Juce

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    ProvideXtra® Juice Drink

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Discontinued Sept 2013
  •  
    Resource® Energy
    (Sip feed)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Resource® Fruit

    View adult BNF View SPC online View childrens BNF
    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
    SMC
    Scottish Medicines Consortium
    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

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    OTC

      

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