Oral Nutritional Supplements
General Notes
- Products within the first line choices category are suitable for most people.
- Products within the other categories should only be considered where first line products are not suitable and there is clinical justification for their use.
- Some products should only be prescribed under the recommendation of a dietitian, or a health care professional with expertise in this area, see dietitian led products for reference
- Products containing less than 1.5Kcal/ml (1-1.49Kcal/ml e.g. Ensure Liquid and Fresubin Original) should not be prescribed.
- Not all ONS are suitable for vegans and many are not gluten/lactose free, or suitable for patients with specific food allergies. Refer to individual product data sheets for product details for this information.
- Use with caution in CKD Stage 3 patients with hyperkalaemia – use under guidance of dietitian in CKD stage 4 & 5.
Practical Information for Prescribers in Primary Care
- ONS products need to be taken at least twice per day to provide a sufficient nutritional boost.
- Ensure directions for use are clear, e.g. one sachet twice a day between meals.
- Prescribe a limited quantity initially (7 day supply) to reduce wastage and no more than a month’s duration for subsequent prescriptions.
- Review period depends on clinical need, good practice suggests initial review after maximum one month then at least three monthly thereafter.
- Reinforce food fortification advice (link) during each review.
Powdered ONS – Cost Effective Choice for Primary Care
Powdered ONS products are more than 50% cheaper than ready-made ONS and are a cost effective option in primary care. However they are NOT SUITABLE FOR ALL PATIENTS, the following should be considered for each individual patient prior to prescribing:
- Ability to make up shakes? (either patient themselves or carer)
- Access to fridge, fresh milk and adequate storage for both milk and prepared product?
- Ability to adhere to the requirements for safe handling of a fresh milk product?
First Line
Powdered ONS >1.5 kcal/ ml (make up with 200ml whole milk)
| Formulary Choice | Product name | Presentation | Nutritional content# | Flavours |
|---|---|---|---|---|
| First choice | Aymes® Shake | 57g sachet Available as 1 box of 7 x 57g sachets of one flavour | 383 kcal 19g protein | Banana, Chocolate, Ginger, Neutral, Strawberry, Vanilla |
Ensure® Shake | 57g sachet Available as 1 box of 7 x 57g sachets of one flavour | 386 kcal 17g protein | Banana, chocolate, strawberry, vanilla | |
Foodlink® Complete | 57g sachet Available as 1 box of 7x57g sachets of one flavour | 383 kcal 19g protein | Banana, Chocolate, Strawberry, |
Ready Made ONS 1.5Kcal/ml Milkshake Style
| Product name | Presentation | Nutritional content# | Flavours | |
|---|---|---|---|---|
| If powdered ONS is not suitable | Aymes® Complete* *cost effective choice | 200ml bottle Available as 1 pack of 4x200ml in one flavour | 300 kcal 12g protein | Vanilla, Strawberry, Chocolate, Banana |
| Ensure® Plus milkshake style | 200ml bottle | 300 kcal 13g protein | Banana, Chocolate, Coffee, Fruits of the Forest, Neutral, , Peach, Raspberry, Strawberry, Vanilla | |
Fortisip® Bottle | 200ml bottle | 300 kcal 12g protein | Banana, Chocolate, Neutral, Orange, Strawberry, Caramel, Tropical, Vanilla |
Juice style and Savoury ONS
Prescribing notes
- Consider the following if sweet or milk based alternatives are disliked.
- Please note ‘Foodlink Complete’ can also be mixed with fruit juices or water to make a juice style ONS. If reconstituting ‘Foodlink Complete’ using alternative liquids note that the nutritional profile will vary.
- Juice style supplements are not recommended as first line product for those with diabetes. Where required they should be used with caution.
- Suitable for those who do not like milky products but these are NOT MILK FREE.
- Note protein content is lower than milkshake style products.
Powdered ONS 1.5kcal/ml Savoury (make up with 200ml hot water)
| Formulary Choice | Product name | Presentation | Nutritional content# | Flavours |
|---|---|---|---|---|
| First Choice | Aymes ActaSolve Savoury® | 57g sachet Available as 1 box of 7 x 57g sachets of one flavour | 250 kcal 9g protein | Chicken, Vegetable |
Ready Made ONS 1.5kcal/ml Juice style
| Formulary Choice | Product name | Presentation | Nutritional content# | Flavours |
|---|---|---|---|---|
| If powdered ONS is not suitable | AltraJuce® *cost effective choice | 200ml bottle | 300 kcal 7.8g protein | Apple, Blackcurrent, Strawberry, Orange |
| Ensure®plus juce | 220ml bottle | 330kcal 11g protein | Apple, Fruit Punch, Lemon-Lime, Orange, Peach, Strawberry | |
| Fortijuce® | 200ml bottle | 300kcal 8g protein | Apple, Blackcurrant, Forest Fruits, Lemon, Orange, Strawberry, Tropical |
Compact ONS
Prescribing notes
Compact style ONS should NOT be prescribed without consideration of the patient’s overall fluid balance and risk of dehydration and are usually recommended after dietetic assessment. See alternative choices above.
Compact style ONS may be considered for:
- those requiring low volume.
- those with early satiety.
Powdered ONS 2.4Kcal/ml Compact Milkshake Style (make up with 100ml whole milk)
| Product name | Presentation | Nutritional content# | Flavours | |
|---|---|---|---|---|
| First choice | Aymes® Shake Compact | 57g sachet Available as 1 box of 7 x 57g sachets of one flavour | 315-320 kcal 15g protein | Banana, Chocolate, Ginger, Strawberry, Vanilla, Neutral |
Foodlink® Complete Compact® | 57g sachet Available as 1 box of 7 x 57g sachets of one flavour | 318 kcal 15g protein | Natural, Strawberry, Vanilla, Chocolate, Banana | |
Ready Made ONS 2.4kcal/ml Compact Milkshake style
#Nutritional content per unit (e.g. per ready-made bottle or per sachet made up as directed). Protein content rounded to the nearest whole number