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. See alternative choices above.
- Suitable for those requiring low volume.
- Suitable for 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
Formulary Choice | Product name | Presentation | Nutritional content# | Flavours |
---|---|---|---|---|
If powdered ONS is not suitable | Altraplen®Compact | 125ml bottle Available as pack of 4x125ml in one flavour | 300 kcal 12g protein | Vanilla, Strawberry, Banana, Hazel Chocolate |
Ensure® Compact | 125ml bottle | 300 kcal 13g protein | Banana, Strawberry, Vanilla | |
Fortisip® Compact | 125ml bottle | 300 kcal 12g protein | Apricot, Banana, Chocolate, Forest Fruit, Mocha, Neutral, Strawberry, Vanilla. |
#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