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9.4.5.1-ONS First Line Products

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 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 ChoiceProduct namePresentation 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,
Natural, Vanilla

 

Ready Made ONS 1.5Kcal/ml Milkshake Style

Product namePresentation 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 style200ml bottle300 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 ChoiceProduct namePresentation Nutritional content#Flavours
First ChoiceAymes 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 ChoiceProduct namePresentation Nutritional content#Flavours
If powdered ONS is not suitable

AltraJuce®

*cost effective choice

200ml bottle300 kcal
7.8g protein
Apple, Blackcurrent, Strawberry, Orange
Ensure®plus juce220ml bottle330kcal
11g protein
Apple, Fruit Punch, Lemon-Lime, Orange, Peach, Strawberry
Fortijuce®200ml bottle300kcal
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 namePresentation Nutritional content#Flavours
First choiceAymes® Shake Compact57g 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 ChoiceProduct namePresentation Nutritional content#Flavours
If powdered ONS is not suitable

Altraplen®Compact

*cost effective choice

125ml bottle
Available as pack of 4x125ml in one flavour
300 kcal
12g protein
Vanilla, Strawberry, Banana, Hazel Chocolate

Ensure® Compact

125ml bottle300 kcal
13g protein
Banana, Strawberry, Vanilla
Fortisip® Compact125ml bottle300 kcal 12g proteinApricot, 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

 

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