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 (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 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. 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 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 suitableAltraplen®Compact125ml 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