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Nottinghamshire Area Prescribing Committee
Joint Formulary
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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).
Foodlink® Complete
View adult BNF View SPC online View childrens BNF
Formulary
Amber 3
  • Available in Banana, Chocolate, Vanilla, Natural and Strawberry flavours
  • Starter pack available containing 1 of each flavour plus vanilla with added fibre and a shaker. NOT FOR REPEAT PRESCRIPTION
  • First line product for primary care. Should be made with 200mls of whole milk, can be made with 125mls of whole milk for patients that can only manage small volumes.
  • On dietician recommendation in secondary care- not stocked at SFH.
     
  •    
    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.
     
  •    
    AYMES Shake
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    Formulary
    Amber 3
  • Available in banana, chocolate, neutral, strawberry and vanilla flavours
  • On dietician recommendation only in secondary care. Not stocked at SFH.
  • Starter pack available containing 1 of each flavour and a shaker. NOT FOR REPEAT PRESCRIPTION.
     
  •    
    Complan® Shake
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    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. 
  •    
    Ensure® Shake
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    Formulary
    Amber 3
  • Available flavours are banana, chocolate, strawberry and vanilla.
  • On dietitian recommendation only in secondary care. Not stocked at SFH 
  •    
    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
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3
    • Available in banana, chocolate, strawberry, and vanilla flavours
    • Starter pack available containing 1 of each flavour. NOT FOR REPEAT PRESCRIPTION.
    • On dietician recommendation only in secondary care. Not stocked at SFH.
     
       
    Ensure® Plus Milkshake style
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3
    • Available flavours are banana, chocolate, coffee, fruits of the forest, neutral, orange, peach, raspberry, strawberry and vanilla.
    • On dietician recommendation only in secondary care. Not stocked at SFH
     
       
    Ensure® Plus Yoghurt style
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3
    • Available flavours are Strawberry swirl and Orchard peach.
    • On dietician recommendation only in secondary care. Not stocked at SFH
     
       
    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
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    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Fortini smoothie multifibre
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    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Fortisip® Bottle
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    Formulary
    Amber 3
    • On dietician recommendation only in secondary care - Fortisip Compact preferred.
    • Available in neutral, banana, chocolate, toffee, orange, tropical fruit, strawberry and vanilla flavours in 200ml bottles
     
       
    Infatrini Peptisorb
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    Restricted Drug Restricted
    • On Dietician recommendation only
     
       
    Infatrini®
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    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.
    Ensure® Plus Juce
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    Formulary
    Amber 3
    • Not stocked at SFH
    • Available in apple, fruit punch, lemon & lime, orange, peach and strawberry flavours
     
       
    Fresubin® Jucy
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3
  • On dietician recommendation only in secondary care. Not stocked at SFH.
  • Available in apple, orange, pineapple, blackcurrant and cherry flavours 
  •    
    Fortijuce®
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    Formulary
    Amber 3
  • Available in forest fruit, lemon, orange, apple, strawberry, blackcurrant and tropical flavours in 200ml bottles
  • Starter pack available containing 6 assorted flavours. NOT FOR REPEAT PRESCRIPTION.
     
  •    
     ....
     Non Formulary Items
    Ensure Plus Savoury

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    Non Formulary
    Grey
     
    Ensure®

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    Non Formulary
     
    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
     
    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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