Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: n/a Review by: March 2020
BNF CHAPTER 9: NUTRITION & BLOOD 9.1 ANAEMIAS
9.1.1 IRON-DEFICIENCY ANAEMIAS
9.1.1.1 ORAL IRON
Use of modified release iron preparations is not recommended since these preparations release iron beyond the duodenum, an area where iron absorption is low. Ferrous gluconate should only be used if the patient has proven intolerant of ferrous sulphate; however any reduction in side effects is mainly due to the lower iron content of this preparation.
Ferrous sulphate 200mg tablets (equivalent to 60mg iron)
Ferrous fumarate 210mg tablets (equivalent to 68mg iron) (primary care only)
140mg/5mL syrup (equivalent 45mg/5mL iron)
Ferrous gluconate 300mg tablets (equivalent to 35mg iron)
9.1.1.2 PARENTERAL IRON
Iron sucrose
(Venofer)
100mg/2mL injection
Iron carboxymaltose 50mg/mL injection
(Ferinject) Limited indications
Contact the ward pharmacist or pharmacy department to determine the dose required to restore iron stores. Iron deficiency should have been established prior to this by checking serum ferritin. The patient’s most recent haemoglobin result will also be needed.
The calculated total required dose of iron sucrose is split into 200mg doses and given up to three times a week. Iron carboxymaltose may be given as a single dose of up to 1000mg.
MHRA safety advice: Anaphylaxis is uncommon but remains a possible adverse reaction to iron preparations. Resuscitation facilities must be available and patients must be observed for at least 30 minutes following every iron infusion.
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: n/a Review by: March 2020
9.1.2 DRUGS USED IN MEGALOBLASTIC ANAEMIAS
Hydroxocobalamin 1mg/mL injection
Folic acid 5mg tablets
2.5mg/5mL syrup
Cyanocobalamin 50mcg tablets https://www.westcheshireccg.nhs.uk/document_uploads/Guidelines/B12guidelinev1_20170210.pdf
9.1.3 DRUGS USED IN HYPOPLASTIC, HAEMOLYTIC, AND RENAL ANAEMIAS
Erythropoietins
For use by Renal, Haematology & Oncology only
Oncology use, see NICE TA142 Erythropoietin (alfa and beta) and darbepoetin for the
treatment of cancer-treatment induced anaemia
Darbepoetin alfa
Epoetin alfa
9.1.4 DRUGS USED IN PLATELET DISORDERS
See haematology guidelines for regimes
Romiplostim available according to NICE TA221
Eltrombopag available according to NICE TA293
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: n/a Review by: March 2020
9.2 FLUIDS AND ELECTROLYTES
9.2.1.1 ORAL POTASSIUM
Sando K 12mmol K+/tablet
Potassium chloride 1mmol/mL syrup SF
600mg m/r tablets (Slow K) (8mmol K+/tablet)
9.2.1.3 ORAL BICARBONATE
Sodium bicarbonate 500mg capsules
9.2.2 PARENTERAL PREPARATIONS FOR FLUID AND ELECTROLYTE IMBALANCE
9.2.2.1 ELECTROLYTES AND WATER
Intravenous sodium
Contact pharmacy for availability of preparations
Intravenous potassium
See COCH SharePoint for list of preparations and administration guidelines
Bicarbonate and lactate
Sodium bicarbonate 1.26% infusion (75mmol HCO3-/500mL)
8.4% injection (50mmol HCO3- / 50mL
Prescribing note Avoid modified release potassium preparations unless effervescent tablets or liquid preparations are inappropriate or not tolerated. Modified release potassium preparations must be taken sitting upright and with plenty of water to avoid oesophageal damage, which may occur if they become trapped in the oesophagus.
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: n/a Review by: March 2020
9.3 INTRAVENOUS NUTRITION Contact Nutrition Team
9.4 ENTERAL NUTRITION
See below for adult enteral product formulary. For paediatrics please refer to: Prescribing Guideline for Cow’s Milk Protein Allergy (CMPA),and information on infant formulas available for this.
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: n/a Review by: March 2020
Countess of Chester Hospital NHS Foundation Trust ADULT ENTERAL PRODUCT FORMULARY
Core feed - may be used prior to Dietetic referral when commencing the starter enteral feeding regimen.
Product Name Presentation Indications* Comments** Availability Jevity 1.0kcal/ml,
isonitrigenous, contains mixed fibre and FOS*** 500/1000/1500ml RTH****
To help maintain normal bowel function in patients requiring enteral feeds.
Core feed. Not suitable for low residue diets.
Regular stock item (see
key to availability below).
Core feeds – may NOT be used without Dietetic/Medical supervision.
Product Name Presentation Indications* Comments** Availability Jevity Plus 1.2 kcal/ml, high
nitrogen, contains mixed fibre and FOS, 500/1000/1500ml RTH.
Higher energy than standard feed. Nutritionally complete balanced feed.
Not suitable for low residue diets.
Regular stock item.
Jevity 1.5kcal 1.5 kcal/ml, high nitrogen, contains mixed fibre and FOS, 500/1000/1500ml RTH.
For increased energy requirements. Nutritionally complete balanced feed.
Not suitable for low residue diets or in hepatic or renal failure.
Regular stock item.
Jevity Promote 1.0kcal/ml, high nitrogen, contains mixed fibre and FOS, 1000ml RTH.
Nutritionally complete in 1000ml excluding potassium and chloride.
Not suitable for low residue diets or in hepatic or renal failure.
Regular stock item.
* All enteral feeds are indicated for patients with existing malnutrition or risk for malnutrition. ** Not suitable for intravenous administration; not suitable for infants under 1 year. *** FOS – Fruco-oligosaccharides. **** RTH – Ready-To-Hang container.
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: n/a Review by: March 2020
Countess of Chester Hospital NHS Foundation Trust ADULT ENTERAL PRODUCT FORMULARY Alternative/specialist feeds - must NOT be used without Dietetic/Medical supervision.
Product Name Presentation Indications Comments Availability Ensure Plus 1.5kcal/ml, high
nitrogen, complete balanced liquid, Non fibre, 500/1000/1500ml RTH.
As Jevity 1.5kcal. High energy and protein needs. Fluid restricted regimens.
May not be suitable for hepatic or renal failure.
Requires order request (see key to availability below).
Osmolite 1.0kcal/ml, non-fibre, isonitrogenous, 500/1000/1500ml RTH.
Standard feed for patients requiring enteral feeds.
May be suitable for patients requiring low residue feed.
Requires order request.
Osmolite Plus 1.2kcal/ml, non-fibre, isonitrogenous, 500/1000/1500ml RTH.
For patients with increased energy and protein needs.
May be suitable for patients requiring low residue feed.
Requires order request.
Perative 1.3kcal/ml, semi elemental, non-fibre, 500/1000ml RTH.
Severe maldigestion/ malabsorption. Jejunostomy feeds.
Regular stock item.
Nepro 2.0kcal/ml, low electrolyte feed, nitrogen dense, low volume, 500ml RTH.
Electrolyte and fluid restrictions.
Regular stock item.
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: n/a Review by: March 2020
Countess of Chester Hospital NHS Foundation Trust ADULT ENTERAL PRODUCT FORMULARY Alternative/specialist enteral feeds continued.
Product Name Presentation Indications Comments Availability Modulen IBD 5kcal/g, elemental
powder feed to be made up to various concentrations with H2O, contains anti-inflammatory factors, 400g tin.
Exclusively designed for Crohn’s disease. Nutritionally complete in 400g.
Can be sole source of nutrition or used as a supplement to diet Can be given via oral route.
Regular stock item. .
Elemental 028 3.8kcal/g, elemental powder feed to be made up to various concentrations with H2O, 100g sachet.
IBD, short bowel syndrome, malabsorption.
Can be sole source of nutrition or used as a supplement to diet. Can be given via oral route.
Requires order request.
Elemental 028 Extra 4.4kcal/g, elemental powder feed to be made up to various concentrations with H2O, 100g sachet.
IBD, short bowel syndrome, malabsorption.
Can be sole source of nutrition or used as a supplement to diet. Can be given via oral route.
Requires order request.
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
Adult Oral Nutrition Supplement Formulary (GP Version)
Suitable for initiation by GP without dietetic input
Contents Powdered Milkshake Style (Not ready to drink) ......................................................................................................................................... 2
Ready to Drink - Milkshake Style ................................................................................................................................................................ 2
Ready to Drink - Savoury Styles .................................................................................................................................................................. 3
Ready to Drink - Juice Style ........................................................................................................................................................................ 3
Compact (Low Volume) Oral Nutrition Supplements ................................................................................................................................. 4
Ready to Eat – Yogurt/Dessert Style .......................................................................................................................................................... 4
Thickened Supplements ............................................................................................................................................................................. 4
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
POWDERED MILKSHAKE STYLE (NOT READY TO DRINK) *Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber
Instructions
Available Flavours/ Presentation
Price (August 2018)
comments
Aymes Shake (Aymes International Ltd.)
Standard ACBS indications
57g sachets (7 x sachets per pack). Banana, Vanilla, Chocolate, Strawberry, Neutral.
Per sachet £0.60
To be mixed with full fat milk
Energy Shake Powder (Anaiah Healthcare)
Standard ACBS indications
57g sachets (4 x sachets per pack). Vanilla, Chocolate, Strawberry, Banana and Neutral flavours.
Per sachet £0.54
To be mixed with full fat milk
Complan Shake (Nutricia Ltd.)
Standard ACBS indications 57g sachet (4 x sachets per pack). Flavours: Banana, Chocolate, Milk, Strawberry, Vanilla.
Per sachet £0.70
To be mixed with full fat milk
Ensure Shake (Abbott Laboratories Ltd.)
Standard ACBS indications 57 g sachet (7 x 57 g per pack). Flavours: Banana, Chocolate, Strawberry, Vanilla.
Per sachet £0.60
To be mixed with full fat milk
READY TO DRINK - MILKSHAKE STYLE
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indication & Prescriber Instructions
Available Flavours/ Presentation
Price (August 2018)
comments
Ensure Plus Milkshake Standard ACBS indications, 200 ml bottle. 200 ml bottle -
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
Style (Abbott Laboratories Ltd.)
CAPD, haemodialysis Flavours: Banana, Chocolate, Coffee, Fruits of the Forrest, Neutral, Orange, Peach, Raspberry, Vanilla
£1.11
Fortisip Bottle (Nutricia Ltd.)
Standard ACBS indications. 200ml bottle. Flavours: Banana, Caramel, Chocolate, Neutral, Orange, Strawberry, Tropical Fruit, Vanilla
200 ml bottle £1.12
-
READY TO DRINK - SAVOURY STYLES
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation
Price (August 2018)
Comments
Powdered (Not ready to drink) VitaSavoury (Nestle Health Science Ltd.)
Standard ACBS indications. 50 g sachet (10 x 50 g sachets per pack). Flavour: Chicken, Golden Vegetable, Leek and Potato, Mushroom
50 g sachet £2.01
-
Ready to Drink
Ensure Plus Savoury (Abbott Laboratories Ltd.)
Standard ACBS indications, CAPD, haemodialysis
200 ml bottle. Flavours: Chicken, Mushroom
200 ml bottle £1.11 -
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
READY TO DRINK - JUICE STYLE
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation
Price (August 2018)
Comments
Ensure Plus Juce Style (Abbott Laboratories Ltd.)
Standard ACBS indications.
220 ml bottle. Flavours: apple, fruit punch, lemon and lime, orange, peach and strawberry
220ml bottle £1.97
-
Fresubin Jucy (Fresenius Kabi Ltd)
Standard ACBS indications. Also CAPD, haemodialysis.
4 x 200 ml EasyBottle. Flavours: Apple, Orange, Pineapple, Blackcurrant, Cherry
200 ml bottle £2.01 -
Fortijuice (Nutricia Ltd)
Standard ACBS indications.
200 ml bottle. Flavours: Lemon, Apple, Orange, Strawberry, Tropical, Forest Fruits, Blackcurrant
200 ml bottle £2.02
-
COMPACT (LOW VOLUME) ORAL NUTRITION SUPPLEMENTS
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indication & Prescriber Instructions
Available Flavours/ Presentation
Price (August 2018)
Comments
Powdered
AYMES Shake Compact (Aymes International Ltd.)
Standard ACBS indications.
57 g sachet (7 x 57 sachets in pack). Flavours: Vanilla, Strawberry, Chocolate, Banana and Neutral Can be added to food and fluid.
Per 57 g sachet £0.60 To be mixed with
full fat milk
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
READY TO EAT – YOGURT/DESSERT STYLE *Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation
Price (August 2018)
comments
Ensure Plus Yogurt Style (Abbot Laboratories Ltd.)
Standard ACBS indications. Also CAPD, haemodialysis.
200 ml bottle. Orchard Peach, Strawberry Swirl
200 ml £1.11 -
THICKENED SUPPLEMENTS
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation
Price (August
2018) Comments
Fresubin Thickened Stage 1 (Fresenius Kabi Ltd)*
Dysphagia or disease-related malnutrition.
200 ml bottle. Liquid/syrup thickness Flavours: Wild Strawberry, Vanilla
200ml Bottle £2.35
Consider dietetic referral for all patients on
thickened fluids
Fresubin Thickened Stage 2 (Fresenius Kabi Ltd)*
Dysphagia or disease-related malnutrition.
200 ml bottle. Liquid/syrup thickness Flavours: Wild Strawberry, Vanilla
200 ml Bottle £2.35
Consider dietetic referral for all patients on
thickened fluids
* Note: these supplements are not yet compliant with the IDDSI framework. This section will be updated in due course.
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
Adult Oral Nutrition Supplement Formulary Not suitable for GP initiation without dietetic review
Contents Powdered Milkshake Style Supplements (Not ready to drink) .............................................................................................. 14
Milkshake Style Supplements (Ready to Drink) .................................................................................................................... 15
Compact (Low Volume) Oral Nutrition Supplements ........................................................................................................... 16
Yogurt/Dessert Style Supplements (Ready to Eat) ............................................................................................................... 17
High Fat Supplements .......................................................................................................................................................... 17
High Protein Supplements ................................................................................................................................................... 19
High Fibre Supplements ....................................................................................................................................................... 20
Peptide-Based Supplements ................................................................................................................................................ 21
Oral nutrition Supplements for Specific Medical Conditions ................................................................................................ 22
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
POWDERED MILKSHAKE STYLE SUPPLEMENTS (NOT READY TO DRINK) *Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber
Instructions
Available Flavours/ Presentation
Price (August 2018)
Suitable for initiation by GP
without dietitian
involvement? Enshake (Abbott Laboratories Ltd.)
Standard ACBS indications. 96.5 g sachet (6 x 96.5 g per pack). Flavours: Banana, Chocolate, Strawberry, Vanilla.
Per sachet £2.45 No
Calshake (Fresenius Kabi Ltd)
Standard ACBS indications. 87 g sachet (7 x 87 g per pack). Flavours: Banana, Chocolate, Neutral, Strawberry, Vanilla.
Per sachet £2.53 No
Scandishake (Nutricia Ltd)
Standard ACBS indications. 85 g sachet (6 x 85 g per pack). Flavours: Banana, Caramel, Chocolate, Strawberry, Unflavoured, Vanilla.
Per sachet £2.59 No
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
MILKSHAKE STYLE SUPPLEMENTS (READY TO DRINK)
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation
Price (August 2018)
Suitable for initiation by GP without dietitian
involvement? Ensure Plus Fibre (Abbott Laboratories Ltd.)
Standard ACBS indications, CAPD, haemodialysis
200 ml bottle. Flavours: Banana, Chocolate, Vanilla, Raspberry, Strawberry
200 ml bottle £2.07
No
Fresubin Protein Energy Drink (Fresenius Kabi Ltd)
Standards ACBS indications, CAPD, haemodialysis
200 ml bottle. Flavours: Cappuccino, Chocolate, Tropical Fruits, Vanilla, Wild Strawberry
200 ml bottle £2.10
No
Fresubin 2 kcal Drink (Fresenius Kabi Ltd)
Standard ACBS indications, CAPD, haemodialysis
200 ml bottle. Flavours: Apricot-Peach, Cappuccino, Fruits of the Forest, Neutral, Toffee, Vanilla
200 ml bottle £2.10
No
Ensure Twocal (Abbott Laboratories Ltd.)
Standard ACBS indications, CAPD, haemodialysis
200 ml bottle. Flavours: Banana, Neutral, Strawberry, Vanilla
200 ml bottle £2.22
No
Fresubin 3.2 kcal (Fresenius Kabi Ltd)
Standard ACBS indications. 125 ml EasyBottle. Flavours: Vanilla-Caramel, Hazelnut
125 ml bottle £2.35
No
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
COMPACT (LOW VOLUME) ORAL NUTRITION SUPPLEMENTS
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation Price (August 2018)
Suitable for initiation by GP without dietitian
involvement? Ready to Drink Fresubin 2kcal Mini (Fresenius Kabi Ltd)
Standard ACBS indications.
125 ml EastBottle (4 pack) Flavours: Vanilla, Fruits of the Forest, Apricot-Peach
125 ml Bottle £1.25
No
Altraplen Compact (Nualtra Ltd.)
Standard ACBS indications.
125 ml bottle. Flavours: Hazel Chocolate, Vanilla, Strawberry, Banana
125 ml bottle £1.33
No
Ensure Compact (Abbott Laboratories Ltd.)
Standard ACBS Indications. 125 ml bottle Flavours: Banana, Strawberry, Vanilla
125 ml bottle £1.33
No
Fortisip Compact (Nutricia Ltd)
Standard ACBS indications.
125 ml bottle Flavours: Apricot, Banana, Forest Fruit, Mocha, Strawberry, Vanilla
125 ml bottle £1.45
No
Fortisip Compact Fibre (Nutritica Ltd)
Standard ACBS indications. 125 ml bottle. Flavours: Mocha, Strawberry, Vanilla
125 ml bottle £2.09
No
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
YOGURT/DESSERT STYLE SUPPLEMENTS (READY TO EAT) *Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber
Instructions
Available Flavours/ Presentation
Price (August 2018)
Suitable for initiation by GP without dietitian
involvement? Ensure Plus Crème (Abbott Laboratories Ltd)
Standard ACBS indications.
Semi-solid in 125g pot. Flavours: Banana, Chocolate, Neutral, Vanilla
125 g pot £1.93 No
Fresubin Yocrème (Fresenius Kabi Ltd)
Standard ACBS indications.
Semi-solid in 125 g pot. Flavours: Apricot-Peach, Biscuit, Lemon, Raspberry
125 g Pot £2.04 No
Fortisip Yogurt Style (Nutricia Ltd.)
Standard ACBS indications.
200 ml bottle. Flavour: Vanilla & Lemon
200 ml £2.14
No
HIGH FAT SUPPLEMENTS
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation
Price (August 2018)
Suitable for initiation by GP without
dietitian involvement?
Calogen (Nutricia Ltd.)
Standard ACBS indications.
Calogen emulsion in 200 ml or 500 ml bottles. Flavours: Neutral, Banana or Strawberry
120 ml (4 x 30 ml)
£2.77 No
Calogen Extra Shot Standard ACBS indications. 40 ml shots (Pack of 6 x 40 120 ml (3 x 40 No
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
(Nutricia Ltd.) ml shots). Flavours: Neutral, Strawberry
ml) £2.88 (£0.96
per shot)
Fresubin 5 kcal shot (Fresenius Kabi Ltd.)
Standard ACBS indications.
120 ml EasyBottle (4 x 120 ml per pack). Flavours: Neutral or Lemon
120 ml bottle £2.96 No
Pro-Cal Shot (Vitaflo International Ltd.)
Standard ACBS indications.
120 ml bottles (6 x 120 ml per pack). Flavours: Neutral, Strawberry, Banana
120 ml bottle £2.45
No
Liquigen (Nutricia Ltd.)
Steatorrhoea associated with cystic fibrosis of the pancreas, intestinal lymphangiectasia, intestinal surgery, chronic liver disease, liver cirrhosis, other proven malabsorption syndromes, ketogenic diet in epilepsy, and in type 1 lipoproteinaemia.
250 ml bottle. Flavours: Neutral
250 ml bottle £9.71
No
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
HIGH PROTEIN SUPPLEMENTS *Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product
Indications & Prescriber
Instructions
Available Flavours/ Presentation
Price (August 2018)
Suitable for initiation by GP without dietitian
involvement? ProSource Liquid (Nutrinovo Ltd.)
Biochemically proven hypoproteinaemia.
30 ml sachet (ready to eat). Packs of 100. Flavours: Neutral, Lemon, Orange Crème, Citrus Berry.
Per 30 ml sachet £1.05
No
ProSource TF (Nutrinovo Ltd)
Hypoproteinaemia. 45 ml sachet (ready to eat). Packs of 100. Unflavoured.
Per 45 ml sachet £1.27 No
ProSource Jelly (Nutrinovo Ltd.)
Hypoproteinaemia. 118 ml jelly pot (ready to eat).Packs of 36. Cases of 36 jellies Flavours: Fruit Punch or orange
118 ml pot £1.94
No
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
HIGH FIBRE SUPPLEMENTS
*Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation
Price (August 2018)
Suitable for initiation by GP without dietitian
involvement? Fresubin 2 kcal Fibre Mini (Fresenius Kabi Ltd.)
Standard ACBS indications.
125 ml bottle. Flavours: Chocolate, Vanilla
Per 125 ml bottle £1.25 No
Ensure Plus Fibre (Abbott Laboratories Ltd.)
Standard ACBS Indications. Also CAPD, haemodialysis.
200 ml bottle. Flavours: Banana, Chocolate, Vanilla, Raspberry, Strawberry
200 ml bottle £2.07
No
Fortisip Compact Fibre (Nutritica Ltd.)
Standard ACBS indications. 125 ml bottle. Flavours: Mocha, Strawberry, Vanilla
125 ml bottle £2.09 No
Fresubin 2 kcal Fibre Drink (Fresenius Kabi Ltd.)
Standard ACBS indications, CAPD, haemodialysis
200 ml bottle. Flavours: Apricot-Peach, Cappuccino, Chocolate, Lemon, Neutral
200 ml bottle £2.10
No
Nutrison Energy Multi Fibre (Nutricia Ltd.)
Standard ACBS indications.
200 ml bottle. Flavours: Vanilla
200 ml bottle £2.27
No
Opti-fibre (Nestle Health Science Ltd.)
Standard ACBS indications. Dietary management for those with intestinal transit disorders.
16 x 5 g sachets or 250 g tin. Flavourless. 1 level tablespoon to be added to 200 ml liquid or 150 g food. Note: if on fluid restriction the minimum amount of fluid is 100 ml per 1 scoop.
5 g sachet £0.15
250 g tin £10.64 No
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
PEPTIDE-BASED SUPPLEMENTS *Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product
Indications & Prescriber
Instructions
Available Flavours/ Presentation
Price (August 2018)
Suitable for initiation by GP without dietitian
involvement? Ready to Drink
Vital 1.5 kcal (Abbott Laboratories Ltd)
Standard ACBS indications.
200 ml bottle. Flavours: Café Latte, Mixed Berry, Vanilla
200 ml bottle £3.17
No
Peptamen (Nestle Health Sciences Ltd.)
Standard ACBS indications.
200 ml bottle (prescribing unit 4 x 200 ml bottles). Flavours: Vanilla
200 ml bottle £3.14
No
Survimed OPD (Fresenius Kabi Ltd.)
Standard ACBS indications.
200 ml EasyBottle. Flavours: Vanilla
200 ml bottle £3.40
No
Joint Formulary – Nutrition & Blood Uploaded by: Liz Kowlessar, February 2019 Approved by Area Prescribing Committee: 03-Jan-19 Review by: March 2020
ORAL NUTRITION SUPPLEMENTS FOR SPECIFIC MEDICAL CONDITIONS *Please note: The suitability of food products for patients requiring a vegan, kosher, halal, or other compliant diet should be confirmed with individual manufacturers.*
Product Indications & Prescriber Instructions
Available Flavours/ Presentation
Price (August
2018)
Suitable for initiation by GP without dietitian
involvement? Inflammatory Bowel Disease
Modulen IBD (Nestlè Health Science)
Crohn’s Disease active phase, and in remission if malnourished
400 g tin with 8.3 g scoop (12 x 400 g tins per case) . Flavour: Neutral (can be flavoured).
400 g tin
£15.06
No
Renal Failure
Nepro (Abbott Laboratories Ltd.)
Enteral feed or nutritional supplement in patients with chronic renal failure who are on haemodialysis or CAPD, or with cirrhosis, or other conditions requiring high energy, low fluid, low electrolyte diet.
220 ml bottle. Flavours: Strawberry, Vanilla
220 ml bottle £2.98 No
Nepro HP (Abbott Laboratories Ltd.)
Patient with chronic or acute kidney disease, on haemodialysis or continuous ambulatory peritoneal dialysis (CAPD). Cirrhosis. Other conditions requiring a high-energy, low electrolyte, low volume enteral feed.
220 ml bottle. Flavours: Strawberry, Vanilla
220 ml bottle £3.39
No
Joint Formulary – Nutrition & Blood Approved by Area Prescribing Committee: n/a Review by: March 2020
9.5 MINERALS
9.5.1 CALCIUM AND MAGNESIUM
9.5.1.1 Calcium supplements
Calcium carbonate 1.25g tablet (500mg, 12.6mmol Ca2+) (Calcichew®)
Sandocal-1000 25mmol Ca2+ (1g calcium)/ effervescent tablet
Calcium-Sandoz 2.7mmol Ca2+ (108.3mg calcium) / 5mL syrup
Calcium gluconate 10% injection (2.25mmoL Ca2+)
Calcium chloride
6.8mmol Ca2+ /10mL Injection (Min-I-Jet®) 10mmol Ca2+ /10mL ampoule
Management of symptomatic hypocalcaemia
Administer a dose of 10mL calcium gluconate 10% (2.25mmol) over 5 minutes into a large vein. If the injection is given too quickly, it may lead to a fall in blood pressure and heart rate. Alternatively, 10mL calcium gluconate 10% can be diluted in 100mL 0.9% sodium chloride and infused over 20 to 30 minutes. This may be followed by repeat injections every 6 to 8 hours or a continuous infusion of 40mL (9mmol) over 24 hours. If further calcium supplements are required give: 1. Alfacalcidol 1microgram orally daily. Adjust dose according to serum calcium. The
usual dose range is 1 to 3 micrograms daily. 2. Sandocal 1000 (1 tablet) daily only if diet is inadequate. Monitor calcium and phosphate closely.
9.5.1.2 Hypercalcaemia and hypercalciuria
Cinacalcet As per NICE TA117 guidance (renal only)
Joint Formulary – Nutrition & Blood Approved by Area Prescribing Committee: n/a Review by: March 2020
9.5.1.3 Magnesium
Magnesium sulphate
50% injection (2mmol /mL)
2mL, 5mL ampoules
Magnesium glycerphosphate
4mmol tablet (unlicensed) NB capsules are not prescribable on FP10
Magnesium-L-aspartate (Magnaspartate)
10mmol Mg2+/dissolvable sachet usual dose = one sachet once daily For long term oral replacement therapy, magnesium aspartate may be preferred to magnesium glycerophosphate (see above). It is a commercially available preparation and therefore more obtainable for FP10 prescribing and dispensing.
Management of hypomagnesaemia
Please refer to guidelines on Hypomagnesaemia Management
9.5.2 PHOSPHORUS
9.5.2.1 Phosphate Supplements
Phosphate-Sandoz 16.1mmol PO43- / tablet
Phosphates Intravenous infusion
9.5.2.2 Phosphate-Binding Agents
See Drug Management of Chronic Kidney Disease for preparations and doses
9.5.4 ZINC
Zinc sulphate 125mg Effervescent tablets (45mg zinc)
Joint Formulary – Nutrition & Blood Approved by Area Prescribing Committee: n/a Review by: March 2020
9.6 VITAMINS
9.6.4 Vitamin D
See local guidelines: Vitamin D deficiency — clinical guidelines for adults
Aviticol® colecalciferol 20,000 IU capsules
(N.B. contains gelatin)
InVita D3® colecalciferol 25,000 IU/ml oral solution (suitable for vegetarians and patients with swallowing difficulties)
Desunin® colecalciferol 800 IU tablets (gelatin free)
Multivitamins for renal dialysis Renavit® 450mg tablets