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 Formulary Chapter 25: A2 - Borderline substances - Full Chapter
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A2.02.02.03  Expand sub section  Nutritional supplements: More than 1.5 kcal/mL and 5 g (or more) protein/100 mL
Aymes Shake Compact (157ml)
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First Choice
Green

 


** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
Ensure Compact (125ml)
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Formulary
Green

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
   
Fortisip Compact (125ml)
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Formulary
Amber Recommended

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
   
Foodlink Complete with Fibre (260ml)
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Formulary
Amber Recommended

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
   
Fresubin 2 kcal Drink (200ml)
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Formulary
Amber Recommended

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
   
Nutricrem
(125g)
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Formulary
Amber Recommended

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **


 

 
   
Altraplen Compact  (125ml)
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Formulary
Amber Recommended

 ** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
   
Aptamil Pepti 2
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Formulary
Green
In primary care 1st choice for mild-moderate CMPA in children aged 6 months to 2 years 
   
Fortisip Compact Protein (125ml)
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Formulary
Amber Recommended

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
   
Fresubin 3.2kcal Drink
(125mL)
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Formulary
Amber Recommended

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
   
Resource 2.0 Fibre (200ml)
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Formulary
Amber Recommended

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **

 
   
Resource Dessert Fruit (125g)
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Formulary
Amber Recommended
Discontinued product 2015

In primary care switch to Nutilis complete stage 3.

In Secondary Care order Ensure Plus Creme through Sodexo helpdesk at Stoke Mandeville; and Supplies at Amersham and Wycombe.

Ensure Plus Creme may be ordered without input from a dietitian.
 
   
Vital 1.5kcal (200ml)
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Formulary
Amber Recommended

** See Buckinghamshire Adult Nutritional Supplement and Tube Feed Formulary at the top of this page for full details **


 

 
   
 ....
 Non Formulary Items
Aymes 2.0kcal  (200ml)

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Non Formulary
Black

In primary care – switch to Aymes ActaGain 2.4 Complete Maxi initiation on the recommendation of a Dietitian only for patients with increased energy and protein requirements.



In secondary care - switch to Ensure TwoCal. Requires Dietitian input.

 
Aymes Shake  (150ml)

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Non Formulary
Black

This product is no longer available. Prescribe Aymes Shake Compact instead.

 
Foodlink Complete  (230ml)

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Non Formulary
Black

In primary care switch to Aymes Shake


 
Foodlink® Complete

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Non Formulary
 
Foodlink® Complete with Fibre

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Non Formulary
 
Forticreme Complete  (125g)

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Non Formulary
Black
In primary care - switch to Fresubin 2Kcal Crème.

In secondary care order Ensure plus creme through Sodexo helpdesk at Stoke Mandeville & Supplies at Amersham & Wycombe.

In hospital, Ensure plus creme may be ordered without input from a dietitian.
 
Fortisip 2 Kcal (previously Fortisip Extra)  (200ml)

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Non Formulary
Black

In Primary Care - switch to Aymes 2.0kcal drink. initiation on the recommendation of a Dietician only for patients with increased energy and protein requirements.

In Secondary Care - switch to Ensure twocal. Requires dietitian input.

 
Fortisip Compact Fibre  (125ml)

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Non Formulary
Black
 
Fortisip® Compact Fibre

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Non Formulary
 
Fortisip® Extra

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Non Formulary
 
Fresubin 2 Kcal Creme  (125g)

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Non Formulary
Black

In primary care: switch to Nutricrem, highly restricted use for patients who require level 4 fluids only.



In secondary care switch and order Ensure Plus Creme through Sodexo Helpdesk at Stoke Mandeville; and Supplies at Amersham and Wycombe.  Ensure Plus Creme may be ordered without input from a Dietitian.

 
Fresubin 2kcal Fibre Drink  (200ml)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
In primary care - switch to Foodlink Complete with Fibre, unless patient or carer unable to prepare powder sip feed when switch to Resource 2.0 Fibre.

In secondary care switch to Ensure TwoCal. Requires Dietitian input
 
Fresubin 2Kcal Mini Drink  (125ml)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
In primary care switch to Aymes shake made up with half the usual volume of milk. If the patient is unable to prepare Aymes shake switch to Ensure Compact.

In secondary care order Ensure Compact through Sodexo helpdesk at Stoke Mandeville and Supplies at Amersham & Wycombe.
Ensure Compact may be ordered without referral to a dietitian
 
Fresubin Powder Extra  (260ml)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
In primary care - switch to Aymes shake.

In Secondary Care order Ensure Shake through Sodexo helpdesk at Stoke Mandeville; and Supplies at Amersham and Wycombe.

Ensure Shake may be ordered without input from a dietitian.
 
Fresubin Protein Energy  (200ml)

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Non Formulary
Black

In Primary Care - Switch to Altraplen Protein. Initiation on the recommendation only for patients with increased energy and protein requirements.

In secondary care - switch to Ensure TwoCal. Requires Dietitian input

 
Fresubin® 2 kcal Fibre Drink

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Fresubin® Creme

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nutilis® Complete Stage 1

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nutricomp Drink Plus  (200ml)

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Non Formulary
Black

In primary care switch to Aymes Shake unless patient/carer unable to prepare powdered sip feed switch to Aymes Complete.

 
Nutricomp Drink Plus Fibre  (200ml)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black

In primary care - switch to Ensure Plus Fibre.


In secondary care - switch to Ensure Plus Fibre order through Sodexo Helpdesk at Stoke Mandeville Hospital; order through Supplies at Amersham and Wycombe. Ensure Plus Fibre may be ordered without input from a dietician.


 

 
Resource Energy  (200ml)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
In Primary Care not recommended switch to Aymes shake unless patient or carer unable to prepare Aymes shake when switch to Ensure Plus

In Secondary Care - not recommeneded - order Ensure plus through Sodexo helpdesk at Stoke Mandeville; and supplies at Amersham and Wycombe. Ensure Plus may be ordered without input from a dietitian.
 
Resource® 2.0

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Non Formulary
 
Resource® Dessert Fruit

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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

Black

Not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.
Drugs which have been evaluated and rejected by the Medicines Value Group (MVG)
Drugs defined as ‘Low Priority’ by the South Central Priorities Committee
New drugs which have not as yet been evaluated by the MVG
Any drug not listed in the Buckinghamshire Formulary  

Red

Drugs which should only be prescribed in secondary care by a specialist.
Require specialist knowledge and/or equipment for patient selection and initiation
Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise toxicity by a specialist
Designated as “hospital only“ by product licence, NICE, DoH or BNF
May need further evaluation by a specialist
Are hospital initiated clinical trial materials  

Red Specialist Centre

As for ‘red’ (above) with the addition of the following:
Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by BHT (or other secondary care provider)
Detailed requirements for Specialist Centre initiation to be described in the wording of the formulary restriction  

Amber Protocol

Drugs which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a drug specific Shared Care Protocol(SCP). Prescribing may be continued in primary care following the SCP
Require specialist knowledge and/or equipment for patient selection and initiation
Require short or medium term (eg. 3 to 6 months) specialist monitoring of efficacy or toxicity. The need for stabilisation will vary with different drugs and patients, but is usually a minimum of 2 months (see principles for shared care)
Require significant long term monitoring
Require ongoing communication between the GP and the specialist
Have clearly defined consultant, GP and patient responsibilities documented in a shared care protocol (see responsibilities for amber protocol drugs)  

Amber Initiation

Drugs suitable for primary care prescribing following specialist initiation
Require specialist knowledge and/or equipment for patient selection
Monitoring does not require specialist knowledge or equipment
If the drug is one with which the primary care prescriber is unfamiliar the specialist is expected to provide sufficient information on the drug indication, dose, duration , monitoring and any further necessary dose adjustments
Require the first prescription to be written by the specialist  

Amber Recommended

Drugs suitable for primary care prescribing following specialist recommendation
As for amber initiation except that:- The first prescription may be written by the GP after specialist recommendation.  

Green

Drugs for which primary care prescribers would normally take full responsibility for prescribing and monitoring
Drugs not included in the Traffic Light list but included on joint formulary.
New drugs classified as red or amber but as greater experience regarding their safety and efficacy is established may move to Green after re-consideration by the MVG and APC.  

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