Therapeutic areaFormulary ChoicesCost (per pack size stated)Rationale for decision / comments
Appendix 1 Borderline substances
Food supplements:
Standard ACBS indications: short-bowel syndrome, intractable malabsorption, pre-operative preparation of under-nourished patients, proven inflammatory bowel disease following total gastrectomy, bowel fistulas, or disease-related malnutrition and dysphagia.

General Practitioners are reminded that the ACBS recommends products on the basis that they may be regarded as drugs for the management of specified conditions.
Assess nutritional status before starting use of food supplements and offer advice about enriching nutritional value of normal diet. Aim of treatment should be recorded and record of weight kept.

Malnutrition Universal Screening Tool (MUST) is available on the Medicines Management section of the CCG intranet together with a guide to developing a Nutrition Support Care Pathway (p.196) for patients in community & Care Home Settings.

A short leaflet produced by NHS Somerset dieticians is available advising on food fortification.

NAGE (Nutrition Advisory Group for Elderly People) produce a range of advice leaflets & posters – details available at: or contact: NAGE, The British Dietetic Association, Cambertown House, Commercial Road, Goldthorpe Industrial, Estate, Goldthorpe, Rotherham, South Yorkshire, S63 9BL. Helpline Number: 01709 889900, Fax Number: 01709 881673
Thickening agentsUsed to thicken food & liquid for patients with swallowing difficulties. Easier to use & more palatable than starch based thickeners.
Main features are:
 Remains fully transparent in clear liquids
 No change in odour or taste; helps to maintain appetite
 Thickens rapidly and does not continue to thicken over time
 Dissolves readily without lumps.
 Less powder required than conventional thickeners as has greater water binding properties.
First lineNutilis Clear®£8.46 (175g)
Second line lineResource® Thicken Up Clear£8.46 (125g)