p. 1376 → Also see TABLE 9 p. 1377
▶ Zuclopenthixol is predicted to decrease the effects of levodopa.
Avoid or monitor worsening parkinsonian symptoms.
Theoretical → Also see TABLE 8 p. 1376
▶ Zuclopenthixol potentially increases the risk of neurotoxicity
when given with lithium.rAnecdotal → Also see TABLE 9
1554 Zolmitriptan — Zuclopenthixol BNF 78
Enteral feeds (non-disease specific) page 1558
Enteral feeds (non-disease specific):
Enteral feeds (non-disease specific):
Nutritional supplements (non-disease specific) 1562
Nutritional supplements: less than 5 g protein/100 mL 1562
Nutritional supplements: 5 g (or more) protein/100 mL 1563
Specialised formulas for specific clinical conditions 1568
Fibre, vitamin, and mineral supplements 1572
Special additives for conditions of intolerance 1575
Feed thickeners and pre-thickened drinks 1575
Flavouring preparations page 1575
Nutritional supplements for metabolic diseases 1581
Glutaric aciduria (type 1) 1581
Homocystinuria or hypermethioninaemia 1581
Maple syrup urine disease 1582
Methylmalonic or propionic acidaemia 1583
Other inborn errors of metabolism 1583
In certain conditions some foods (and toilet preparations)
have characteristics of drugs and the Advisory Committee on
Borderline Substances (ACBS) advises as to the
circumstances in which such substances may be regarded as
drugs. Prescriptions issued in accordance with the
Committee’s advice and endorsed ‘ACBS’ will normally not
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. Doctors should satisfy themselves that the
products can safely be prescribed, that patients are
adequately monitored and that, where necessary, expert
hospital supervision is available.
Foods which may be prescribed on FP10, GP10 (Scotland),
All the food products listed in this appendix have ACBS
approval. The clinical condition for which the product has
been approved is included with each entry.
Note Foods included in this appendix may contain
cariogenic sugars and patients should be advised to take
appropriate oral hygiene measures.
For most enteral feeds and nutritional supplements, the
main source of carbohydrate is either maltodextrin or
glucose syrup; other carbohydrate sources are listed in the
relevant table, below. Feeds containing residual lactose (less
than 1 g lactose/100 mL formula) are described as ‘clinically
lactose-free’ or ‘lactose-free’ by some manufacturers. The
presence of lactose (including residual lactose) in feeds is
indicated in the relevant table, below. The primary sources
of protein or amino acids are included with each product
entry. The fat or oil content is derived from a variety of
sources such as vegetables, soya bean, corn, palm nuts, and
seeds; where the fat content is derived from animal or fish
sources, this information is included in the relevant table,
below. The presence of medium chain triglycerides (MCT) is
also noted where the quantity exceeds 30% of the fat
Enteral feeds and nutritional supplements can contain
varying amounts of vitamins, minerals, and trace
elements—the manufacturer’s product literature should be
consulted for more detailed information. Feeds containing
vitamin K may affect the INR in patients receiving warfarin.
The suitability of food products for patients requiring a
vegan, kosher, halal, or other compliant diet should be
confirmed with individual manufacturers.
Note Feeds containing more than 6 g/100 mL protein or
2 g/100 mL fibre should be avoided in children unless
recommended by an appropriate specialist or dietician.
Nutritional values of products vary with flavour and pack
size—consult product literature.
Other conditions for which ACBS products can be prescribed
This is a list of clinical conditions for which the ACBS has
Dermatitis, Eczema and Pruritus
Aveeno ® Cream; Aveeno ® Lotion; E45 ® Emollient Bath Oil;
Disfiguring skin lesions (birthmarks, mutilating
Covermark ® classic foundation and finishing powder;
Dermacolor ® Camouflage cream and fixing powder;
Keromask ® finishing powder and masking cream; Veil ®
Cover cream and Finishing Powder. (Cleansing Creams,
Cleansing Milks, and Cleansing Lotions are excluded).
May be prescribed on an FP10 only when ordered in such
quantities and with such directions as are appropriate for
the treatment of patients, but not if ordered for general
For patients suffering from dry mouth as a result of having
(or having undergone) radiotherapy, or sicca syndrome.
AS Saliva Orthana ®; Biotène Oralbalance ®; Glandosane ®;
1556 Borderline substances BNF 78
Borderline substances | Appendix 2
Photodermatoses (skin protection in)
LA Roche-Posay Anthelios ® XL SPF 50+ cream; Sunsense ®
Ultra (Ego) SPF 50+; Uvistat ® Lipscreen SPF 50, Uvistat ®
Standard ACBS indications: Disease-related malnutrition,
intractable malabsorption, pre-operative preparation of
malnourished patients, dysphagia, proven inflammatory
bowel disease, following total gastrectomy, short-bowel
Prices quoted in Appendix 2 are basic NHS net prices; for
further information see Prices in BNF.
BNF 78 Borderline substances 1557
Borderline substances | Appendix 2
Table 1 Enteral feeds (non-disease specific)
Enteral feeds: 1 kcal/mL and less than 5 g protein/100 mL
Borderline substances standard
ACBS indications p. 1557 except
bowel fistula and pre-operative
preparation of malnourished patients.
Not suitable for child under 2 years
Fresubin 1500 Complete liquid:
Feed in flexible pack contains
Borderline substances standard
blackcurrant, nut, peach, chocolate,
vanilla 200 ml = £2.36; Fresubin
Original tube feed liquid: 500 ml =
£4.57; 1000 ml = £9.07; 1500 ml =
Borderline substances standard
ACBS indications p. 1557 except
bowel fistula and pre-operative
preparation of malnourished patients.
Not suitable for child under 2 years
Fresubin Original Fibre liquid:
500 ml = £5.18; 1000 ml = £10.34
Borderline substances standard
ACBS indications p. 1557 except
Not suitable for child under 2 years
Jevity liquid: 500 ml = £5.83;
Borderline substances standard
Nutrison liquid: 500 ml = £5.39;
500 ml = £4.85; 1000 ml = £9.47;
Borderline substances standard
ACBS indications p. 1557 except
Nutrison Multi Fibre liquid: 500 ml =
£5.83; 500 ml = £5.47; 1000 ml =
Borderline substances standard
Osmolite liquid: 500 ml = £5.40;
1000 ml = £9.48; 1500 ml = £14.22
1558 Enteral feeds (non-disease speci
Borderline substances | Appendix 2
Borderline substances standard
ACBS indications p. 1557; also cows’
milk protein intolerance, lactose
Fresubin Soya Fibre liquid: 500 ml =
Borderline substances standard
ACBS indications p. 1557; also cows’
milk protein and lactose intolerance
Nutrison Soya liquid: 500 ml =
Borderline substances standard
ACBS indications p. 1557 except
bowel fistula; also cows’ milk protein
Nutrison Soya Multi Fibre liquid:
Short bowel syndrome, intractable
malabsorption, proven inflammatory
Nutrison Peptisorb liquid: 500 ml =
£7.72; 500 ml = £8.49; 1000 ml =
Short bowel syndrome, intractable
malabsorption, proven inflammatory
Peptamen liquid: vanilla 800 ml =
Borderline substances standard
ACBS indications p. 1557; also growth
£7.64; 800 ml = £13.56; 1000 ml =
£15.28; HN liquid 500 ml = £7.36
Enteral feeds: Less than 1 kcal/mL and less than 5 g protein/100 mL
AMINO ACID FORMULA (ESSENTIAL AND NON-ESSENTIAL AMINO ACIDS)
Nil Short bowel syndrome, intractable
malabsorption, proven inflammatory
Elemental 028 Extra liquid: summer
Nil Short bowel syndrome, intractable
malabsorption, proven inflammatory
Elemental 028 Extra powder: plain,
banana, orange 100 gram = £7.75
BNF 78 Enteral feeds (non-disease speci
Borderline substances | Appendix 2
Enteral feeds (non-disease specific): 5 g (or more) protein/100 mL
Enteral feeds: 1.5 kcal/mL and 5 g (or more) protein/100 mL
Contains fish oil and fish gelatin
Borderline substances standard
Fresubin 2250 Complete liquid:
Borderline substances standard
Strawberry flavour may contain traces
Fresubin Energy liquid: unflavoured
cappuccino, banana 200 ml = £1.40
Contains fish oil and fish gelatin
Borderline substances standard
Fresubin Energy liquid: 500 ml =
£5.60; 1000 ml = £11.01; 1500 ml
Borderline substances standard
banana, caramel, cherry, chocolate,
Contains fish oil and fish gelatin
Borderline substances standard
Contains fish oil and fish gelatin
Borderline substances standard
ACBS indications p. 1557; also CAPD
Fresubin HP Energy liquid: 500 ml =
Borderline substances standard
Not suitable for child under 2 years;
Jevity 1.5kcal liquid: 500 ml =
£6.98; 1000 ml = £13.15; 1500 ml
Borderline substances standard
Nutrison Energy liquid: 500 ml =
£5.87; 500 ml = £6.28; 1000 ml =
Borderline substances standard
Nutrison Energy Multi Fibre liquid:
500 ml = £6.57; 500 ml = £6.97;
Borderline substances standard
Osmolite 1.5kcal tube feed liquid:
500 ml = £6.28; 1000 ml = £11.84;
Borderline substances standard
Not suitable for use in child under
Resource Energy liquid: apricot,
strawberry & raspberry, vanilla
1560 Enteral feeds (non-disease speci
Borderline substances | Appendix 2
Borderline substances standard
ACBS indications p. 1557; except
proven inflammatory bowel disease
and following total gastrectomy; not
recommended for use in children
Vital 1.5kcal liquid vanilla: 200 ml =
Enteral feeds: Less than 1.5 kcal/mL and 5 g (or more) protein/100 mL
Borderline substances standard
Fresubin 1000 Complete liquid:
Borderline substances standard
Fresubin 1200 Complete liquid:
Borderline substances standard
Fresubin 1800 Complete liquid:
Borderline substances standard
Not suitable for child under 2 years;
Jevity Plus liquid: 500 ml = £6.99;
Borderline substances standard
ACBS indications p. 1557; also CAPD,
Not suitable for child under 2 years;
Jevity Plus HP gluten free liquid:
Borderline substances standard
Not suitable for child under 2 years;
Jevity Promote liquid: 1 litre =
Borderline substances standard
ACBS indications p. 1557 except
Not suitable for child under 6 years;
Nutrison 800 Complete Multi Fibre
Disease related malnutrition in
patients with low energy and/or low
Nutrison 1000 Complete Multi Fibre
Borderline substances standard
ACBS indications p. 1557 except
Nutrison 1200 Complete Multi Fibre
liquid: 1500 ml = £19.33; 1000 ml =
BNF 78 Enteral feeds (non-disease speci
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