PKU orange cooler 10 liquid (Vitaflo International Ltd)
87 ml (ACBS) . NHS indicative price = £5.01
PKU purple cooler 10 liquid (Vitaflo International Ltd)
87 ml (ACBS) . NHS indicative price = £5.01
PKU red cooler 10 liquid (Vitaflo International Ltd)
87 ml (ACBS) . NHS indicative price = £5.01
PKU white cooler 10 liquid (Vitaflo International Ltd)
87 ml (ACBS) . NHS indicative price = £5.01
PKU yellow cooler 10 liquid (Vitaflo International Ltd)
87 ml (ACBS) . NHS indicative price = £5.01
▶ Nutritional supplement for the dietary management of
phenylketonuria in children over 3 years.
LIQUID, protein equivalent (essential and non-essential amino
acids except phenylalanine) 15 g, carbohydrate 7 g, energy
386 kJ (92 kcal)/130-mL pouch, with vitamins, minerals, and
PKU orange cooler 15 liquid (Vitaflo International Ltd)
130 ml (ACBS) . NHS indicative price = £7.46
PKU purple cooler 15 liquid (Vitaflo International Ltd)
130 ml (ACBS) . NHS indicative price = £7.46
PKU red cooler 15 liquid (Vitaflo International Ltd)
130 ml (ACBS) . NHS indicative price = £7.46
PKU white cooler 15 liquid (Vitaflo International Ltd)
130 ml (ACBS) . NHS indicative price = £7.46
PKU yellow cooler 15 liquid (Vitaflo International Ltd)
130 ml (ACBS) . NHS indicative price = £7.46
▶ Nutritional supplement for the dietary management of
phenylketonuria in children over 3 years.
LIQUID, protein equivalent (essential and non-essential amino
acids except phenylalanine) 20 g, carbohydrate 9.4 g, energy
517 kJ (124 kcal)/174-mL pouch, with vitamins, minerals, and
PKU orange cooler 20 liquid (Vitaflo International Ltd)
174 ml (ACBS) . NHS indicative price = £10.02
PKU purple cooler 20 liquid (Vitaflo International Ltd)
174 ml (ACBS) . NHS indicative price = £10.02
PKU red cooler 20 liquid (Vitaflo International Ltd)
174 ml (ACBS) . NHS indicative price = £10.02
PKU white cooler 20 liquid (Vitaflo International Ltd)
174 ml (ACBS) . NHS indicative price = £10.02
PKU yellow cooler 20 liquid (Vitaflo International Ltd)
174 ml (ACBS) . NHS indicative price = £10.02
▶ Nutritional supplement for the dietary management of
phenylketonuria. Not recommended for children under 3 years.
POWDER, protein equivalent (essential and non-essential amino
acids except phenylalanine) 15 g, carbohydrate 3.4 g, energy
310 kJ (74 kcal)/25 g, with vitamins, minerals, and trace
elements. To flavour unflavoured products, see FlavourPac
PKU express 15 powder 25g sachets lemon (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £219.69
PKU express 15 powder 25g sachets orange (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £219.69
PKU express 15 powder 25g sachets tropical (Vitaflo International
30 sachet (ACBS) . NHS indicative price = £219.69
PKU express 15 powder 25g sachets unflavoured (Vitaflo
30 sachet (ACBS) . NHS indicative price = £219.69
▶ Nutritional supplement for the dietary management of
phenylketonuria. Not recommended for children under 3 years.
POWDER, protein equivalent (essential and non-essential amino
acids except phenylalanine) 20 g, carbohydrate 4.7 g, energy
422 kJ (101 kcal)/34 g, with vitamins, minerals, and trace
elements. To flavour unflavoured products, see FlavourPac
PKU express 20 powder 34g sachets lemon (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £283.83
PKU express 20 powder 34g sachets orange (Vitaflo International
30 sachet (ACBS) . NHS indicative price = £283.83
BNF 78 Nutritional supplements for metabolic diseases 1585
Borderline substances | Appendix 2
PKU express 20 powder 34g sachets tropical (Vitaflo International
30 sachet (ACBS) . NHS indicative price = £283.83
PKU express 20 powder 34g sachets unflavoured (Vitaflo
30 sachet (ACBS) . NHS indicative price = £283.83
▶ For use as part of the low-protein dietary management of
phenylketonuria in children 6 months–10 years (unflavoured),
POWDER, protein equivalent (essential and non-essential amino
acids except phenylalanine) 10 g, carbohydrate 10.3 g
(unflavoured)/8.9 g (flavoured), fat less than 100 mg, energy
346 kJ (81 kcal) (unflavoured)/322 kJ (76 kcal) (flavoured)/24 g,
with vitamins, minerals, and trace elements. PKU Orange
contains soya. To flavour unflavoured products, see FlavourPac
PKU gel powder 24g sachets unflavoured (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £151.98
PKU gel powder 24g sachets orange (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £151.98
PKU gel powder 24g sachets raspberry (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £151.98
▶ Nutritional supplement for the dietary management of
phenylketonuria in children over 4 years and adults including
LIQUID, protein equivalent (essential and non-essential amino
acids except phenylalanine) 10 g, carbohydrate 4.4 g, fibre
250 mg, energy 245 kJ (58 kcal)/62.5 mL, with vitamins,
PKU Lophlex LQ 10 liquid berry (Nutricia Ltd)
62.5 ml (ACBS) . NHS indicative price = £5.61
PKU Lophlex LQ 10 liquid juicy berries (Nutricia Ltd)
62.5 ml (ACBS) . NHS indicative price = £5.61
PKU Lophlex LQ 10 liquid juicy citrus (Nutricia Ltd)
62.5 ml (ACBS) . NHS indicative price = £5.61
PKU Lophlex LQ 10 liquid juicy orange (Nutricia Ltd)
62.5 ml (ACBS) . NHS indicative price = £5.61
PKU Lophlex LQ 10 liquid juicy tropical (Nutricia Ltd)
62.5 ml (ACBS) . NHS indicative price = £5.61
▶ Nutritional supplement for the dietary management of
phenylketonuria in children over 4 years and adults including
LIQUID, protein equivalent (essential and non-essential amino
acids except phenylalanine) 20 g, carbohydrate 8.8 g, fibre
500 mg, energy 490 kJ (115 kcal)/125 mL, with vitamins,
PKU Lophlex LQ 20 liquid berry (Nutricia Ltd)
125 ml (ACBS) . NHS indicative price = £11.19
PKU Lophlex LQ 20 liquid juicy berries (Nutricia Ltd)
125 ml (ACBS) . NHS indicative price = £11.19
PKU Lophlex LQ 20 liquid juicy citrus (Nutricia Ltd)
125 ml (ACBS) . NHS indicative price = £11.19
PKU Lophlex LQ 20 liquid juicy orange (Nutricia Ltd)
125 ml (ACBS) . NHS indicative price = £11.19
PKU Lophlex LQ 20 liquid juicy tropical (Nutricia Ltd)
125 ml (ACBS) . NHS indicative price = £11.19
PKU Lophlex LQ 20 liquid orange (Nutricia Ltd)
125 ml (ACBS) . NHS indicative price = £11.19
▶ Nutritional supplement for the dietary management of
phenylketonuria in children over 4 years and adults including
20.2 g, fibre 1 g, energy 706 kJ (166 kcal)/109 g, with vitamins,
PKU Lophlex Sensation 20 berries (Nutricia Ltd)
327 gram (ACBS) . NHS indicative price = £35.76
▶ Nutritional supplement for the dietary management of
phenylketonuria in children over 8 years and adults.
POWDER, protein equivalent (essential and non-essential amino
acids except phenylalanine) 39 g, carbohydrate 34 g, fat less
than 500 mg, energy 1260 kJ (297 kcal)/100 g, with vitamins,
minerals, and trace elements. To flavour unflavoured products,
see Modjul Flavour System p. 1576.
PKU Maxamum oral powder 50g sachets orange (Nutricia Ltd)
30 sachet (ACBS) . NHS indicative price = £292.20
PKU Maxamum oral powder 50g sachets unflavoured (Nutricia Ltd)
30 sachet (ACBS) . NHS indicative price = £292.20
PKU Maxamum powder orange (Nutricia Ltd)
500 gram (ACBS) . NHS indicative price = £97.44
PKU Maxamum powder unflavoured (Nutricia Ltd)
500 gram (ACBS) . NHS indicative price = £97.44
Methionine-free TYR Anamix ® Infant
▶ Nutritional supplement for the dietary management of proven
tyrosinaemia type 1 in children from birth to 3 years.
POWDER, protein equivalent (essential and non-essential amino
acids except methionine, phenylalanine, and tyrosine) 13.1 g,
carbohydrate 49.5 g, fat 23 g, fibre 5.3 g, energy 1915 kJ
(457 kcal)/100 g, with vitamins, minerals, and trace elements;
standard dilution (15%) provides protein equivalent 2 g,
carbohydrate 7.4 g, fat 3.5 g, fibre 800 mg, energy 287 kJ
TYR Anamix Infant methionine free powder (Nutricia Ltd)
400 gram (ACBS) . NHS indicative price = £42.17
▶ Nutritional supplement for the dietary management of proven
tyrosinaemia where plasma-methionine concentrations are
normal in children from birth to 3 years.
POWDER, protein equivalent (essential and non-essential amino
acids except phenylalanine and tyrosine) 13.1 g, carbohydrate
49.5 g, fat 23 g, fibre 5.3 g, energy 1915 kJ (457 kcal)/100 g, with
vitamins, minerals, and trace elements; standard dilution (15%)
provides protein equivalent 2 g, carbohydrate 7.4 g, fat 3.5 g,
fibre 800 mg, energy 287 kJ (69 kcal)/100 mL.
TYR Anamix Infant methionine free powder (Nutricia Ltd)
400 gram (ACBS) . NHS indicative price = £42.17
TYR Anamix Infant powder (Nutricia Ltd)
400 gram (ACBS) . NHS indicative price = £42.17
▶ Nutritional supplement for the dietary management of proven
tyrosinaemia in children 1–10 years.
POWDER, protein equivalent (essential and non-essential amino
acids except phenylalanine and tyrosine) 8.4 g, carbohydrate
11 g, fat 3.9 g, energy 475 kJ (113 kcal)/29-g sachet, with
vitamins, minerals, and trace elements.
TYR Anamix Junior oral powder 29g sachets (Nutricia Ltd)
30 sachet (ACBS) . NHS indicative price = £206.40
▶ Nutritional supplement for the dietary management of
tyrosinaemia type 1 (when nitisinone (NTBC) is used, see
nitisinone p. 1067), type II, and type III, in children over 1 year.
LIQUID, protein equivalent (essential and non-essential amino
acids except phenylalanine and tyrosine) 10 g,carbohydrate
8.8 g, fat 4.8 g, fibre 310 mg, energy 500 kJ (119 kcal)/125 mL,
with vitamins, minerals and trace elements.
TYR Anamix Junior LQ liquid (Nutricia Ltd)
125 ml (ACBS) . NHS indicative price = £9.78
▶ Nutritional supplement for the dietary management of
tyrosinaemia in children over 3 years and adults.
LIQUID, protein equivalent (essential and non-essential amino
acids except tyrosine and phenylalanine) 15 g, carbohydrate 7 g,
1586 Nutritional supplements for metabolic diseases BNF 78
Borderline substances | Appendix 2
fat 500 mg, energy 393 kJ (92 kcal)/130 mL, with vitamins,
TYR orange cooler 15 liquid (Vitaflo International Ltd)
130 ml (ACBS) . NHS indicative price = £12.31
TYR red cooler 10 liquid (Vitaflo International Ltd)
87 ml (ACBS) . NHS indicative price = £7.60
TYR red cooler 15 liquid (Vitaflo International Ltd)
130 ml (ACBS) . NHS indicative price = £12.31
TYR red cooler 20 liquid (Vitaflo International Ltd)
174 ml (ACBS) . NHS indicative price = £15.89
▶ Nutritional supplement for the dietary management of
tyrosinaemia in children over 8 years and adults.
POWDER, protein equivalent (essential and non-essential amino
acids except tyrosine and phenylalanine) 15 g, carbohydrate
3.4 g, fat less than 100 mg, energy 310 kJ (74 kcal)/25 g, with
vitamins, minerals, and trace elements. To flavour unflavoured
products, see FlavourPac p. 1575.
TYR express 15 oral powder 25g sachets (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £362.37
▶ Nutritional supplement for the dietary management of
tyrosinaemia in children over 8 years.
POWDER, protein equivalent (essential and non-essential amino
acids except tyrosine and phenylalanine) 20 g, carbohydrate
4.7 g, fat less than 100 mg, energy 416 kJ (99 kcal)/34 g, with
vitamins, minerals, and trace elements. To flavour unflavoured
products, see FlavourPac p. 1575.
TYR express 20 oral powder 34g sachets (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £468.17
▶ Nutritional supplement for the dietary management of
tyrosinaemia in children 1–10 years.
GEL, protein equivalent (essential and non-essential amino
acids except tyrosine and phenylalanine) 10 g, carbohydrate
10.3 g, fat less than 100 mg, energy 339 kJ (81 kcal)/24 g, with
vitamins, minerals and trace elements. To flavour unflavoured
products, see FlavourPac p. 1575.
TYR gel oral powder 24g sachets (Vitaflo International Ltd)
30 sachet (ACBS) . NHS indicative price = £233.29
▶ Nutritional supplement for the dietary management of
tyrosinaemia in children over 4 years and adults, including
pregnant women (in conjunction with standard folic acid
LIQUID, protein equivalent (essential and non-essential amino
acids except phenylalanine and tyrosine) 20 g, carbohydrate
8.8 g, fat less than 500 mg, fibre 500 mg, energy 509 kJ
(120 kcal)/125 mL, with vitamins, minerals, and trace elements.
TYR Lophlex LQ 20 liquid (Nutricia Ltd)
125 ml (ACBS) . NHS indicative price = £17.39
▶ Nutritional supplement for the management of tyrosinaemia in
children and adults where plasma-methionine concentrations
POWDER, protein equivalent (essential and non-essential amino
acids except phenylalanine and tyrosine) 77 g, carbohydrate
4.5 g, fat nil, energy 1386 kJ (326 kcal)/100 g. To flavour
unflavoured products, see Modjul Flavour System p. 1576.
XPHEN TYR Tyrosidon Free AA Mix powder (Nutricia Ltd)
500 gram (ACBS) . NHS indicative price = £201.74
▶ Nutritional supplement for the dietary management of
tyrosinaemia type I in children and adults where plasmamethionine concentrations are above normal.
POWDER, protein equivalent (essential and non-essential amino
acids except methionine, phenylalanine, and tyrosine) 77 g,
carbohydrate 4.5 g, fat nil, energy 1386 kJ (326 kcal)/100 g. To
flavour unflavoured products, see Modjul Flavour System
XPTM Tyrosidon powder (Nutricia Ltd)
500 gram . NHS indicative price = £91.31
BNF 78 Nutritional supplements for metabolic diseases 1587
Borderline substances | Appendix 2
Cautionary and advisory labels
Guidance for cautionary and advisory labels
Medicinal forms within BNF publications include code numbers
of the cautionary labels that pharmacists are recommended to
add when dispensing. It is also expected that pharmacists will
counsel patients and carers when necessary.
Counselling needs to be related to the age, experience,
background, and understanding of the individual patient or
carer. The pharmacist should ensure understanding of how to
take or use the medicine and how to follow the correct dosage
schedule. Any effects of the medicine on co-ordination,
performance of skilled tasks (e.g. driving or work), any foods or
medicines to be avoided, and what to do if a dose is missed
should also be explained. Other matters, such as the possibility
of staining of the clothes or skin, or discolouration of urine or
stools by a medicine should also be mentioned.
For some medicines there is a special need for counselling,
such as an unusual method or time of administration or a
potential interaction with a common food or domestic remedy,
and this should be mentioned where necessary.
Most preparations are dispensed in unbroken original packs
that include further advice for the patient in the form of patient
information leaflets. Label 10 may be of value where
appropriate. More general leaflets advising on the
administration of preparations such as eye drops, eye
ointments, inhalers, and suppositories are also available.
In general no label recommendations have been made for
injections on the assumption that they will be administered by a
healthcare professional or a well-instructed patient. The
labelling is not exhaustive and pharmacists are recommended
to use their professional discretion in labelling new
preparations and those for which no labels are shown.
Individual labelling advice is not given on the administration
of the large variety of antacids. In the absence of instructions
from the prescriber, and if on enquiry the patient has had no
verbal instructions, the directions given under ‘Dose’ should be
It is recognised that there may be occasions when pharmacists
will use their knowledge and professional discretion and decide
to omit one or more of the recommended labels for a particular
patient. In this case counselling is of the utmost importance.
There may also be an occasion when a prescriber does not wish
additional cautionary labels to be used, in which case the
prescription should be endorsed ‘NCL’ (no cautionary labels).
The exact wording that is required instead should then be
specified on the prescription.
Pharmacists label medicines with various wordings in
addition to those directions specified on the prescription. Such
labels include ‘Shake the bottle’, ‘For external use only’, and
‘Store in a cool place’, as well as ‘Discard.... days after opening’
and ‘Do not use after....’, which apply particularly to antibiotic
continue to be used when appropriate; indeed, ‘For external use
only’ is a legal requirement on external liquid preparations,
while ‘Keep out of the reach of children’ is a legal requirement
on all dispensed medicines. Care should be taken not to obscure
other relevant information with adhesive labelling.
It is the usual practice for patients to take standard tablets
with water or other liquid and for this reason no separate label
The label wordings recommended by the BNF apply to
medicines dispensed against a prescription. Patients should be
aware that a dispensed medicine should never be taken by, or
shared with, anyone other than for whom the prescriber
intended it. Therefore, the BNF does not include warnings
against the use of a dispensed medicine by persons other than
for whom it was specifically prescribed.
The label or labels for each preparation are recommended
after careful consideration of the information available.
However, it is recognised that in some cases this information
may be either incomplete or open to a different interpretation.
The BNF will therefore be grateful to receive any constructive
comments on the labelling suggested for any preparation.
For BNF 61 (March 2011), a revised set of cautionary and
advisory labels were introduced. All of the existing labels were
user-tested, and the revised wording selected reflects
terminology that is better understood by patients.
Wordings which can be given as separate warnings are labels
1–19, 29–30, and 32. Wordings which can be incorporated in an
appropriate position in the directions for dosage or
administration are labels 21–28. A label has been omitted for
number 20; labels 31 and 33 no longer apply to any medicines in
the BNF and have therefore been deleted.
If separate labels are used it is recommended that the
wordings be used without modification. If changes are made to
suit computer requirements, care should be taken to retain the
Comprehensive Welsh translations are available for each
cautionary and advisory label.
1 Warning: This medicine may make you sleepy
Rhybudd: Gall y feddyginiaeth hon eich gwneud yn gysglyd
To be used on preparations for children containing
antihistamines, or other preparations given to children
where the warnings of label 2 on driving or alcohol would
2 Warning: This medicine may make you sleepy. If this happens,
do not drive or use tools or machines. Do not drink alcohol
Rhybudd: Gall y feddyginiaeth hon eich gwneud yn gysglyd.
Peidiwch â gyrru, defnyddio offer llaw neu beiriannau os yw
hyn yn digwydd. Peidiwch ag yfed alcohol
To be used on preparations for adults that can cause
drowsiness, thereby affecting coordination and the ability to
drive and operate hazardous machinery; label 1 is more
appropriate for children. It is an offence to drive while under
the influence of drink or drugs.
Some of these preparations only cause drowsiness in the
first few days of treatment and some only cause drowsiness
In such cases the patient should be told that the advice
applies until the effects have worn off. However many of
these preparations can produce a slowing of reaction time
and a loss of mental concentration that can have the same
Avoidance of alcoholic drink is recommended because the
effects of CNS depressants are enhanced by alcohol. Strict
prohibition however could lead to some patients not taking
the medicine. Pharmacists should therefore explain the risk
1588 Cautionary and advisory labels for dispensed medicines BNF 78
Cautionary and advisory labels | Appendix 3
and encourage compliance, particularly in patients who may
think they already tolerate the effects of alcohol (see also
label 3). Queries from patients with epilepsy regarding
fitness to drive should be referred back to the patient’s
Side-effects unrelated to drowsiness that may affect a
patient’s ability to drive or operate machinery safely include
blurred vision, dizziness, or nausea. In general, no label has
been recommended to cover these cases, but the patient
should be suitably counselled.
3 Warning: This medicine may make you sleepy. If this happens,
do not drive or use tools or machines
Rhybudd: Gall y feddyginiaeth hon eich gwneud yn gysglyd.
Peidiwch â gyrru, defnyddio offer llaw neu beiriannau os yw
To be used on preparations containing monoamine-oxidase
inhibitors; the warning to avoid alcohol and dealcoholised
(low alcohol) drink is covered by the patient information
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