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Jersey Shore Hospital
Approved List of Nutritional Supplement Therapeutic
Substitutions
Non Formulary Supplement
Ordered
Approved Formulary
Comments/ P&T Approval
Therapeutic Equivalent
Boost, Nutren 1.0
Ensure
Boost Plus, Nutren 1.5
Ensure Plus
Resource 2.0, Nutren 2.0
Two Cal HN
Boost Glucose Control, Nutren
Glytrol
Glucerna 1.2 Cal
ISO Source HN, Osmolite 1.0,
Osmolite 1.5
Osmolite 1.2 Cal
Nutren 1.0 Fiber
Jevity 1.2 Cal
Modular: Protein supplements
Liqua Cel, Pro Source, Promod
liquid
ProStat 64
Intact oral or tube feeding
supplement (lactose free,
gluten free) Flavor: vanilla
Intact oral or tube feeding
supplement (lactose free,
gluten free)
Flavor: vanilla
Low volume, high calorie,
high protein formula.
Intact oral or tube feeding
supplement
(gluten free)
Flavor: vanilla
Intact oral or tube feeding
supplement
(gluten & lactose free)
Flavor: vanilla
High nitrogen, lactose free,
low reside supplement for
tube feedings. (If 1.0 or 1.5
is ordered use the same
product but a higher/ lower
volume of formula may be
needed.) Unflavored
Lactose free, dietary fiber
formula used for use as
tube feeding only.
Contains a prebiotic that
stimulates beneficial growth
of bacteria in the colon.
Unflavored.
A liquid, sugar free protein
supplement for wound
healing & bariatric patients.
Ideal with medication pass.
Flavors: natural, wild cherry
12/28/10
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