As a Primary Care Physician (PCP), through whom can I order Nutren 1.5 (nutrition supplement)?

Ordering Nutren 1.5 as a Primary Care Physician

As a PCP, you can order Nutren 1.5 directly through medical nutrition suppliers, durable medical equipment (DME) companies, or hospital/outpatient pharmacies that stock enteral nutrition products, though working with a registered dietitian for prescription and monitoring is strongly recommended to ensure appropriate use and reduce inappropriate prescribing. 1, 2

Direct Ordering Channels

Medical Nutrition Suppliers and DME Companies

• Nutren 1.5 is a commercially available oral nutritional supplement and enteral feeding formula manufactured by Nestlé that can be ordered through standard medical nutrition supply chains 1
• Contact DME companies that specialize in enteral nutrition products, as they typically stock Nutren 1.5 and can arrange delivery directly to patients 1
• Hospital outpatient pharmacies often maintain formularies of enteral nutrition products including Nutren 1.5 1

Product Specifications

• Nutren 1.5 provides 150 kcal per 100 mL with 6g protein, 16.9g carbohydrate, and 6.8g fat, with an osmolality of 430-510 mOsm/kg 1
• Contains 100mg calcium and 100mg phosphorus per 100 mL, with 5.1 mmol sodium and 4.8 mmol potassium 1
• Water content is 78%, making it a calorically dense formula suitable for patients requiring volume restriction 1

Critical Recommendation: Involve a Registered Dietitian

Evidence for Dietitian-Led Prescribing

• Transferring nutritional supplement prescribing privileges to dietitians results in significantly fewer inappropriate prescriptions (11% vs 34% inappropriate prescriptions; P = 0.002) compared to physician-only prescribing 2
• Dietitians complete relevant laboratory assessments more frequently (75% vs 43%; P = 0.001) and arrange follow-up evaluations more often (84% vs 30%, P < 0.001) 2
• Physicians more frequently prescribe supplements to patients who are not malnourished or who have contraindications to receiving supplements 2

Collaborative Ordering Process

• The ordering process requires close collaboration between physician, clinical pharmacist, and dietitian for optimal outcomes 1
• In some centers, prescribing of nutritional support has been successfully transferred to experienced and trained pharmacists or dietitians working with nutrition support teams 1
• Reference to established guidelines for ordering and managing nutritional support encourages appropriate patient selection and tailoring prescriptions to individual needs 1

When Nutren 1.5 is Appropriate

Clinical Indications

• Patients requiring high-calorie, moderate-protein enteral nutrition who cannot meet nutritional needs orally 1
• Suitable for both oral supplementation and tube feeding in patients with functional gastrointestinal tracts 1
• Can be used in patients with chronic kidney disease (with appropriate monitoring of electrolytes and phosphorus) 1

Contraindications and Cautions

• Not appropriate for patients with normal nutritional status - this represents inappropriate prescribing 2
• Requires careful consideration in patients with diabetes due to carbohydrate content, though diabetes-specific formulas may be more appropriate 1
• Monitor electrolyte content (particularly potassium and phosphorus) in patients with renal impairment 1
• Avoid in patients with contraindications to high-energy, electrolyte-containing solutions 2

Practical Implementation Steps

Initial Assessment Requirements

• Document nutritional screening results showing malnutrition risk or inadequate oral intake 1
• Verify that artificial nutrition support is needed when oral intake is absent or inadequate for 5-7 days (earlier in malnourished patients) 1, 3
• Complete relevant laboratory assessments including albumin, prealbumin, and electrolytes before prescribing 2

Prescription Details

• Specify volume and frequency based on caloric and protein needs (e.g., "Nutren 1.5,240 mL twice daily" provides approximately 720 kcal and 28.8g protein) 1
• Include clear instructions for administration (oral vs tube feeding route) 1
• Arrange dietitian follow-up evaluation within 1-2 weeks of initiation 2

Monitoring Plan

• Schedule follow-up to assess tolerance, adequacy of intake, and nutritional status improvement 1
• Monitor body weight, functional status, and relevant laboratory parameters 1
• Reassess need for continued supplementation regularly, as prolonged use without reassessment represents suboptimal care 2

Common Pitfalls to Avoid

• Do not prescribe without documented malnutrition or inadequate oral intake - this is the most common prescribing error 2
• Avoid prescribing without arranging appropriate follow-up and monitoring 2
• Do not use as a substitute for comprehensive nutritional assessment by a qualified professional 4, 2
• Recognize that physician nutrition education is often inadequate, and consultation with nutrition specialists improves outcomes 5, 4, 6