A KASHRUS GUIDE FOR THE OB-GYN PATIENTDr. Joel Pleeter, Village OB-GYN
Rabbi Dovid Heber, Star-K Kashrus Administrator

This list was updated in August 2007. See Taking Your Medicine section for related articles. This list is available to physicians for reprinting. Contact Rebecca Mark at

When visiting an obstetrician/gynecologist, a patient may be given prescriptions or recommendations for an array of products by her physician. The patient may be confused about whether a particular product is kosher. The following guide was prepared to help clarify the kashrus issues regarding these products.¹

Ideally, one should purchase medicinal products and vitamins with a reliable kosher certification. Unfortunately, this is not always possible. In the event a product is not kosher approved, one should consult her Rav, as one does with any halachic question. The following guidelines in this regard are the halachic ruling of Rabbi Moshe Heinemann, Star-K Rabbinic Administrator. Note: The following are general halachic guidelines and cannot possibly cover all scenarios. Under no circumstances should an individual forgo taking a prescribed medication without first consulting her physician and Rav.

Choleh Sheyaish Bo Sakana - Someone who is ill and whose life may be in danger. A choleh sheyaish bo sakana may use any non-kosher medication if an equally effective kosher medicine is not readily available. Included in this category is someone whose life is currently not in danger, but if untreated could develop a life threatening complication. This includes an elderly person who has the flu or an infant with a fever.

Additional examples include the following:

• One who has a heart condition, diabetes, substantially elevated blood pressure, kidney disease, severe depression or any other serious condition.
  
• Someone with an infection (except for those skin infections known to be non-life threatening, e.g. acne) may take antibiotics.
  
• A pregnant woman whose life is in danger e.g. blood clotting disorder, toxemia, or who is in active labor, or who is in danger of having a miscarriage.
  
• A woman who is in active labor.
  
• A woman who has given birth within the past seven days without any known complications or who has postpartum complications that are or may become life threatening. This may apply for an extended period of time, depending upon her condition.
  

All instructions given by the doctor should be carefully followed, including taking the medication for the prescribed number of days,even though the symptoms may have subsided. This also applies to non-kosher medication that is flavored and tastes good. All of the above is equally applicable on Pesach to medication which contains chometz.

Choleh She'ain Bo Sakana - Someone whose life is not in danger. This includes anyone who is bedridden, is noticeably not functioning up to par due to pain or illness, or has a fever which is not potentially life threatening. A child under six years of age who has discomfort is also considered a choleh she'ain bo sakana. This category also includes the following:

• One who is experiencing symptoms of the flu.
• One who suffers from chronic debilitating arthritis pain.
• One who suffers from migraine headaches or mild depression.
• A pregnant woman suffering from non-life threatening complications e.g. lower back pain.
• A woman who has given birth in the past thirty days without any known problems or who is experiencing non-life threatening postpartum complications. This may apply for an extended period of time.

Those listed above may take non-kosher medication shelo k'derech achila, in an uncommon way of eating, if a kosher alternative is not readily available.² Items which are designed to be swallowed³ without chewing caplets, swallow tablets, and even gelatin capsules, poor tasting chewable tablets, and poor tasting liquids have a shelo k'derech achila status. For example, if someone has the flu, and the only fever reducer available is a non-kosher gelatin capsule, one may swallow the product. Similarly, one may swallow Celebrex in a gelatin capsule or tablets containing chondroiton derived from non-kosher bovine trachea cartilage for chronic debilitating arthritis pain. However, under normal circumstances one may not take non-kosher products if it requires eating in a normal manner e.g. non-kosher chewable tablets that taste good.One who suffers from menopausal symptoms e.g. hot flashes should consult a Rav to determine whether she is in the category of choleh she’ain bo sakana. A pregnant woman often has the status of a choleh sh’ain bo sakana. For a further discussion, see below.

Maychush and Baree - One who is experiencing slight discomfort he has a maychush e.g. slight joint pains or a runny nose or is healthy and takes vitamins and supplements to maintain good health (he is a baree)should make every effort to ensure that the product is either kosher certified or contains all kosher ingredients. If this is not possible, a Rav should be consulted since in some instances non-kosher products taken shelo k'derech achila may be permissible.⁴ Taking non-kosher medication that requires eating in a normal manner (e.g. non-kosher chewable tablets that taste good is not permissible.)

During Pregnancy - As indicated above, a pregnant woman whose life may be in danger or is in danger of having a miscarriage is a choleh sheyaish bo sakana. A pregnant woman who is suffering from non-life threatening complications e.g. lower back pain often occurring in the third trimester or nausea is a choleh she'ain bo sakana and may take any medication shelo k'derech achila, in an uncommon manner, so that she feels better. In addition, a pregnant woman with no known complications who is advised by her physician to take a specific medicine or vitamin for her benefit or for the benefit of the baby even for preventive measures may take a non-kosher product shelo k'derech achila⁵ if an equally effective kosher variety is not available.

Prometrium, which is currently only available in gelatin capsules may be taken by a choleh she'ain bo sakana or a choleh sheyaish bo sakana (e.g. one who requires pregnancy support). Estratest which contains gelatin, and Premarin and Prempro, which may contain non-kosher ingredients, may be taken even by a choleh she'ain bo sakana. These products are commonly prescribed to middle aged women as part of an HRT Hormone Replacement Therapy to avoid development of osteoporosis⁶, a condition which often occurs as women age⁷. In such a case, with the advice of her physician, a woman may swallow a non-kosher capsule if an equally effective kosher substitute is not available.⁸

Dairy - Almost all products listed in the Approved OB-GYN Prescriptions List see below contain lactose, a dairy ingredient.⁹ These dairy products may not be taken for one hour after eating meat, however, since they are swallowed and not chewed, they may be taken after waiting only one hour.

Shabbos - One who has a mechush on Shabbos may not take medication or supplements to help alleviate the discomfort¹⁰. However, someone classified as a choleh whether in danger or not may take any medication necessary. A pregnant woman may take all necessary medications and vitamins on Shabbos. Someone who is a baree, in good health, and takes a product to change the normal function of the body e.g. caffeine pills to avoid falling asleep, may also take this product on Shabbos. Many products listed on the Approved OB-GYN list see below are in this category. These pills may be taken on Shabbos.

Additional information regarding the kashrus of medications and vitamins may be found in the medicine section of Kashrus Kurrents articles and in the medicine list on our web site. Passover guidelines and medications approved for use on Pesach are published annually by the Star-K in conjunction with Kollel Los Angeles.

The following is a list of companies with kosher certified supplements, health, and pharmaceutical products. Products are certified only when bearing the symbol of the certifying agency.

Star-K Certified when bearing Star-K Symbol
Amway/Access Business Group	Arizona Nutritional Supplements	Guardian Drug
Life Science Laboratories	Melaleuca	Nature's Sunshine
Nutralife Health Products	Preventive Medical Group	Raritan Pharmaceuticals
Shaklee	Simplexity	Sunrider
Trout Lake Farm
Certified by Other Agencies
First Quality Health - OU	Freeda - OU	Landau Volover
Maxi-Health - OU	Navitco - OU	Novartis - OU
Nature’s Answer Kof-K	Nutri-Supreme Research Kof-K	Solgar Kof-K

The following is a list of kosher approved tablet products often prescribed by an OB-GYN. Consult your physician prior to taking any medication. Company names are indicated for prescription drugs. This is not a Pesach list. Note that this list only indicates the kosher status of the product. In regards to the use of many of these products due to other halachic issues, a Rav should be consulted. Also note, the following products not listed are addressed in the article above: Estratest, Premarin, Prempro, Prometrium.

Advanced NatalCare-OU	KV		Advanced RF NatalCare-OU	KV
Alesse Dairy	WY		Aygestin Dairy	DRM
Brevicon Dairy	WTS		Compazine Tablets Dairy	SK
Cyclessa Dairy	ORG		Demulen Pareve Placebo - Dairy	PMC
Desogen Dairy	ORG		Diflucan Tabs & Susp	PFZ
Estrostep Dairy	WC		Estrostep Fe Dairy	WC
Femhrt Dairy	WC		Fosamax Reg Tabs Dairy	MRK
Fosamax Oral Solution	MRK		Jolivette Dairy	WTS
Leena Dairy	WTS		Levlen Dairy	BLX
LevoraDairy	WTS		Loestrin 24 Fe Dairy	WC
Lo/Ovral Dairy	WY		Low-Ogestrel Dairy	WTS
Lutera Dairy	WTS		Menest Dairy	MNP
Microgestin Dairy	WTS		Microgestin Fe Dairy	WTS
Mircette Dairy	DRM		MonoNessa Dairy	WTS
Modicon Dairy	OM		Necon Dairy	WTS
Nor-QD Dairy	WTS		Norinyl Dairy	WTS
Nora-Be Dairy	WTS		NutriNate Chewables- OU	KV
Ogestrel Dairy	WTS		NutriNate Chewables- OU	KV
Ortho-Cyclen Dairy	OM		Ortho-Micronor Dairy	OM
Ortho-Novum Dairy	OM		Ortho-Tri-Cyclen (Regular), Dairy	OM
Ovcon Dairy	WC		Prenate Elite - OU	SCL
Provera Dairy	PFZ		Reclipsen Dairy	ORG
Remeron (Regular)	ORG		Remeron SolTab	ORG
Tri-Nessa Dairy	WTS		Tri-Norinyl Dairy	WTS
Triphasil Dairy	WY		Trivora Dairy	WTS
Ultra NatalCare OUD - Dairy	KV		Wellbutrin Reg Tabs	GSK
Yasmin Dairy	BLX

Note: This is not a Pesach list. Also, several of the following products are not recommended during pregnancy. Consult your physician prior to taking any medication. See our Approved Over-the-Counter Medications list for additional over-the-counter antacid, anti-diarrheal, anti-nausea, cold/allergy/decongestant, fiber, lactose intolerant, laxative, pain reliever, and sleeping aid medications.

DIAGNOSTIC
Glucose Tolerance Beverage  - OU	FS
Glucose Tolerance Beverage  - OU	CH
Glucose Tolerance Beverage  - OU	PS
Glucose Tolerance Beverage  - OU	ND
GoLytely Beverage	BRT
NuLytely Beverage	BRT
PAIN RELIEVER / ALLERGY prescription only; see OTC list for additional products
Allegra Tabs	AVT
Allegra-D Tabs	AVT
Allegra-Oral Suspension	AVT
Darvocet - N50 Tablets	EL
Darvocet - N100 Tablets	EL
EC-Naprosyn Delayed Release Tabs	RC
Imitrex Tablets Dairy	GSK
Naprosyn Reg Tabs & Suspn	RC
Percocet Tablets	END
Percodan Tablets	END
Tylenol With Codeine Tabs	OM
PRENATAL VITAMINS
Advanced NatalCare  - OU	KV
Advanced RF NatalCare  - OU	KV
NutriNate Chewables  - OU	KV
Prenate Elite  - OU	SCL
Ultra NatalCare - Dairy - OUD	KV
SLEEPING AIDS
Ambien CR Tablets - Dairy	SRL
Nytol Quick Caps - Dairy	GSK
Sominex Original Formula Tablets	GSK
Unisom Sleeptabs Tablets	PFZ
SUPPLEMENTS - see also Prenatal Vitamins
Boost - Dairy When bearing - OUD	MJ
Citracal Reg. Calcium Tablets When bearing - OU	MSS
Ensure - Dairy When bearing - OUD	RS
Ferro-Sequels Iron Tablets Dairy	INV
SlimFast - Dairy When bearing - OUD	UNL
Tums(when bearing Diamond K)Regular Tabs - Assorted Fruit, Peppermint; EX Tabs - Assorted Berries, Assorted Fruit, Assorted Tropical Fruit, Wintergreen; Ultra Tabs - Asstd Berries, Asstd Fruit, Asstd Tropical Fruit, Peppermint, Spearmint; Smoothies - Peppermint, Tropical, Berry Fusion; Cool Relief Cool Mint Tabs - Dairy; Smoothies - Assorted Fruit, Cocoa & Crème -Dairy.	GSK
THYROID
Levothroid	FR
Synthroid Tablets Dairy	ABB

The following are products that may always be used without kosher certification: Antibiotics for an infection - except for those skin infections known to be non-life threatening (e.g. acne), Enemas, Intravenous IV, Externally applied products including: Antiseptics, Creams, Dermatologicals, Emollients, Gels, Injections, Rubbing Alcohols, Lotions, Oils, Ointments, Powders, Shampoo, Soaps.


Footnotes:

1. The purpose of this article is to address the kosher status of OB-GYN medications. In regards to the use of various products prescribed by an OB-GYN, other halachic issues beyond the scope of this article may also apply. A Rav should be consulted to address these issues. Also, this article is in no way intended to advise consumers as to whether a specific product should be taken. Every patient is different. One should consult with her physician regarding the effectiveness and side effects of each product. A pregnant woman should discuss with her doctor whether a product is safe to take during pregnancy.

2. An exception to this rule is if the product is basar b'chalav, a heated milk and meat mixture. This is quite rare in medicinal products, however, if it does occur, a Rav should be consulted.

3. See Minchas Shiomo 17.

4.See Shach YD 155:13, based on the explanation of the Chochmas Adam in Binas Adam 52. See also Mesorah vol. 14, pg. 90.

5.The laws for this woman are similar to a choleh she'ain bo sakana as addressed above.

6. For a full discussion regarding osteoporosis and the kashrus status of arthritis remedies, see the "She Sells Sea Shells - But Are They Kosher? The Kashrus Status of Glucosamine and Other Arthritis Remedies" article.

7. One who has developed osteoporosis may be considered a choleh sheyaish bo sakana.

8. However, if a healthy individual wishes to take non-kosher supplements to prevent an illness unlikely to occur, a Rav should be consulted, as the halacha is similar to one who has a mechush.

9. For individuals who keep cholov Yisroel there may be various leniences. Consult a Rav.

10. This halacha also applies to Yom Tov but does not apply on Yom Tov Sheini i.e. the second day of the Shalosh Regalim [Pesach, Shavuos and Sukkos], the last day of Pesach, and Simchas Torah. For purposes of this halacha, the second day of Rosh Hashana is not considered Yom Tov Sheini and this halacha applies.

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Manufacturers
ABB Abbott Labs AVT Aventis BLX Berlex BRT Braintree Labs CH Cardinal Health DRM Duramed EL Eli Lily END Endo Labs FH First Horizon FR Forest FS Fisher Scientific GSK Glaxo Smithkline INV Inverness Medical KV KV Pharmaceutical - Ethex Brand MA Major MCN McNeil Nutritionals MJ Mead Johnson MNP Monarch Pharm	MRK Merck MSS Mission ND Nerl Diagnostic NM Nature Made NVX Novavax OM Ortho-McNeil ORG Organon PFZ Pfizer PS Perk Scientific RC Roche RS Ross SCL Scielp SRL Searle WC Warner-Chilcott WFH Women First Healthcare WTS Watson WY Wyeth UNL Unilever