Kashrus Guide for the OB-GYN Patient

October 2016

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). 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 maychush 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.

Click here to view the OBGYN medicine listing