Pesach Medication: The Halachos and Lists

For many years, Rabbi Gershon Bess has prepared a Guide for Pesach Medications and Cosmetics. This list has been published and distributed by Kollel Los Angeles. For over a decade, STAR-K Kosher Certification in conjunction with Kollel Los Angeles has made this list more widely available to the general public. This guide, available in Jewish bookstores nationwide, has served as an important resource to kosher consumers.

Sefer Kovetz Halachos (Hilchos Pesach 12:4) states in the name of HaRav Shmuel Kamenetzky, shlit”a, that l’chatchila one should take a medication approved for Pesach (see ibid. footnote #5 that mentions the availability and use of reliable Pesach lists and guides).

There are four issues that must be addressed to fully understand the list:

  • The Halachos of Taking Medication on Pesach
  • The Importance of the List
  • How the List is Prepared
  • Cosmetics and Personal Care Products

I. The Halachos of Taking Medication on Pesach

The following halachos are based on the psak of Rav Moshe Heinemann, shlit”a, and Rabbi Gershon Bess, shlit”a. (The halachos in the earlier sections of the book are based on the psak of Rav Moshe Heinemann, shlit”a.)

Important: No one should refrain from taking any required medication, even if it contains chometz, without first consulting his physician and rav.

Note: All medications for a heart condition, diabetes, abnormal blood pressure, stroke, kidney disease, lung disease, depression, epilepsy, the immune system (transplant anti-rejection), and cancer treatment (including precautionary) may be taken on Pesach. Furthermore, all prescription medication taken on a regular basis for chronic conditions should be changed only with the consultation of your physician (if you cannot reach your physician, you should continue to take your regular prescription without change). Some examples of such chronic conditions include the following: any psychiatric condition, prostate condition, Crohn’s Disease, celiac, colitis, high cholesterol, Parkinson’s Disease, anemia, Multiple Sclerosis, thyroid condition, and asthma.

Choleh Sh’yaish Bo Sakana

If someone’s life is in danger, or may be in danger, he must take any chometz medication unless an equally effective non-chometz medication is readily available. One may also take chometz medication to prevent a possible sakana. This is true regardless of the form of the medication (i.e., swallowable tablets & caplets, capsules, liquid & chewable tablets). Swallowable tablets or caplets are preferred, if readily available. Individuals in a sakana situation should not switch medications and should continue with their regular prescriptions, whether or not they contain chometz (unless a doctor advises otherwise).

Examples include the following:

  • Someone with an infection (except for those skin infections known to be non-life threatening, e.g., acne) should take prescribed antibiotics. One should finish the course that is prescribed.
  • An elderly person with the flu.
  • A pregnant woman whose life is at risk (e.g., blood clotting disorder, toxemia) or who is in active labor or in danger of having a miscarriage.
  • A woman who has given birth within the past seven days or who has postpartum complications that are or may become life-threatening. This may apply for an extended period of time greater than seven days, depending upon her condition.

Choleh Sh’ein Bo Sakana

Someone whose life is not in danger. This includes anyone who is bedridden, noticeably not functioning up to par due to pain or illness, or has a fever which is not potentially life-threatening.

This category also includes the following:

  • 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 between 7 and 30 days prior to Yom Tov without any known problems or sakana, or who is experiencing non-life-threatening postpartum complications. This may apply for an extended period of time after 30 days.
  • A child under age six with any illness or discomfort.

L’halachah, such a person may swallow any tablet, caplet or capsule regardless of whether or not it contains chometz (unless an equally effective non-chometz medicine is available). However, where possible, one should use only medications that do not contain chometz.

It should be noted that a choleh she’ain bo sakana may consume kitniyos (Mishnah Brura 453:7) even in a normal manner. Choleh she’ain bo sakana has the same definition in these cases as it does in Hilchos Shabbos, when taking medication on Shabbos would be permissible (i.e., “nafal l’mitta” – ill enough to feel like he needs to go to bed). Therefore, medication in any form (i.e., chewable or swallow tablet, capsule, caplet, powder, liquid, etc.) may be taken by a choleh she’ain bo sakana if they appear on the approved Pesach list or if one can determine that they are chometz-free. This is true even if the product contains corn starch or other kitniyos ingredients. Similarly, non-chometz baby formula (e.g., Enfamil) and nutritional products (e.g., Ensure) which contain kitniyos are permissible for use by infants and the elderly, as in regards to this halachah such individuals are considered a choleh she’ain bo sakana.

Above products that contain kitniyos should be prepared on disposable or non-chometz utensils. Also, one should purchase new baby bottles for Pesach. These kelim should not be used with Pesachdik products, and the work area for preparation and rinsing should not be in the Kosher for Pesach kitchen (i.e., use a laundry room or bathroom sink).

Mechush (slight discomfort) or Boh’ree (healthy)

One who is experiencing a slight discomfort (e.g., slight joint pain or runny nose) or who is in good health may only take products that are chometz-free and not considered kitniyos. Note just because a medicine is “gluten-free” does not necessarily mean it is chometz-free.

If one must chew a tablet or take a liquid medication for minor discomfort, he may do so if it appears on the approved medication list or if someone knowledgeable in Kashrus can ascertain this by reviewing the ingredients. It should preferably be kitniyos-free. Halachically, it may be permissible to ingest a medication even if it contains kitniyos when the kitniyos are botel b’rov, since shishim is not required (see Mishnah Brura 453:9).

It should be noted that the medication list primarily addresses the “chometz-free” status, and for certain medications it does not address the issue of kitniyos (since kitniyos is permissible for a choleh and/or is batel b’rov).

Since one who has a mechush or is a boh’ree may not consume kitniyos in a normal fashion (i.e., chew a pleasant tasting kitniyos tablet or kitniyos liquid), one should ascertain that the medication is not only chometz-free but also kitniyos-free (or at least confirm that the kitniyos is batel b’roiv).
Furthermore, in most cases information gathered for the list is not based on a mashgiach inspection of the facility, but rather on information provided by the manufacturer. Although, l’halachah, this information is reliable (see Section III)nonetheless it is praiseworthy for one who has a mechush or is healthy to refrain from taking medicinal products k’derech achila (eaten in a normal manner – e.g., pleasant tasting chewable tablets or liquid) unless these items are certified for Pesach. This halachah generally also applies to vitamins taken to maintain good health.

II. The Importance of the List

The following list is important for all types of cholim on Pesach.

Choleh Sh’yesh Bo Sakana

As indicated, l’halachah, such a choleh may take anything if a substitute is not available.
Unfortunately, there are individuals who inappropriately discontinue medication for life-threatening conditions during Pesach without consulting a physician, unless the medicine appears on an approved list. The list provides necessary information for consumers, ensuring that such mistakes are not made.

Furthermore, as previously indicated, even one who is in sakana should l’chatchila use a medication that is chometz-free, if possible. This list provides this information.

Choleh She’ain Bo Sakana

Such an individual may not consume chometz in a normal manner but may eat kitniyos.
Medicine taken by such individuals often lists ingredients that may be derived from chometz. For example, sorbitol, a sweet calorie-free sugar alcohol derived from glucose found in medication, mouthwash, and toothpaste is often derived from corn but could also come from wheat (e.g. soribtol from Europe is often chometz based). There is no way to know its source by reading the label. “Gluten-Free” does not necessarily mean chometz-free. For example, a product with chometz based sorbitol can still be labeled gluten-free as it no longer contains gluten but is still chometz.
Rabbi Bess’ research confirms which products are chometz-free, something often impossible for a rav or choleh to ascertain on his own.

Mechush or Boh’ree

As indicated, such a person may take only chometz-free and preferably kitniyos-free products.
This list provides chometz-free information (e.g., which aspirin or ibuprofen may be taken) and often indicates when there is no kitniyos, as well.

Note: Except where indicated, the list does not address the kosher status of the product, only the chometz-free status. This means that if a product appears on the list it does not necessarily mean that the product is kosher. It may be non-kosher and chometz-free. Furthermore, this article does not address the halachos of taking medication on Shabbos and Yom Tov.

Bal Yeraeh u’Bal Yematze

One can assume there are no bal yeraeh or bal yematze (owning chometz) issues regarding owning any medicine on the chometz-free list. The reason is because we rely upon information provided by the company. Furthermore, if a tablet (not on the list) contains chometz it is unlikely that a k’zayis of chometz is in the entire container; therefore, there is no prohibition of ownership over Pesach (See Chometz After Pesach Chart).

III. How Information is Obtained and on What Halachic Basis

Rabbi Bess contacts the company and asks numerous questions. Information is updated every year and is accepted only when submitted in writing. Rav Moshe Feinstein, zt”l, was of the opinion that one may rely on written information provided by a company (Igros Moshe YD I:55). A medicine can also be added to the list if it only contains ingredients that are definitively chometz-free.

This system of review is implemented for this project only and would not be relied upon for products certified by STAR-K Kosher Certification and other reliable hechsherim. When a company is certified by STAR-K, a careful review of formulations and factory inspections are conducted and these halachic leniencies are not relied upon. Furthermore, the information submitted by the company is not as detail-oriented as a formulation and factory review, and approval of a STAR-K certified product (e.g., with flavors or various other ingredients). However, with regard to approved medication, l’halachah, one may rely upon this information. The reason is as follows: As indicated in Igros Moshe, we consider the information on the list to be accurate.

Even if one suspects that a company provided inaccurate information (e.g., they could not adequately determine the type of alcohol in use), halachically there are other additional leniencies and he can rely upon the information that is provided.

These issues are beyond the scope of this article, but include: 1) Dealing with a choleh; 2) According to some opinions, the taste of a medicine makes its consumption shelo k’derech achila; 3) Swallowing a tablet made to swallow is shelo k’derech achila; 4) A halachic rov (majority) of chometz-free sources may also apply.

STAR-K Kosher Certification is grateful to Rabbi Gershon Bess for all of his research, as well as Kollel Los Angeles for providing this list to a diverse group of kosher consumers who refer to this guide for reliable Pesach information. This Pesach Guide has benefited many ill and conscientious consumers who wish to fulfill the “chumros d’Pesach”. It has also assisted many rabbonim and kashrus professionals who must answer numerous shailos regarding Pesach, thus facilitating a Chag Kasher V’Sameach for countless individuals.

  1. For a full discussion regarding the laws of taking non-kosher medication during the year, as well as on Shabbos and Yom Tov, see Kashrus Kurrents article ‘A Kashrus Guide to Medications, Vitamins, and Nutritional Supplements’ or call our office.