Confused About Medications On Passover?

Between the kasher l’Pesach lists published by numerous kashrus organizations and the plethora of hashgachas printed on food packaging, consumers have an easy time stocking their pantries with every conceivable type of food. But what rules apply to medicines on Passover? Must they too be “kosher for Passover”? How would one discover if a particular medication is permissible on Passover? Does it matter for what condition someone is taking medicine?

It is important to recognize that while the year-round laws of kashrus and laws of Passover function in parallel, they also function independently. That is, certain products may be kosher for Passover but not kosher for a Jewish person to consume and other products might be kosher year-round but not kosher for Passover. For instance, one may never feed one's pet food that contains meat and dairy cooked together. On the other hand, during Passover one may not feed chametz to one's animals whether or not the food would be kosher for year-round use. This explains why animal food must also be kosher for Passover, even though it does not have to be otherwise kosher.

The same concept applies to the discussion of medications. Certain medications may be permitted during the year even though they are not kosher. When Passover comes, the question arises whether the restrictions of Passover would preclude their use. This is why published lists of medications for Passover give a disclaimer that inclusion on the list does not imply that the medication is kosher, only that it does not contain chametz or possibly kitniyos. But are the “kosher for Passover” medicine lists that are published yearly necessary?

I wonder whether the kosher for Passover medication lists are responsible for more harm than benefit. From discussions with observant physicians, it appears clear that many patients with serious condition are not taking their medications on Pesach because they either cannot find them on a list or do not even check. The ubiquitous use of generic drugs has only made the situation worse, since few of those are on any Pesach medication list. A physician practicing in Boro Park has told me that he sees multiple post-Pesach hospital admissions of people who have stopped their heart medicines and developed congestive heart failure.

The problem is apparent from a typical letter I received last year after publishing an article on the kashrus status of medications on Passover:

I read your article about medications on Passover and it made me wonder whether I may be permitted to take my Synthroid medication that I usually take daily. In the past I would just skip the week of Passover but my doctor objected when he found out about it last year. Do you think it would be OK to take Synthroid pills on Passover?

While I appreciate the questioner’s dedication to keeping Pesach scrupulously, it is ironic that brand name Synthroid has been listed as non-chametz on multiple widely available lists of kosher for Passover medications for several years, so there should have been no issue in the first place. Rather than consult a kosher for Passover medicine list (if one even knows that such lists exist) it seems that many people just skip their medications. I confirmed with a posek that the questioner did not even need a list, since she would be allowed to take her Synthroid for hypothyroidism even without it being kosher for Passover, so long as it was a non-chewable pill.

Nevertheless, it is important to understand which medications do need supervision. The following is a basic halachic analysis of medications for Pesach.

Are medicines considered edible? The status of ingested medicine on Passover is different from that of the rest of the year in two major ways. First, while during the rest of the year only eating non-kosher food (with the exception of mixtures of meat and milk) is forbidden, on Passover, in addition to the prohibition of eating chametz, one is forbidden to own or derive any benefit from it.

The second difference involves the point at which a food is considered to have been transformed into a non-edible substance. During the year, a food that is not fit to be eaten by a normal person is not considered to be a food with respect to the laws of kashrus. When Passover arrives, only a substance that is not fit to be eaten by a dog before Passover is considered to be non-edible and therefore not chametz. The halachic question of interest is which types of medications are considered fit to be eaten by a dog and which are considered completely non-edible.

If a person has even a questionable life-threatening illness or condition, he clearly may utilize any food, drink, or medication appropriate for his condition, regardless of whether it contains chametz – provided that a convenient substitute without chametz is not easily available. Eating chametz in such a situation is mandatory because of the overriding biblical obligation to preserve life. While it is praiseworthy for an ill person to check his medication list against one of the published kosher for Passover medication lists, this is only for his own peace of mind, so he can be reassured he is not ingesting chametz or so he can ask his physician if any of the chametz-free medications are appropriate substitutes.

But under no circumstances should Passover be used as an excuse for seriously ill or potentially seriously ill people (such as those with heart conditions, hypertension, diabetes, or infections) to stop taking prescription medications without clear directions from a doctor.

Do pills need to be kosher for Passover? A patient who is not seriously ill may not take any medicine that contains even a small amount of edible chametz. But a question arises regarding the status of a medication containing chametz that is unpleasant tasting and not fit for canine consumption. While it might seem that this should be automatically permitted, the resolution of this matter is based on the interpretation of one sentence in tractate Pesachim (21b): “Rava said: one who scorches his bread before the time that chametz is forbidden may benefit from it after the time that chametz becomes forbidden.”

One line of reasoning explains that while chametz that has been rendered completely inedible may be used over Passover, it may not be eaten. Were someone to choose to ingest such a substance, he would be de facto declaring that he actually considers the material to be edible, a concept called achshevei. The other line of reasoning argues that not only is one permitted to derive benefit from severely burned bread, one may even eat it. The only reason the Talmud did not state outright that it may be eaten is that people do not usually eat such materials.

According to this second argument, medicines that contain chametz no longer fit for a dog may be taken freely by anyone. According to the first argument, such medications may be problematic for non-severely ill people (because of achshevei). But does achshevei apply to medicine – and is swallowing a pill considered eating?

Regarding the first question, Rav Shlomo Zalman Aurbach explained that the disagreement between the two approaches principally applied to cases where the medicine itself was the spoiled chametz.Today, the main issue concerns chametz that is used as a binder or coating, while the actual medicinal component is not chametz. In such a case, is the chametz considered spoiled if it is irreversibly mixed with something that is not edible?

Rav Yehoshua Neuwirth, author of Shmiras Shabbas K’hilchasah, accepts the ruling of the Chazon Ish that “pills containing flour mixed with things that are not fit for human consumption can no longer be considered chametz since the flour can no longer be separated out nor used to leaven other flour. Nor can the patient be said to attach importance (achshevei) to the flour rather than the medication. These pills therefore may be swallowed on Pesach.” Rav Neuwirth answers our second question by ruling that swallowing a pill is not considered eating in the usual way.

Rav Moshe Feinstein ruled that even non-seriously ill patients may swallow chametz-containing non-chewable pills on Passover for two reasons. First, any chametz in the pill was nullified before Passover. Second, Rav Feinstein ruled that achshevei does not apply to medication, since a person would eat virtually anything, food or non-food, if he thought it would make him feel better or cure him. By swallowing a pill, a person does not imply that he considers the pill to be a food, he only utilizes it for its curative properties.

While other major poskim agree, Rav Ovadia Yosef and Rav Shlomo Zalman Aurbach add the caveat that this applies only to a non-seriously ill person (choleh sh’ain bo sakana), but that a person with only a minor ailment or mild discomfort may not take pills likely to contain chametz.

Finally, it is important to remember that most pills, if they have any problematic substances, likely contain cornstarch, which is kitniyos, not true chametz. Even regarding pills that do contain wheat starch, the chametz is almost certainly rendered inedible before Passover. For these reasons, even a non-seriously ill person is certainly permitted to take any type of non-chewable pill on Passover (unless there is a readily available substitute with no chametz concerns) and has no excuse for discontinuing medication without the advice of a physician.

Chewable pills and flavored liquids: Nevertheless, while bitter liquids or tasteless non-chewable pills are permitted, flavored liquids or chewable pills with a taste are much more problematic. This is a particular problem for pediatric medications which are usually one of these two types. Several rabbinic organizations have published practical guidelines to help navigate the complex variety of medicine types. One simple formulation from the Chicago Rabbinical Council, an excellent starting point for evaluating which medications need to be kosher for Passover, divides medicines into three basic categories:

A. Non-chewable pills other than vitamins and food supplements which do not need Passover certification.

B. Liquid and chewable medications containing chametz, which require input from doctor and rabbi.

C. Liquid and chewable medications containing kitniyos which may be used by someone who is ill, but not by a healthy person to relieve minor discomfort.

It is clear that kosher for Passover lists are most useful for flavored liquid and chewable medicines and non-essential products such as over-the-counter medications and vitamin and food supplements. It is still necessary to consult a competent halachic authority if you have any questions into what category a given non-essential medication falls.

Additionally, there are unique issues related to children’s medications and many types of non-conventional treatments, such as homeopathic remedies, that may require special consideration. There are many excellent resources available online and at Jewish bookstores if you wish to obtain more information about kosher for Passover medicines, cosmetics, and toiletries.

Dr. Daniel Eisenberg is with the Department of Radiology at the Albert Einstein Medical Center in Philadelphia. He is a recognized expert on topics relating to Jewish biomedical ethics who lectures around the world and has given a weekly Jewish medical ethics shiur for over 17 years. Dr. Eisenberg’s articles appear in a number of periodicals and books, as well as on his own website (www.jewishmedicalethics.com) and sites such as Jlaw.com and Aish.com.