Reviewed January 2024

For many years, Rav Gershon Bess prepared a Guide for Pesach Medications and Cosmetics which was published and distributed by Kollel Los Angeles. A partnership with STAR-K and the Kollel to make this information more widely available to the general public is still going strong after more than a quarter century. The Medications and Cosmetics Guide, available in Jewish bookstores nationwide, serves as an invaluable resource for kosher consumers seeking to purchase these items for Yom Tov.

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

The halachos pertaining to medication and cosmetic use on Pesach are based on the joint psak of Rabbi Moshe Heinemann, shlit”a, and Rav Gershon Bess, shlit”a.

THE MEDICINE LIST DOES NOT ADDRESS KITNIYOS or YEAR-ROUND KASHRUS
Except where indicated, the Medicine List does not address the kosher status of the product, ONLY its chometz-free status. Therefore, products appearing on the list may be both non-kosher and chometz-free. Also note that this brief article does not address the many halachos concerning taking medication on Shabbos and Yom Tov.1

The Medicine List primarily addresses the “chometz-free” status of a medication. Unless otherwise indicated, it does not address the kitniyos status of the product, since kitniyos is permissible for a choleh and/or is batel b’rov (see here ).

IMPORTANT GUIDELINES REGARDING MEDICATION USAGE ON PESACH
No one should refrain from taking any required medication, even if it contains chometz, without first consulting his physician and rav.
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, 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: Any psychiatric condition, prostate condition, Crohn’s disease, celiac disease, colitis, high cholesterol, Parkinson’s disease, anemia, Multiple Sclerosis, thyroid condition, and asthma.

Categories of Cholim

There are three main categories of cholim that we will address: choleh sheyeish bo sakana, choleh she’ein bo sakana, and mechush or bahree. Each has different halachos with respect to medications on Pesach.

(1) Choleh Sheyeish Bo Sakana: Someone whose life is/may be in danger

L’Halacha, such a choleh may take anything if a substitute is not available.
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. If an equally effective non-chometz medicine is available, lechatchila it should be taken. If necessary, 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.
This category includes:

• 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.
• Someone who has COVID-19 with moderate or severe symptoms of coronavirus and is either elderly, or has underlying medical conditions that cause an increased risk for severe illness from COVID-19 (e.g., diabetes, heart condition, etc.).
• 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.

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. This Medicine List provides necessary information for consumers, ensuring that such mistakes are not made.

(2) Choleh She’ein Bo Sakana: Someone whose life is not in danger

Such a choleh may not consume chometz in a normal manner but may eat kitniyos. 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:

• Someone recovering from COVID-19 who is weak but no longer in a sakana state.
• 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’Halacha, such a person may swallow any tablet, caplet or capsule that is manufactured with the intent for the consumer to swallow, regardless of whether or not it contains chometz (unless an equally effective non-chometz medicine is available).

A choleh she’ein bo sakana may consume kitniyos (Mishnah Berurah 453:7) even in a normal manner. Choleh she’ein 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’mita” – ill enough to feel like he needs to go to bed). Therefore, medication in any form (i.e., chewable or swallowable tablet/ capsule/caplet/ powder/liquid) may be taken by a choleh she’ein bo sakana if it appears on the approved Pesach Medicine List or if one can determine that it is 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 since, with regard to this Halacha, such individuals are considered a choleh she’ein bo sakana.

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

Medicine taken by a choleh she’ein bo sakana 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., sorbitol 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 instance, 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. (See the end of this article for additional details about the research process.)

(3) Mechush (slight discomfort) or Bahree (healthy)

A person who has a mechush or is considered bahree may consume only chometz-free and preferably kitniyos-free products.

This Medicine List provides chometz-free information (e.g., identifying which aspirin or ibuprofen brands are approved for Pesach) and often indicates when there is no kitniyos, as well.

One who is experiencing a slight discomfort (e.g., slight joint pain or runny nose), or who is in good health, may take only those products that are chometz-free and not considered kitniyos. As noted above, a medicine that is ‘gluten-free’ might not necessarily be ‘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 Medicine List or if someone knowledgeable in kashrus can ascertain this by reviewing the ingredients. The medicine should preferably be kitniyos-free. Halachically, it may be permissible to ingest a medication even if it contains kitniyos when the kitniyos are batel b’rov, since shishim is not required (see Mishnah Berurah 453:9).
Since one who has a mechush or is a bahree may not consume kitniyos in a normal fashion (i.e., chew a pleasant tasting kitniyos tablet or kitniyos liquid), he should ascertain that the medication is not only chometz-free but also kitniyos-free (or at least confirm that the kitniyos is batel b’rov).
Furthermore, in most cases information gathered for the Medicine List is not based on a mashgiach inspection of the facility but rather on information provided by the manufacturer. Although, l’Halacha, this information is reliable, nonetheless it is praiseworthy for one who has a mechush or is healthy to refrain from taking medicinal products kederech achila (eaten in a normal manner – e.g., pleasant tasting chewable tablets or liquid) unless these items are certified for Pesach. This Halacha generally also applies to vitamins taken to maintain good health.

Bal Yeira’eh u’Bal Yematzeh

One can assume there are no bal yeira’eh or bal yematzeh (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 approved Medicine List) contains chometz, it is unlikely that there is a kezayis of chometz in the entire container; therefore, there is no prohibition of ownership during Pesach. (See Chometz After Pesach Chart).

Compiling the Medicine List: How the Information Is Obtained and The Halachic Rationale

In order to compile the annual Medicine and Cosmetics lists, Rabbi Bess contacts the company and asks numerous questions. The information is updated anew every year and accepted only when submitted by the company in writing. Rav Moshe Feinstein, zt”l, was of the opinion that one may rely on written information provided by a company (Igros Moshe Y.D. I:55). Additionally, a medicine can be added to the list if it contains only 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 and other reliable hechsheirim. When a company is certified by STAR-K, detail-oriented reviews of ingredients, formulations and factories are conducted, and the halachic leniencies of compiling lists based on written responses are not relied upon. Nevertheless, with regard to approved medication, l’Halacha, one may rely upon this information. 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, additional leniencies that one may rely upon often apply.

A full discussion of these leniencies is beyond the scope of this article but include:

• The halachos that are applied to a choleh.
• The unpleasant taste of a medicine, which according to some opinions, makes its consumption shelo kederech achila.
• Swallowing a tablet made to be swallowed (vs. chewed) is shelo kederech achila.
• A halachic rov (majority) of chometz-free sources may also apply.

STAR-K Kosher Certification is grateful to both Rabbi Gershon Bess for all of his tireless research, and to Kollel Los Angeles, for providing this Medicine List to a diverse group of kosher consumers who have referred to this guide for decades for reliable Pesach information. This Pesach Guide has benefited many conscientious consumers who require medication and 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 kosher vesame’ach for Klal Yisroel.

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