"From Machon Puah"

Medication on Pesach

At this time of year, one of the most common questions that we get here in the Puah Institute is “what medication can be taken on Pesach?”
Couples in active fertility treatments, the vast majority of whom are considered to be “choleh she-ein bo sakana” - person who is sick with a non-life threatening illness, often need to take several medications in the course of their treatment. The timing of ingesting the medications is usually very time sensitive. Even a single missed or late dose can disrupt the treatment cycle.

Before we discuss the general halachic guidelines, we must note that this column is not intended to be used as a source for halachic decision making. If you have a real-life situation that needs a halachic decision, we recommend consulting your local Rabbinic authority.

Any chametz medication that is essential for the treatment of a life threatening disease and cannot be replaced with an equivalent pesachdikke drug, can be taken on Pesach. Pikuach nefesh, the obligation to save a life, displaces the mitzva in the Torah forbidding eating chametz on Pesach.

Furthermore, in discussing general medications, the Shulchan Aruch refers to a medicinal compound called “teriaka” that contained flour and was therefore chametz. It reviews a debate about “teriaka” regarding the permissibility of eating it and one’s obligation to dispose of it before Pesach. The debate centers on the status of “teriaka” and if it is considered to be food. Those who hold that it is indeed food, require it to be disposed of prior to Pesach. This who hold it not to be food argue that anything that is not edible, or food, is not considered to be chametz and can remain in one’s possession over Pesach.

The Shulchan Aruch takes a middle ground in this debate. The Shulchan Aruch’s position is that “teriaka” cannot be eaten on Pesach, yet it need not be destroyed prior to Pesach; one does not violate the prohibition against owning chametz when in possession of this compound. 

He argues that “teriaka” in and of itself is not a food and therefore does not require disposal. However, in his opinion, an item that is not considered food that is nonetheless eaten elevates in status to the level of food by the mere fact that people are eating it. Possessing the “teriaka” is only a problem once it is eaten, because then it would be considered to be food and subject to chametz prohibitions. Therefore, it can be owned, but not ingested.

If we extend this reasoning to modern medicines, it would appear that we are forbidden to swallow medicines containing chametz. However, when discussing modern medicines there is another point to consider: the amount of chametz in the medicine.

The majority of the chametz found in modern medicines is the starch that is used to bind the chemical compounds together and in the flavoring of the medicines (very often corn syrup, molasses or some other sweetener/ flavor) to make them sweet and not bitter and thus, more palatable and edible (or foodlike).

In Kashrut, a mixture that contains forbidden items is de facto (“bedieved”) permitted if the forbidden item is less than 1/60th of the entire compound mixture. The prohibition against chametz on Pesach is even more stringent and is forbidden even when the chametz is less than one part in a thousand of the mixture.
While that stringency applies to mixtures made on Pesach itself, there is a dispute regarding mixtures that are made prior to Pesach. The dispute revolves around the uncertainty of the chametz in the mixture is still considered substantive, even if the mixture was made prior to Pesach. If it is considered substantive, it would “reawaken” on Pesach and be forbidden no matter when the mixture was made and of course, if not - it would be permitted.

The Rema seems to contradict himself in this discussion. In one place he states that the chametz part does “reawaken” on Pesach and in another he says that it does not “reawaken”. The Chazon Ish explains the discrepancy by explaining that in a case of food it does reawaken but in the case of non-food it does not reawaken and remains a permitted mixture.

Some opinions are strict and hold that the act of ingesting a pill or medicine proves that for them it is considered to be food - and thus not permitted. However, most authorities, using this reasoning, consider bitter or tasteless medicines to be non-foods no matter what and thus de facto permit them in the case of need. Sweet and flavored medicines which, like “teriaka” can be argued to be elevated to the status of food because people are eating it and it is indeed food-like, would not be permitted.

Therefore one should look for medication that is certified as Kosher for Pesach but can rely on all non-sweet medication if there is a genuine medical need, as authorized by their rabbinic authority.

The Puah Institute is based in Jerusalem and helps couples from all over the world who are experiencing fertility problems. Puah offers free counseling in five languages, halachic supervision, and educational programs. Offices in Jerusalem, New York, Los Angeles and Paris. Contact: (02) 6515050, (Isr) - 718-336-0603 (US) puahonline.org

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