Medications: Difference between revisions

# On a fast day one that is not feeling well and wants to take a pill is permitted to do so. Some say one should wrap the pill in a tissue before swallowing it.<ref>Halichos Shlomo Moadim 2:13:footnote 8. </ref> Some poskim say that one may not use water to swallow a pill.<ref>Nishmas Avraham 550:4.</ref> (However, if one's doctor instructs him to take a pill on a fast day then even according to this opinion using a little water is permitted).<ref> Harav Yisroel Belsky Shlita, Halichos Shlomo Moadim ([[Pesach]] etc) 16:3, Nishmas Avraham 5:page 46. </ref> Others say if one cannot take a pill without water then one may use a little water.<ref>Harav Yisroel Belsky Shlita, see Teshuvos V’hanhugos 3:156. </ref> One should avoid this if possible on [[Tisha BeAv]], and on [[Yom Kippur]] since using water in order to swallow a pill is forbidden.<ref>Harav Yisroel Belsky Shlita, see Teshuvos V’hanhugos 3:156.</ref> One is permitted to take a medication before a fast if it will enable him to have an easier fast.<ref>Nechamas Yisroel 27:22. </ref>

# There is a discussion in the poskim if one is allowed to use mouthwash on the morning of a fast day. Some poskim are stringent,<ref>Harav Yisroel Belsky Shlita, see Kinyan Torah 2:49:2, Modanei Yeshurin page 108, Chai Ha’Levi 5:48, Divrei Chachumim page 166:471 quoting the opinion of Harav Sheinberg Shlita. Some say if there is a need, brushing ones teeth is permitted (Divrei Chachumim Ibid). </ref> while others say if one will have bad breath then it is permitted.<ref>Be’er Moshe 8:94. Refer to Minchas Yitzchok 4:109. </ref>

# Taking Listerine Pocketpaks® (that have a hechsher) is not permitted on a fast day since one swallows the liquid which melts in the mouth.

# When one walks down the aisles in a pharmacy he may see many pills which contain a [[gelatin]] coating. This issue involves the discussion of [[gelatin]]. Below we will discuss what [[gelatin]] is and what its kosher status is, and how it applies to ingesting gel-caps.

# The source of [[gelatin]] is almost always the bones or hides of non-kosher animals. To improve the quality of the process, the raw material is pretreated by soaking the hard bones in a mixture of lime and water between 70-120 days.  Soft bone and hides are treated with a five percent concentration of mineral acids for ten to thirty hours. [[Gelatin]] is then extracted from the pretreated material in a process which is like [[cooking]]. The bones are warmed in a series of runs at increasing temperatures. Eventually [[gelatin]] liquor is formed, which is then filtered and evaporated to remove the water and concentrate the liquor. The liquor is then cooled to form a gel. The gel is dried and cut into desired shapes.<ref>Refer to Medicines and Kashrus page 16, [[Gelatin]] in Jewish Law pages 15-22 in great depth, Yabia Omer Y.D. 8:11.  See Journal of Halacha and Contemporary Society 30:page 67:footnote 2 who maintains that most [[gelatin]] today is from pig skins. </ref>

# The Toras Kohanim<ref>Parshas Sheminei 2:4. </ref> says the posuk "from non-pure animals one should not eat their flesh"<ref>Vayikra 11:8. </ref> excludes bones, sinews, and hooves. There is a discussion if there is no issur at all, or if there is an issur d'rabanan to consume the above items. The Rambam<ref>Hilchos Machalas Asuros 4:18. Refer to Rashi Vayikra 11:8 “mivsaram.” See Kashrus pages 245-249.</ref> is of the opinion that "one who eats from a non-kosher animal, it's skin, bones, sinews, horns, hooves, or nails, even though they are forbidden, is excused from punishment." It seems from the opinion of the Rambam that bones are forbidden d'rabanan, while others maintain that he does not seem to imply even an issur d'rabanan.<ref>Refer to Igros Moshe Y.D. 2:27 (end) page 44 who says [[gelatin]] is a sofuk issur.  </ref> The opinion of Tosfas<ref>Mesechtas Avodah Zarah 69a “ha’hu.” Refer to Rosh Avodah Zarah 5:11. </ref> who talks about permitting bee legs implies that bones are indeed permitted.The opinion of some poskim is that the Rambam when implying that an issur d'rabbanan exists for bones was referring to soft bones which have some moisture to it, but hard and dry bones are permitted even according to the Rambam.<ref>Refer to Achiezer 3:33:5, Introduction of the Tzitz Eliezer volume 4 where he brings the opinion of Harav Yecheskel Abramsky zt”l. Some say there are no commercially made [[gelatin]] that come from hard bones today (Journal of Halacha and Contemporary Society 30:page 69). </ref>

# The Rama<ref>Y.D. 87:10, see Shach 114:21. Refer to Pischei Teshuva 87:19, 21. </ref> says an animal's stomach lining which was salted and dried out so that it becomes like a piece of wood may be filled with milk since it does not retain any taste of meat.<ref>Refer to Shach 33 who says this applies to other organs as well, but initially this should not be done (Be’er Heitiv 27, see Pri Megadim Eishel Avraham 33). Refer to Achi Ezer 3:33:5 who says the Shach does not apply to hard bones. Some say this does not apply when a product is dried in a modern facility (Journal of Halacha and Contemporary Society 30:page 72:footnote 14). </ref> The same would apply to [[gelatin]] which is completely dried out.<ref>Opinion of Harav Shlomo Zalman Aurbach zt”l quoted in Kashrus and Medicines page 53:footnote 20, see Yabia Omer Y.D. 8:11 in depth.  </ref>

# A question which arises is, if a non-kosher food becomes like wood but is later edible does it change the status or does it retains its previous non-kosher status? Some say that once the product was dried it may not regain its non-kosher status.<ref>Refer o Shach Y.D. 114:21, Pischei Teshuva Y.D. 87:20, Nodeh B’Yehuda Y.D. 26, Aruch Ha’shulchan Y.D. 87:43, Achiezer 2:11, 3:33:5, Har Tzvi Y.D. 83, opinion of Harav Henkin zt”l (Edos L’Yisroel page 132), Orchos Habayis page 29.  </ref> Others are stringent in this regard.<ref>Pri Megadim Eishel Avraham Y.D. 87:33, Chasam Sofer Y.D. 81, see Igros Moshe Y.D. 1:37, 2:27, Kovetz Teshuvos 1:73:page 107.  See Mishnas Rav Aron 1:17:2. </ref>

# The opinion of the Achiezer<ref>2:11, 3:33:5. </ref> and others<ref>Refer to [[Gelatin]] in Jewish Law pages 95-119 in depth, Tzitz Eliezer introduction to volume 4 quoting the opinion of Harav Yecheskel Abramsky zt”l, Yabia Omer Y.D. 8:11 in depth, Harav Yecheskel Abramsky zt”l adds until now (1951) it has been accepted that [[gelatin]] is not permitted. Therefore he is concerned about permitting it. </ref> is to permit the consumption of [[gelatin]]. The opinion of Harav Henkin zt"l<ref>Edos L’Yisroel page 177. </ref> is that since this matter is not decided one should be stringent. This is the opinion of Harav Moshe Feinstein zt"l<ref>Igros Moshe Y.D. 2:27 (end). </ref> and others as well.<ref>Mishnas Rav Aron 17, Kovetz Teshuvos 1:73:page 107, Medicines and Kashrus pages 16-17 quoting other poskim.</ref> The opinion of the Israeli Rabbinate is to permit the consumption of [[gelatin]],<ref>Journal of Halacha and Contemporary Society 30:page 66:footnote 1. One who moves to Eretz Yisroel should ask if he can follow their opinion. </ref> while the Mehadrin kosher certification in Eretz Yisroel do not allow [[gelatin]].<ref>Kashrus page 349.  </ref> The major kashrus organizations in the United States do not allow non-certified [[gelatin]].<ref>The Laws of [[Pesach]]: A Digest 2006 page 602. </ref> (The above discussion does not apply to taking gel-caps, as this will be discussed below).

# [[Gelatin]] made from a kosher source is considered pareve.<ref>Igros Moshe Y.D. 1:37, 2:27, Mishnas Rav Aron 1:16. </ref> Kosher [[gelatin]] is [[gelatin]] made from fish<ref>One may eat this together with meat as well and we are not concerned about the halacha of refraining from eating fish and meat together (Mesechtas Pesachim 76b, Shulchan Aruch Y.D. 116:2). In addition it is botel b’shishim. Some say maybe the whole concern was flesh of the fish with meat not the skins or bones. Additionally, the [[gelatin]] made from fish (and other sources) does not have a flavor (Star–K Kashrus Kurrents in an article by Rabbi Mushell). </ref> or glatt kosher beef hides.

# One who is sick is permitted to eat a non-kosher food (which is normally ossur b'achilah) in an unusual manner.<ref>Shulchan Aruch Y.D. 155:3, Shach 14, Mishna Brurah O.C. 466:1. An example of this is giving someone non-kosher food through intravenous. </ref> Based on this, the opinion of some poskim is that swallowing a pill made from a [[gelatin]] coating is permitted, since it is for a <u>sick person</u> and it is not the usual manner of eating.<ref>Opinion of Harav Henkin zt”l quoted in Edos L’Yisroel page 132, opinion of Harav Shachter Shlita as expressed in OU document I-97. He adds that the gel-caps have no taste to them and are nifsal from feeding to a dog. [https://www.yutorah.org/sidebar/lecture.cfm/894931/rabbi-hershel-schachter/berachos-73-38b-39a-ta-am-matzah-and-maror-non-kosher-pills-kavush-kemevushal-kezayis-beriah/ Rav Schachter (Brachot Shiur 73 min 18-30)] ruled that strictly speaking it is permitted to take non-kosher pills. If kosher ones are available he should get those to avoid the spiritual determinants of non-kosher like Rama about sucking non-kosher milk. He explained that certainly if a person is a choleh shein bo sakana it is permitted since it is shelo kderech achilato. But furthermore, the gelatin pills are permitted since it is nifsal machila and even if it is reconstituted it isn’t considered non-kosher (Chavot Daat YD 103). There's no achshevei since it is eaten in a reconstituted form and not when it is mixed with other ingredients (Rav Chaim Ozer 3:31). That's in Rav Schachter's opinion why Rav Soloveitchik was lenient to take non-kosher pills. Also, [https://www.hebrewbooks.org/pdfpager.aspx?req=1525&st=&pgnum=295 Rabbi Yitzchak Abadi in Or Yitzchak 1:24] permits all medicines that are bitter or don't have a taste since they aren't food and are considered nifsal machila.

* See Yachava Daat 2:60 who assumes it is shelo kderech achilato if it doesn't taste good and not nifsal machila.  

* [https://oukosher.org/halacha-yomis/many-medications-encased-gelatin-capsules-may-used/?category Rav Belsky] held that hard capsules can be eaten by a choleh and the soft capsules can be eaten in a tissue paper. This is only when there are no alternatives.</ref> However, there are poskim who maintain that swallowing a pill is the regular manner of consumption.<ref>Refer to Nodeh B’Yehuda Y.D. 35, Pischei Teshuva Y.D. 155:6, Har Tzvi Y.D. 97, opinions of Harav Shlomo Zalman Aurbach zt”l and Harav Elyashiv Shlita quoted in Medicines and Kashrus page 57:footnote 17, Yeishiv Moshe page 165, Shemiras [[Shabbos]] K’hilchoso 40:footnote 169, Halichos Shlomo Moadim ([[Pesach]]) 1:page 69. This is the opinion of Harav Yisroel Belsky Shlita quoting the opinion of Harav Henkin zt”l, see www.koltorah.org. </ref> Others are lenient and maintain that swallowing a pill is considered an unusual manner.<ref>Halichos Shlomo 1:17:1 (although he is quoted in the footnote above as saying otherwise), see Toras Chaim (Chullin 120) who is lenient</ref> In addition, even those who are stringent by [[gelatin]], it would not apply to medicines. However, according to the stringent opinion above regarding [[gelatin]], one who only has a headache<ref>Refer to Halichos Shlomo Moadim ([[Pesach]]) pages 71-72 who is unsure if this should be permitted with a slight pain. See Minchas Shlomo 1:17:3. </ref> or slight discomfort<ref>This does not apply to one who is bedridden (Halichos Shlomo Moadim [[Pesach]]) pages 71-72:8. The Shach 13 says this heter of the Rama is even for a healthy person. See Mishnah L’melech Hilchos Yesodei Hatorah 5:8 in depth, Zera Emes 2:48. Refer to Pri Megadim M.Z. O.C. 328:11, Shagas Aryeh 74, Binas Adom 52:page 86, Shevet Ha’Levi 7:135 who argue. Harav Yisroel Belsky Shlita maintains if one has a headache he should not swallow gel-caps without wrapping it in a tissue. </ref> should take a pill which has no [[gelatin]] or wrap the gel-cap in a tissue.<ref>Refer to Mesora 14:page 92. Others say the custom is to be lenient with one who has even a headache (Chai Ha’Levi 3:111:2). </ref>

# Children's medicine liquid medicine are generally sweet. If it contains glycerin and one doesn't have information that it is the kosher type of glycerin one shouldn't use the medicine until one first dilutes it 12 ml of another food to 1 ml of medicine.<ref>Rabbi Dovid Heber in [https://www.star-k.org/articles/articles/medicine/452/a-kashrus-guide-to-medications-vitamins-and-nutritional-supplements Kosher Kurrents 2005] wrote that glycerin in medicines is a safek deoritta since much of it is made from animals even though some of it is made from plants. However, since it is only a safek it is permitted to mevatel it. One can do so if one dilutes the medicine 1 to 12 of another food without lossing the potency of the medicine. See Mesorah Journal v. 7 pp. 91-97 by Rabbi Dovid Heber for a potential justification of giving medicines to children even if there are non-kosher ingredients. His argument is as follows: Feeding an isur derabbanan to a child is a machloket rashba and rambam (Bet Yosef OC 343). It might only be an isur derabbanan if it is a chatzi shiur in a tarovet. Also the isur is only a safek isur. Therefore, possibly there's a safek safeka, safek if it is a muter glycerin and if it is asur perhaps it is derabbanan (chatzi shiur btarovet). On the rabbinic level it is muter since it is a safek derabbanan. Additionally, a child is a choleh for whom some allow feeding a derabbanan isur. Either way it is a leniency based on complex factors.  

* [https://www.yutorah.org/lectures/lecture.cfm/731730/rabbi-daniel-stein/רפואות-שנתערבו-בהם-גליצערי-ן/ Rabbi Daniel Stein] in an article permits children medicines with glycerins for a number of reasons: 1) If the taste is bad even though there's other flavors added and it leaves a bad aftertaste perhaps that's considered nifsal machila. It seems difficult because donkey urine, ear wax, and mucus aren't considered nifsal machila (RSZA in Minchat Shlomo 1:17, Halichot Shlomo Nissan ch. 4 Dvar Halacha 9 p. 72). 2) Though it might be shelo kderech achila since it isn't taste good. Then for a sick person it is muter. 3) They're safek made from plants. 4) Isur Shenishtana since it changed from the taste and look from animal fat. 5) Maybe made inedible in the processing. 6) If its taste is masked by the other flavors you only need bitul brov since it doesn't have any taam and we can use kefilah. 7) It is only chatzi shiur of isur in a taarovet and for a sick person perhaps it is muter. He quotes Rav Schachter and Rav Willig as agreeing with him.</ref> However, the [https://www.star-k.org/resource/list/RR8I4NNG/Pain-Relievers-and-Fever-Reducers Star-K has an updated list] of kosher children's medicines which as of December 2018 includes Infant and Children's Advil and Tylenol. See [https://www.star-k.org/resources_medicine here] for more brands or medicines.

# There are ingredients in some toothpaste which are non-kosher animal products such as glycerin. Nonetheless, many poskim are lenient to allow a person to use such toothpastes since the non-kosher ingredients are inedible, mixed with kosher ingredients, and a person doesn't intend to eat the toothpaste but rather to brush with it, which is the halachic equivalent of tasting.<ref>Har Tzvi 95 was lenient with non-kosher toothpastes because the ingredients were processed so that they were inedible, they were mixed with kosher ingredients, and also a person is justing tasting the toothpaste and spitting it out. [http://www.tzohar.org.il/?p=2422 tzohar.org] quotes Ama Dvar p. 155 quoting Rav Mordechai Eliyahu who agreed. They also quote Mishneh Halachot 9:153 who disagreed. [https://oukosher.org/blog/consumer-kosher/kashruth-issues-of-toothpaste/ OU] wrote that some rabbis don't feel one can rely on the Har Tzvi today since the toothpastes have a good taste. But others still rely on the Har Tzvi. They cited Rav Henkin responsa 75 who mostly agreed with the Har Tzvi but wouldn't be lenient with toothpastes with glycerin.</ref>

# Some say that one shouldn't use mouthwash with glycerin in it since one might swallow some and glycerin can be made from teref animals.<ref>Rav Belsky (cited in article "Kashrut Rulings From Rabbi Belsky ZT"L" p. 37) held that since sometimes a person swallows some mouthwash it is forbidden to use it if there's an ingredient in it that isn't kosher such as glycerin (similar to Taz 98:2). He didn't consider mouthwash to be considered inedible.</ref> Others are lenient but still recommend getting a kosher one if available. See [https://www.crcweb.org/OTCMedicineReport.pdf CRC's list] for recommended mouthwashes and toothpastes.<ref> [https://www.ok.org/kosherspirit/fall-2007/students-questions/#:~:text=a%20kosher%20symbol%3F-,Answer%3A,not%20require%20a%20kosher%20symbol. The OK] is lenient on mouthwash and lipstick since they are not consumed. [https://www.crcweb.org/OTCMedicineReport.pdf CRC] quotes Rav Gedalya Dov Schwartz as holding that mouthwash doesn't need a hechsher but it is preferable to get one if it is possible. [https://www.koltorah.org/halachah/do-dental-products-require-a-hechsher-part-ii-the-kashrut-of-toothpaste-and-mouthwash-year-round-and-pesach-by-dr-ephraim-rudolph-98 Rav Jachter] quotes Rav Schachter as holding that mouthwash is considered inedible and therefore permitted even without a hechsher.</ref>