Kosher Rx: Navigating the Kashrus of Medications and Vitamins
This article is intended for educational purposes only. For specific halachic questions, consult with your rabbi.
Q: Does medicine in pill form need to be kosher certified?
A: Rabbi Moshe Feinstein, zt”l, maintained that pills have no flavor and are nifsal me’achilas adam (not fit for human consumption). Therefore, pills without kosher certification may be swallowed for medicinal purposes.
Despite this heter (leniency), Rav Moshe writes that if a kosher-certified version of the pill is available, one should make an effort to use the kosher option. The OU does certify certain medications, but it will not certify any that contain non-kosher ingredients. Consumers can search for OU-certified medications on the OU Kosher mobile app or website: oukosher.org/product-search/.
Q: If Rav Moshe’s heter relies on the fact that pills have no flavor, what about sugar-coated pills that are sweetened to make swallowing them easier?
A: When taking sugar-coated pills, one must check the ingredients to ensure that non-kosher substances such as gelatin are not included. Other potentially problematic ingredients that may be added to tablet coatings include (di)acetylated monoglyceride, triacetin and polysorbates. However, a choleh (one who is considered ill) is permitted to consume non-kosher medicines, provided that he does so shelo k’derech achilaso—in an unusual manner. Therefore, in cases of significant need, a choleh may wrap these pills in tissue paper to ensure they are consumed shelo k’derech achilaso.
Q: What if there are actual non-kosher ingredients in pills, such as when the capsules are made from gelatin?
A: Rabbi Yisroel Belsky, zt”l, who served as the senior posek at OU Kosher for nearly thirty years, distinguished between two types of gelatin capsules: hard capsules and soft capsules. Regarding medicines encased in hard gelatin capsules (such as those commonly used for antibiotics), Rabbi Belsky said that the minhag is to permit them for a choleh. This is based on the concept mentioned already that a choleh is permitted to consume non-kosher medicines, provided that he does so shelo k’derech achilaso—in an unusual manner. Since it is uncommon to eat dried-out, plastic-like gelatin capsules, one who is ill is permitted to swallow them. Still, this leniency should only be relied upon if a kosher alternative is not available.
On the other hand, soft gelatin capsules—often used for vitamins, fish oils and some over-the-counter medications—should not be used, according to Rabbi Belsky. These soft capsules are frequently made from pigskin gelatin and are kept soft and pliable with large amounts of glycerin. If one has no other alternative, Rabbi Belsky recommended wrapping a soft gelatin capsule in tissue paper, which constitutes an even more unusual manner of consumption.
However, Rabbi Hershel Schachter, senior posek for OU Kosher, rules that there is no difference between soft and hard gelatin. Even with soft gelatin capsules, it is abnormal to swallow gelatin in this form. Accordingly, for medical reasons, the capsule may be swallowed without wrapping in paper.
Q: Do chewable or liquid medicines need to be kosher?
A: Liquid and chewable medicines are not considered nifsal me’achilah, so they can be halachically problematic.
Liquid medicines often contain ingredients like glycerin—sometimes derived from non-kosher animal fat or recycled non-kosher cooking oil—and emulsifiers such as polysorbates, which can also be non-kosher. If a medicine contains glycerin derived from animal fat, the medicine is non-kosher and, unless someone is a choleh she’yeish bo sakanah (a sick individual with a potentially life-threatening condition), it should not be taken. Instead, one should seek a kosher-certified source. If a kosher source is not available, and in cases of pressing need—such as administering liquid ibuprofen to a child with a high fever—one may dilute the medicine, since the glycerin is not a key ingredient. The medicine should be diluted so that the glycerin is batel beshishim (nullified if it is less than 1/60th of the mixture). Glycerin typically comprises about 10 percent of the medicine. A doctor or pharmacist should be consulted to ensure that this dilution does not compromise the medicine’s efficacy. In most cases, this requires diluting a teaspoon of medicine in about an ounce of water or juice.
Regarding cough medicines, where glycerin can also play a functional role in coating the throat, the amount of glycerin can be much higher. It is not clear what degree of dilution would be necessary, and according to some posekim, it’s not even clear if dilution is acceptable. One should therefore purchase cough medicine that does not contain glycerin.
Even if a liquid medicine does not contain glycerin, it is still not recommended without kosher certification because it may contain unknown flavors. However, if the only concern is the presence of unknown flavorings, and no kosher equivalent is available, one may be lenient in cases of strong need.
For a child who cannot swallow a pill, a pill crusher can be used to powder the medicine so that it can be mixed into applesauce or similar foods, obviating the need to take a non–kosher certified liquid medicine. Check with a pharmacist to make sure that this is acceptable.
For infant medicines, if a company claims to use only vegetable-based ingredients, one can be lenient if there is no other option. Rabbi Schachter maintains that if one has no kosher option, a small child may be given non-kosher liquid medicine.
Chewable tablets without certification should be avoided, as they might contain non-kosher ingredients used as binders. If a chewable tablet contains stearic acid or magnesium stearate as a binder, it is advisable to determine whether the company uses only vegetable stearates. Alternatively, it can be wrapped in tissue paper and swallowed so that it is shelo k’derech achilaso.
If lactose is used as a binder or filler, this would make the chewable tablet dairy. However, the Aruch Hashulchan (YD 89:7) writes that for refuah (medical purposes), one need only wait one hour between eating meat and dairy, provided one rinses one’s mouth.
Gelatin might also be used as a binder. If a chewable tablet contains gelatin and there is a strong need to take this medicine, it should be wrapped in tissue paper and swallowed.
Some posekim, however, consider pungent-tasting liquid medicines to be equivalent to “iruv bo davar mar” (a “bitter substance” mixed with kosher food). The Rambam writes that if one eats non-kosher food in an abnormal manner, such as by mixing it with bitter ingredients, it is only a rabbinic prohibition. Chazal therefore permitted a choleh to consume non-kosher food in an abnormal manner when necessary for his wellbeing. According to this lenient view, liquid medicines are acceptable for a choleh even if there is no sakanah (life-threatening condition), provided the medicines have a bad taste.
It is, however, halachically preferable to dilute the medicine so that the glycerin will be batel, in order to avoid all uncertainties. Of course, the best option is to purchase kosher-certified medicines. Currently, there is a small number of kosher-certified liquid ibuprofen, acetaminophen and cough medicines available.
Because there are so few kosher-certified liquid and children’s medicines, OU Kosher encourages consumers to contact the manufacturers and ask them to pursue kosher certification for their products.
Q: Do vitamins in pill form need a hechsher?
A: Rabbi Belsky would cite Rav Moshe, who considered vitamin pills to be nutritional supplements—meant to address the deficiencies of processed food. Therefore, they are considered a form of food and, as such, require kosher certification. If the vitamins are taken for therapeutic or medicinal purposes (rather than simply as a dietary supplement), then they would be classified like any other medicinal pill and would be permitted.
Rabbi Schachter maintains that even multivitamins are taken for medical purposes and therefore the halachos of medicines apply to them as well.
Many vitamins on the market come in gelatin capsules, which are commonly derived from non-kosher sources. Aside from the issue of gelatin in the capsule itself, vitamins may also contain non-kosher ingredients. Ideally, one should try to obtain vitamins with kosher certification. The OU certifies certain vitamins as well. Consumers can search for OU-certified vitamins on the OU Kosher mobile app or website: oukosher.org/product-search/.
This article was prepared for publication by Chaya Miriam Waintman—special thanks to Rabbi Gavriel Price, OU Kosher rabbinic coordinator and ingredient research expert, and Rabbi Eli Gersten, recorder of OU pesak and policy.
This article is partially based on “The Kashruth of Medications and Vitamins,” presented by Rabbi Hershel Schachter at Yeshivas Ohr HaChaim in Kew Gardens Hills on February 5, 2008, at a Harry H. Beren ASK OUTREACH kashrus shiur. Listen to the shiur at https://outorah.org/p/7408/.
This article is also partially based on OU Kosher’s Halacha Yomis, a daily email containing brief halachic tidbits, as well as Daf Hakashrus, a monthly OU newsletter for kashrus professionals. To sign up to receive Halacha Yomis, visit oukosher.org/halacha-yomis/, and to sign up to receive Daf Hakashrus, visit oukosher.org/blog/articles/daf-ha-kashruth/.