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December 2013 back

A KASHRUS GUIDE FOR THE OB-GYN PATIENTDr. Joel Pleeter, Village OB-GYN
Rabbi Dovid Heber, Star-K Kashrus Administrator

This list was updated in December 2013 See Taking Your Medicine section for related articles. This list is available to physicians for reprinting. Contact Janine Chapman at


When visiting an obstetrician/gynecologist, a patient may be given prescriptions or recommendations for an array of products by her physician. The patient may be confused about whether a particular product is kosher. The following guide was prepared to help clarify the kashrus issues regarding these products.1

Ideally, one should purchase medicinal products and vitamins with a reliable kosher certification. Unfortunately, this is not always possible. In the event a product is not kosher approved, one should consult her Rav, as one does with any halachic question. The following guidelines in this regard are the halachic ruling of Rabbi Moshe Heinemann, Star-K Rabbinic Administrator. Note: The following are general halachic guidelines and cannot possibly cover all scenarios. Under no circumstances should an individual forgo taking a prescribed medication without first consulting her physician and Rav.

Choleh Sheyaish Bo Sakana - Someone who is ill and whose life may be in danger. A choleh sheyaish bo sakana may use any non-kosher medication if an equally effective kosher medicine is not readily available. Included in this category is someone whose life is currently not in danger, but if untreated could develop a life threatening complication. This includes an elderly person who has the flu or an infant with a fever.

Additional examples include the following:

  • One who has a heart condition, diabetes, substantially elevated blood pressure, kidney disease, severe depression or any other serious condition.
  • Someone with an infection (except for those skin infections known to be non-life threatening, e.g. acne) may take antibiotics.
  • A pregnant woman whose life is in danger e.g. blood clotting disorder, toxemia, or who is in active labor, or who is in danger of having a miscarriage.
  • A woman who is in active labor.
  • A woman who has given birth within the past seven days without any known complications or who has postpartum complications that are or may become life threatening. This may apply for an extended period of time, depending upon her condition.

All instructions given by the doctor should be carefully followed, including taking the medication for the prescribed number of days,even though the symptoms may have subsided. This also applies to non-kosher medication that is flavored and tastes good. All of the above is equally applicable on Pesach to medication which contains chometz.

Choleh She'ain Bo Sakana - Someone whose life is not in danger. This includes anyone who is bedridden, is noticeably not functioning up to par due to pain or illness, or has a fever which is not potentially life threatening. A child under six years of age who has discomfort is also considered a choleh she'ain bo sakana. This category also includes the following:

  • One who is experiencing symptoms of the flu.
  • 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 in the past thirty days without any known problems or who is experiencing non-life threatening postpartum complications. This may apply for an extended period of time.
Those listed above may take non-kosher medication shelo k'derech achila, in an uncommon way of eating, if a kosher alternative is not readily available.2 Items which are designed to be swallowed3 without chewing caplets, swallow tablets, and even gelatin capsules, poor tasting chewable tablets, and poor tasting liquids have a shelo k'derech achila status. For example, if someone has the flu, and the only fever reducer available is a non-kosher gelatin capsule, one may swallow the product. Similarly, one may swallow Celebrex in a gelatin capsule or tablets containing chondroiton derived from non-kosher bovine trachea cartilage for chronic debilitating arthritis pain. However, under normal circumstances one may not take non-kosher products if it requires eating in a normal manner e.g. non-kosher chewable tablets that taste good.One who suffers from menopausal symptoms e.g. hot flashes should consult a Rav to determine whether she is in the category of choleh she’ain bo sakana. A pregnant woman often has the status of a choleh sh’ain bo sakana. For a further discussion, see below.

Maychush and Baree - One who is experiencing slight discomfort he has a maychush e.g. slight joint pains or a runny nose or is healthy and takes vitamins and supplements to maintain good health (he is a baree) should make every effort to ensure that the product is either kosher certified or contains all kosher ingredients. If this is not possible, a Rav should be consulted since in some instances non-kosher products taken shelo k'derech achila may be permissible.4 Taking non-kosher medication that requires eating in a normal manner (e.g. non-kosher chewable tablets that taste good is not permissible.)

During Pregnancy - As indicated above, a pregnant woman whose life may be in danger or is in danger of having a miscarriage is a choleh sheyaish bo sakana. A pregnant woman who is suffering from non-life threatening complications e.g. lower back pain often occurring in the third trimester or nausea is a choleh she'ain bo sakana and may take any medication shelo k'derech achila, in an uncommon manner, so that she feels better. In addition, a pregnant woman with no known complications who is advised by her physician to take a specific medicine or vitamin for her benefit or for the benefit of the baby even for preventive measures may take a non-kosher product shelo k'derech achila5 if an equally effective kosher variety is not available.

Prometrium, which is currently only available in gelatin capsules may be taken by a choleh she'ain bo sakana or a choleh sheyaish bo sakana (e.g. one who requires pregnancy support). Premarin and Prempro, which may contain non-kosher ingredients, may be taken even by a choleh she'ain bo sakana. These products are commonly prescribed to middle aged women as part of an HRT Hormone Replacement Therapy to avoid development of osteoporosis6, a condition which often occurs as women age7. In such a case, with the advice of her physician, a woman may swallow a non-kosher capsule if an equally effective kosher substitute is not available.8

Dairy - Almost all products listed in the Approved OB-GYN Prescriptions List see below contain lactose, a dairy ingredient.9 These dairy products may not be taken for one hour after eating meat, however, since they are swallowed and not chewed, they may be taken after waiting only one hour.

Shabbos - One who has a maychush on Shabbos may not take medication or supplements to help alleviate the discomfort10. However, someone classified as a choleh whether in danger or not may take any medication necessary. A pregnant woman may take all necessary medications and vitamins on Shabbos. Someone who is a baree, in good health, and takes a product to change the normal function of the body e.g. caffeine pills to avoid falling asleep, may also take this product on Shabbos. Many products listed on the Approved OB-GYN list see below are in this category. These pills may be taken on Shabbos.

Additional information regarding the kashrus of medications and vitamins may be found in the medicine section of Kashrus Kurrents articles and in the medicine list on our web site. Passover guidelines and medications approved for use on Pesach are published annually by the Star-K in conjunction with Kollel Los Angeles.


CERTIFIED PRODUCTS

The following is a list of companies with kosher certified supplements, health, and pharmaceutical products. Products are certified only when bearing the symbol of the certifying agency.

Star-K Certified
when bearing Star-K Symbol

Amway/Access Business Group

Arizona Nutritional Supplements

Life Science Laboratories

Melaleuca

Nutralife Health Products Raritan Pharmaceuticals

Shaklee

Simplexity

Sunrider
Trout Lake Farm Virun Wholefoods

Additional Kosher vitamins and supplements certified by various Kashrus agencies are available at www.koshervitamins.com. Consumers should confirm that the Kosher symbol from a reliable certifying agency is on the label of the product.

APPROVED OB-GYN PRESCRIPTIONS 2014

The following is a list of kosher approved tablet products often prescribed by an OB-GYN. Consult your physician prior to taking any medication. Company names are indicated for prescription drugs. This is not a Pesach list. Note that this list only indicates the kosher status of the product. In regards to the use of many of these products due to other halachic issues, a Rav should be consulted. Also note, the following products not listed are addressed in the article above: Estratest, Premarin, Prempro, Prometrium.

Aygestin Dairy
TV   Azurette Dairy
WTS
Beyaz Dairy BLX Brevicon Dairy WTS
Diflucan Tabs & Susp
PFZ Enablex WC
Estrace Dairy WC Estrostep Fe Dairy WC
Femcon Dairy FE-WC Femhrt Dairy PTC
Femtrace Dairy WC Fosamax Reg Tabs Dairy
PTC
Fosamax Oral Solution
PTC Jolivette Dairy WTS
Leena Dairy WTS Levlen Dairy BLX
Levora Dairy WTS Low-Ogestrel Dairy WTS
Lutera Dairy WTS Menest Dairy MNP
Microgestin Dairy WTS Microgestin Fe Dairy WTS
Modicon Dairy OM Necon Dairy WTS
Nor-QD Dairy WTS Norinyl Dairy
WTS
Nora-Be Dairy
WTS Ogestrel Dairy
WTS
Ortho-Cept Dairy
JNS Ortho-Novum Dairy OM
Ortho-Micronor Dairy JNS Ovcon Dairy WC
Provera Dairy PUP Quasense Dairy WTS
Reclipsen Dairy WTS Remeron (Regular) Dairy OR
Remeron SolTab OR Sarafem WC
Safyral Dairy BYX Sronyx Dairy WTS
Tilia FE Dairy WTS TriNessa Dairy WTS
Tri-Norinyl Dairy
WTS Trivora Dairy WTS
Wellbutrin Reg Tabs GSK Yasmin Dairy BYR
Yaz Dairy BYR Zovia Dairy WTS
Zenchent Dairy
WTS



ADDITIONAL KOSHER APPROVED PRODUCTS
OFTEN RECOMMENDED BY OB-GYNs

Note: This is not a Pesach list. Also, several of the following products are not recommended during pregnancy. Consult your physician prior to taking any medication. See our Approved Over-the-Counter Medications list for additional over-the-counter antacid, anti-diarrheal, anti-nausea, cold/allergy/decongestant, fiber, lactose intolerant, laxative, pain reliever, and sleeping aid medications.

DIAGNOSTIC
Glucose Tolerance Beverage - Easy Dex AM
Glucose Tolerance Beverage - Sun-Dex FD
Glucose Tolerance Beverage - Trutol FD
GoLytely Beverage
BRT
NuLytely Beverage BRT
PAIN RELIEVER / ALLERGY
prescription only; see OTC list
for additional products
Allegra 12 hr – Tablets S-AVT
Allegra D 12 hr – Tablets S-AVT
Allegra 24 hr (but not D) – Tablets S-AVT
Anaprox RC
Darvocet Tablets
XAN
EC-Naprosyn Delayed Release Tabs
RC
Imitrex Tablets Dairy
GSK
Naprosyn Reg Tabs & Suspn
RC
Percocet Tablets END
Percodan Tablets
END
Tylenol With Codeine Tabs OM
PRENATAL VITAMINS (PRESCRIPTION)
Nestabs (Reg.) WMCH
SLEEPING AIDS
Ambien CR Tablets - Dairy SRL
Mid-Nite Tablets - Original PM CIH
Nytol Quick Caps (Dairy)

GSK
Sominex Original Formula Tablets GSK
Unisom PM Pain Sleepcaps PFZ
Unisom Sleeptabs Tablets PFZ
Unisom Sleepmelts - Meltaway PFZ
SUPPLEMENTS - see also Prenatal Vitamins
Boost - Dairy When bearing - OUD MJ
Ensure - Dairy When bearing - OUD RS
Ferro-Sequels Iron Tablets Dairy
INV
SlimFast - Dairy When bearing - OUD UNL

Tums

Regular Tabs - Assorted Fruit, Peppermint GSK
Extra Strength Tabs - Assorted Berries, Assorted Fruit, Assorted Tropical Fruit, Wintergreen
Ultra Tabs - Assorted Berries, Assorted Fruit, Assorted Tropical Fruit, Peppermint
Smoothies - Peppermint, Assorted Fruit, Berry Fusion
Freshers - Spearmint
THYROID
Levothroid FR
Synthroid Tablets Dairy ABB


PRODUCTS ALWAYS APPROVED

The following are products that may always be used without kosher certification: Antibiotics for an infection - except for those skin infections known to be non-life threatening (e.g. acne), Canker Sore Medication, Castor Oil (with no additives), Enemas, Injections, Intravenous (IV), Mineral Oil (with no additives), Sodium Bicarbonate (pure baking soda), Externally applied products including: Antiseptics, Creams, Dermatologicals, Ear Drops, Emollients, Epsom Salts, Eye Drops, Gels, Lotions, Oils, Ointments, Nasal Sprays, Powders, Rubbing Alcohols, Shampoos, and Soaps.


Footnotes:

1.
The purpose of this article is to address the kosher status of OB-GYN medications. In regards to the use of various products prescribed by an OB-GYN, other halachic issues beyond the scope of this article may also apply. A Rav should be consulted to address these issues. Also, this article is in no way intended to advise consumers as to whether a specific product should be taken. Every patient is different. One should consult with her physician regarding the effectiveness and side effects of each product. A pregnant woman should discuss with her doctor whether a product is safe to take during pregnancy.

2.
An exception to this rule is if the product is basar b'chalav, a heated milk and meat mixture. This is quite rare in medicinal products, however, if it does occur, a Rav should be consulted.

3.
See Minchas Shiomo 17.

4.
See Shach YD 155:13, based on the explanation of the Chochmas Adam in Binas Adam 52. See also Mesorah vol. 14, pg. 90
.

5. The laws for this woman are similar to a choleh she'ain bo sakana as addressed above.

6. For a full discussion regarding osteoporosis and the kashrus status of arthritis remedies, see the "She Sells Sea Shells - But Are They Kosher? The Kashrus Status of Glucosamine and Other Arthritis Remedies" article.

7. One who has developed osteoporosis may be considered a choleh sheyaish bo sakana.

8. However, if a healthy individual wishes to take non-kosher supplements to prevent an illness unlikely to occur, a Rav should be consulted, as the halacha is similar to one who has a maychush.

9. For individuals who keep cholov Yisroel there may be various leniences. Consult a Rav.

10. This halacha also applies to Yom Tov but does not apply on Yom Tov Sheini i.e. the second day of the Shalosh Regalim [Pesach, Shavuos and Sukkos], the last day of Pesach, and Simchas Torah. For purposes of this halacha, the second day of Rosh Hashana is not considered Yom Tov Sheini and this halacha applies.

.


Manufacturers
ABB Abbott Labs
AM Aeromed
BYX Bayer
BLX Berlex
BRT Braintree Labs
CIH Concepts in Health
END Endo Labs
FD Fischer Diagnostic
FR Forest
GSK Glaxo Smithkline
INV Inverness Medical
JNS Janssen Pharm
MA Major
MJ Mead Johnson
MNP Monarch Pharm
MRK Merck
OM Ortho-McNeil
OR Orgenon
PFZ Pfizer
PTC Physicians Total Care
PUP Pharmacia-Upjohn
RC
Roche
RS Ross
S- AVT Sanofi Aventis
SP Schering Plough
SRL Searle
TAN Tandyne
TV Teva
UNL Unilever
WC Warner-Chilcott
WMCH Women's Choice
WTS Watson
XAN Xanodyne






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