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Liquid Medicines

Rabbi Dovid Cohen
Administrative Rabbinical Coordinator of the cRc

September 2008

 

Liquid medicines (e.g. cough medicine, liquid Tylenol) contain active and inactive ingredients.  The former typically pose no kashrus or Pesach concerns and have an unpleasant taste, while the latter are often food-ingredients which may be kosher-sensitive (and/or chametz) and have a pleasant taste.  The active ingredients usually comprise a relatively small portion of the “medicine” and some of the reasons inactive ingredients are included, may be found in the footnote.1

A.  Edibility

Liquid medicines are palatable, especially in the 1-2 teaspoon doses which are common, but their taste is sufficiently less pleasant than tea, soda, and other beverages, that few people would voluntarily consume them if not for their medicinal value.  Additionally, inasmuch as the medicines contain active ingredients which are potentially harmful if ingested in large quantities, no one would consider drinking a cupful of such medicines unless ordered to do so by a physician.

Should liquid medicines be treated as edible since they are palatable and are regularly consumed by consumers, as inedible (nifsal mei’achila) since they do not taste as good as the average beverage, or possibly as food items eaten in an abnormal manner (sheloh k’derech achila)? 

It would seem that Shulchan Aruch2 addresses this question.  He rules that:
דבר שנתערב בו חמץ ואינו מאכל אדם כלל, או שאינו מאכל כל אדם כגון התריאק"ה וכיוצא בו,
אע"פ שמותר לקיימו אסור לאכלו עד אחר הפסח.
Mishnah Berurah3 explains that the difference between the two cases cited in Shulchan Aruchאינו מאכל אדם כלל and אינו מאכל כל אדם – is that the former refers to items which have been rendered completely inedible, while the latter refers to items which are edible enough to be consumed by people who are ill but would not be eaten by an average, healthy person.  The fact that these cases are collectively listed as being “inedible” seems to indicate that an item, such as cough syrup, which a person would only consume when he is sick, is considered inedible.4

Some contemporary Poskim who accept this reading of Shulchan Aruch nonetheless argue that modern-day liquid medicines are too “tasty” to qualify for this halacha, such that even healthy people would drink them (if they had not been told it was medicine).  Others, including Rav Schwartz, dispute this on factual grounds and because they hold that the fact that it is unhealthy for anyone to consume too much medicine renders it sufficiently as a non-food that it qualifies for this halacha.  Although this dispute appears to be based on a deep disagreement as to what the term “edible” includes, it is also likely that there are many items which the two sides would readily agree on.  As this document is not the forum for sampling different medicines to determine whether they meet this standard of inedibility, our discussion will continue with the assumption that certain liquid medicines qualify for the principle outlined in Shulchan Aruch, i.e. a liquid medicine which is only edible to be consumed by a sick person, is considered inedible.

B.  Ach’shvei

Although we have seen Shulchan Aruch offer a lenient ruling, we must consider his final words where he rules that medicines are only considered inedible as relates to retaining ownership of them on Pesach, but one is still forbidden from eating them during PesachMishnah Berurah 442:21 explains that one may not consume them on Pesach because of the principle of ach’shvei, i.e. the act of eating demonstrates (mid’rabannan) that the person considers it “edible”.  Seemingly, ach’shvei should also apply to liquid medicines such that their edibility status should be a moot point, and one should be forbidden from consuming non-kosher liquid medicines.5 

Ach’shvei on medicine  

However, this leads to a further question.  The aforementioned halacha, of an inedible (food or) medicine is the specific example for which the principle of ach’shvei is recorded in Shulchan Aruch; how then can we reconcile this reference with the view of most Acharonim that the principle of ach’shvei does not apply to medicines?  The answer to this question depends on the two reasons given as to why ach’shvei should not apply to a medicine, as follows:

  1. Ach’shvei is limited to items which the person wants to consume (since the consumption of that item indicates that the person considered it a “food”), and therefore only applies to the active ingredients in medicine but not to the inactive ingredients (Chazon Ish OC 116:8 and others).
  2. Ach’shvei views the act of eating as an indicator that the person values this product as a food-item, but the act of consuming medicines merely shows that the person values the item for its health benefits and not necessarily as a food.  This is evidenced by the fact that people willingly ingest repulsive medicines.  (Iggeros Moshe OC II:92 and others).

According to the first reason, we can suggest that the reason ach’shvei applies to the medicine discussed in Shulchan Aruch is that he was discussing a case where the chametz served a medicine/active role (and there may not have even been such a thing as “inactive ingredients” in medicines in those days), but nowadays when the chametz or non-kosher ingredients are typically found in the inactive ingredients, the principle of ach’shvei does not apply.6  Accordingly, liquid medicines which contain kosher-sensitive inactive ingredients would be permitted because the overall medicine is considered inedible, and ach’shvei does not apply.

To answer our question according to the second explanation, we have to digress and explain a bit about the medicine discussed in Shulchan Aruch, תריאק"ה Theriac (a.k.a. treacle or theriaca) is cited in the Gemara7 and in early non-Jewish sources, and included an assortment of herbs, foods and animal parts8 which were blended and fermented to create a potion used as an anti-venom.  Theriac was difficult to obtain9 (and expensive) such that common folk who acquired some of it would keep it in their homes in case of emergency.10  However, the nobility who could afford and obtain theriac on a regular basis, would take it as a daily prophylactic.  Thus, theriac served two roles – both to treat and prevent illness. 

With this introduction, we can suggest that the (second) reason outlined above as to why ach’shvei does not apply to medicine is limited to cases where the person is consuming the medicine for treatment of an illness, for in that case it is correct that the consumption of the theriac or other medicine merely demonstrates that the person wants to heal himself and gives no indication that he considers this to be “food”.  However, when one consumes a medicinal item in order to prevent illness, then that consumption is more akin to how/why people eat food, i.e. for their general health and well-being, and it is possible to apply the principle of ach’shvei to such an act.11  

Accordingly, we can understand that Shulchan Aruch’s ruling that one may not consume theriac on Pesach is limited to those who do so for preventative reasons, as in that case the consumption of the theriac is an example of the principle of ach’shvei.  This reading of Shulchan Aruch is quite reasonable in light of the fact that one who required theriac as an anti-venom would be permitted to consume any chametz as they would be treated as being in danger (sakanah).12 

Thus, we have answered our last question according to both explanations as to why there is no ach’shvei on medicine.  Either ach’shvei does not apply to inactive ingredients and Shulchan Aruch applies ach’shvei in cases where the chametz has a medicinal role in the treatment, or ach’shvei does not apply to medicines taken to treat illness and Shulchan Aruch is discussing chametz which is taken as a prophylactic.

With this explanation, it is clear that the first issue raised also does not apply.  We had suggested that although Shulchan Aruch indicates that liquid medicines are inedible, it should be forbidden to consume them based on the final words of Shulchan Aruch that ach’shvei forbids their consumption.  However, we have now seen that the strict ruling of Shulchan Aruch is limited to specific cases, i.e. where the chametz is an active ingredient or where it is used in a preventative role, both of which are irrelevant to most contemporary cases of liquid medicines.

Summary

In summary, Shulchan Aruch appears to rule that items which are consumed by sick people but not by average people are considered inedible.  Although Shulchan Aruch rules that people should not consume such items because of the principle of ach’shvei, the Acharonim rule that ach’shvei generally does not apply to medicine, and we reconciled that ruling with Shulchan Aruch in a manner which permits liquid medicines taken to treat illnesses for a choleh

1 Some reasons companies add inactive ingredients are: (a) to act as a diluent (i.e. to sufficiently dilute the active ingredient so that the patient can reasonably measure the proper dose), (b) as a preservative or emulsifier, (c) to coat the throat, and/or (d) to mask the taste of the active ingredient.

2 Shulchan Aruch 442:4, taken from Rambam, Hil. Chametz U’matzah 4:12.

3 Mishnah Berurah 442:20-21.

4 Shulchan Aruch cannot possibly mean that the items are edible but consumption of them is just treated as being sheloh k’derech achila, for if so, it would be forbidden to retain ownership of these items over Pesach.  We will revisit this idea below.

5 Although we will attempt to answer this question, it is not clear that ach’shvei even applies to liquid medicines purchased in a retail store since ach’shvei is a d’rabannan principle and it is not clear that it applies in cases where there is only a safek whether the liquid medicine contains non-kosher ingredients.

6 See Gra”z 442:22 and also there in Kuntres Acharon #11 who stresses the chametz’s active/medicinal role to answer a different question.

7 Gemara, Shabbos 109b and Nedarim 41b.

8 Tur 442 mentions that it contained אפעה , a type of snake.

9 The great difficulty in obtaining theriac is part of why Jews considered keeping it over Pesach even though it contains chametz; see Rabbeinu Manoach to Rambam ibid.

10 This is equivalent to the once-common practice of keeping a vial of ipecac syrup in one’s medicine cabinets in case of need to induce vomiting.

11 This is in line with Rav Yisroel Belsky’s report that Rav Moshe Feinstein related that although he holds that ach’shvei does not apply to medicines (as noted above), he agrees that ach’shvei does apply when one consumes vitamin pills since those are taken as food-replacers.

12 A somewhat similar way of reconciling the second explanation with Shulchan Aruch is to say that the “eating” “created” by ach’shvei is considered sheloh k’derech achila (for the food is inherently inedible), and cholim are permitted to eat food sheloh k’derech achila.  Thus, Shulchan Aruch’s strict ruling is limited to those taking theriac for preventative purposes (i.e. non-cholim) but a choleh could effectively ignore foods considered which are only considered “edible” due to the principle of ach’shvei.  (See Ksav Sofer OC 111 (towards the end) who appears to link the principles of ach’shvei and sheloh k’derech achila).  According to this line of reasoning, (a) one may retain ownership to theriac because it is inedible until the person eats it, (b) it is considered sheloh k’derech achila when the person actually eats it, and (c) the only people permitted to consume liquid medicines would be cholim who are permitted to consume non-kosher sheloh k’derech achila.

 

HaRav Gedalia Dov Schwartz, Shlit"a
Rosh Beth Din

HaRav Yona Reiss, Shlit"a
Av Beth Din

 

Rabbi Sholem Fishbane
Kashruth Administrator

Rabbi Levi Mostofsky
Executive Director

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