Medicines are the subject of some of the most common questions on Pesaĥ. There is concern that pills contain wheat-based starch. The purpose of the starch is to solidify and harden the pills. Had the starch been produced from potatoes or kitniyot, there would be no problem even for Ashkenazim, as for medicinal purposes one may swallow pills containing kitniyot. But what about starch extracted from a type of grain that can become ĥametz? It must be emphasized that a dangerously ill person whose treatment requires eating ĥametz has a mitzva to eat ĥametz. Saving a life overrides the prohibition against eating ĥametz. The question applies to an ill person whose life is not at risk.
The answer depends on the taste of the medicine: if it is flavored, like syrup, lozenges, or chewables, then one must ascertain that it is kosher for Pesaĥ. In case of doubt, its use is forbidden. However, if the medicine is bitter or tasteless to the point that it is not fit as food, it may be swallowed on Pesaĥ. Even if the starch was derived from wheat, since it has been mixed with various bitter substances it is inedible and has lost its status as ĥametz. As we have seen, ĥametz that was rendered unfit for a dog’s consumption before Pesaĥ is no longer considered ĥametz and may be kept on Pesaĥ. The fact that one wants to swallow the medicine does not demonstrate that the ĥametz in the medicine is important to him, since the medicine, not the ĥametz, is significant for him, and the ĥametz itself is bitter and unfit for consumption. The ĥametz in it is thus batel and not prohibited (Ĥazon Ish, Mo’ed 116:8; Igrot Moshe, OĤ 2:92).
Some meticulously observant people try to avoid even bitter medicines that contain ĥametz. They show concern for the opinion of the few poskim who maintain that medicine is not considered unfit for animal consumption since we deem it significant, and it is thus rabbinically prohibited. Other poskim permit bitter medicines that contain ĥametz starch for one who is bedridden or whose entire body is in pain, but rule stringently for one suffering from mild aches and pains.
However, most poskim maintain that bitter medicines containing ĥametz may be taken by any ill person, even only to reduce mild pain, as a prophylactic, or to fortify the body.
Practically speaking, if one is uncertain whether certain bitter or tasteless medicines contain wheat starch, he may swallow them without ensuring that they are free of wheat starch. As we have seen, most poskim maintain that medicines rendered unfit for animal consumption before Pesaĥ may be consumed during Pesaĥ even if they are known to contain ĥametz. Even one who prefers to comply with the stringent opinion on this issue need not be strict if he is uncertain whether the medicine contains ĥametz. This is especially true nowadays, when we know that potato and corn starch are used more widely than wheat starch. Thus, in practice, one may consume bitter or tasteless medicines on Pesaĥ without ascertaining whether they contain ĥametz. When one knows for certain that a particular medicine contains ĥametz starch, he may choose to rely on the lenient opinion of most poskim or the stringent minority.
. Ĥametz that was rendered unfit for a dog’s consumption prior to Pesaĥ is no longer considered ĥametz, and according to Ha-ma’or, Ran, and other Rishonim it may even be eaten on Pesaĥ. Conversely, Rosh, Rabbeinu Yeruĥam, and other Rishonim maintain that this type of ĥametz is rabbinically prohibited, since by eating it the person assigns importance (“aĥshevei”) to it and shows that, for him, the food is still edible. Accordingly, SA 442:9 and MB 43 ad loc. rule that one may keep such an item over Pesaĥ since it is unfit for a dog’s consumption and thus not considered ĥametz. However, he may not eat it, since by eating it he assigns significance to it. Thus, according to Ha-ma’or and Ran one would certainly be permitted to swallow bitter ĥametz-containing pills on Pesaĥ, and even according to Rosh and those who agree with him it may be permissible, since the Aĥaronim debate whether swallowing ĥametz that is unfit for a dog’s consumption for medicinal purposes assigns significance to the ĥametz. Sha’agat Aryeh §75 states this indeed assigns significance to the ĥametz, whereas Ktav Sofer OĤ §111 states that it does not impart significance. If the ĥametz is not the main ingredient in the pill, most Aĥaronim maintain that even Rosh would concede that swallowing a bitter pill does not impart significance to the ĥametz. See Ĥavalim Ba-ne’imim 5:4; Ĥazon Ish, Mo’ed 116:8; Igrot Moshe OĤ 2:92; Yeĥaveh Da’at 2:60; SSK 40:74; and many others.
However, it seems that SAH 442:22 derives from the case of tiryaka, an edible type of medicine, that Rosh would prohibit swallowing a pill as well. Most authorities, who are lenient, would differentiate between tiryaka, which is eaten by the ill, and medicines that are swallowed but not eaten. Moreover, even when the starch is from wheat flour, it generally did not have time to rise, and at worst would be classified as ĥametz nuksheh, which did not undergo a complete leavening and is only rabbinically prohibited. Since this ĥametz nuksheh is part of a mixture within a bitter pill, there is no reason to be stringent. Nevertheless, some incline toward stringency (Arugot Ha-bosem §99, and Atzei Ha-Levanon §19). As stated, some have written that these pills are permissible according to the letter of the law, but the holy people of Israel are customarily strict even about avoiding ĥametz mixed into a bitter pill (Tzitz Eliezer 10:25:20). On the other hand, Nishmat Avraham OĤ 1:466:1 states that most pills do not contain ĥametz at all. It is further stated there in the name of R. Ovadia Yosef that even though he writes in Yeĥaveh Da’at 2:60 that only a genuinely sick person may be lenient, if it is uncertain whether or not the pill contains ĥametz, there is no need to ascertain. As noted, the vast majority of poskim maintain that it is not at all prohibited to swallow a bitter pill, and even one with a minor ailment may take a pill that contains ĥametz rendered unfit for a dog before Pesaĥ started.