Purim on Mounjaro: The Fast, the Seudah, and the Drinking

Purim celebrates the story of Esther with some of the most joyful customs of the Jewish year. The Fast of Esther, from dawn until nightfall, usually falls the day before, though in some years it moves earlier. Then come the Megillah readings in the evening and the morning, gifts of food to friends, gifts to people in need, costumes, noise, and a festive afternoon meal, the seudah. Many people also observe a custom of drinking. Baskets of hamantaschen and sweets travel from house to house all day.

If you take Mounjaro or compounded tirzepatide, Purim brings a fast, a big meal, alcohol, and a lot of sugar into about 36 hours. If you have type 2 diabetes and take insulin or a sulfonylurea, each of those affects your blood sugar. Here is how to plan.

The Fast of Esther

The Fast of Esther is a minor fast, and Jewish law is generally lenient about minor fasts for people who are ill. If you have diabetes, ask your rabbi and your clinician before keeping one. The decision belongs to you, your clinician, and your rabbi.

The prescribing information for Mounjaro says people who take it with insulin or an insulin secretagogue, such as a sulfonylurea, may have an increased risk of hypoglycemia, including severe hypoglycemia. A day without food raises that risk. If you take either kind of medicine, talk to your prescriber before the fast. Never change those medications on your own.

If you do fast

Eat a meal with protein before dawn, such as eggs, yogurt, or cheese with whole-grain toast, and drink water. During the day, know the signs of low blood sugar: shakiness, sweating, a fast heartbeat, sudden hunger, irritability, or confusion. Break the fast and treat a low right away if you notice them. Breaking a fast for your health is a reasonable choice. When the fast ends, start with something gentle before a full meal, since the evening Megillah reading often comes first.

The seudah

The festive meal often includes brisket, roast chicken, kreplach, kugel, and challah. Start with the protein, keep starchy sides small, and eat slowly. On Mounjaro, rich dishes can fill you up quickly, so stop at the first sign of fullness. Our guide on what to eat after an injection has ideas for foods that tend to sit well.

The drinking custom

The custom of drinking on Purim is well known, but it is not a requirement to harm your health. Many rabbis teach that it can be met by drinking a little more than usual and then napping, and that no one should drink in a way that harms their health. Ask your rabbi what fits you.

On Mounjaro, have any alcohol with food rather than on an empty stomach, alternate each drink with water, and know that some people find alcohol affects them differently on these medications. Alcohol can also lower blood sugar, sometimes hours later and sometimes overnight, especially for people who take insulin or a sulfonylurea. If that is you, ask your diabetes care team how to handle drinking, and never drink after a fast without eating first.

Hamantaschen and gifts of food

Purim is built for sharing, so passing sweets along is in the spirit of the day. Enjoy one hamantasch, then give the rest of your basket to friends, neighbors, or a food pantry. If you are putting together gifts of food yourself, consider including something with protein, such as nuts or cheese, alongside the sweets.

Plan your dose around Purim

Side effects tend to be strongest after each dose increase, and many people notice them most in the day or two after an injection. If an increase would fall in the week of Purim, ask your provider whether to hold it until afterward. The Mounjaro label allows the day of weekly administration to be changed as long as the two doses are at least 3 days (72 hours) apart, but ask your provider before you change it. Our guide on when to increase your tirzepatide dose covers how those decisions are usually made.

Never skip a dose to drink more

It can be tempting to skip an injection so you can eat and drink more at the seudah. Do not. The Mounjaro label says to take a missed dose as soon as possible within 4 days (96 hours), and to skip it and take the next dose on your regular day if more than 4 days have passed. Our guide on taking a break and restarting covers why stopping and restarting is more involved than it sounds.

Costumes and injection sites

Tight costumes, belts, and harnesses can press on the abdomen and thighs. If a recent injection site is tender, choose a different site for your next dose. The prescribing information for Mounjaro lists the abdomen and thigh, or the back of the upper arm if someone else gives the injection. Our guide on GLP-1 injection sites covers each option.

Megillah readings and late nights

The evening reading often comes right after the fast, and the morning reading early the next day. Eat something before the morning reading, sit when you can, and stand up slowly afterward. A late night of celebrating followed by an early start is a lot, so plan a rest in the afternoon if you can.

Watch for under-eating

A fast followed by a day of sweets and drinks can leave you short on real food. Watch for persistent fatigue, feeling cold, hair shedding, dizziness when you stand, losing strength, and losing weight faster than you and your provider intended.

Consider this scenario: a man on Mounjaro who also takes insulin keeps the Fast of Esther without talking to his doctor, eats a few hamantaschen when it ends, and the next afternoon drinks several glasses of wine at the seudah before the food comes out. That night he wakes up sweaty and confused. Talking with his prescriber and rabbi about the fast, eating a real meal when it ended, having wine with food and alternating with water, and asking his diabetes care team about drinking would very likely have prevented the low.

The short version

For Purim on Mounjaro, talk to your clinician and rabbi before the Fast of Esther, especially if you take insulin or a sulfonylurea. If you fast, eat protein before dawn and break the fast if you feel unwell. At the seudah, start with protein, have alcohol only with food, and alternate with water. Share your hamantaschen, ask about holding a dose increase, never skip a dose to drink more, and avoid injecting where costumes press.

If you want a provider who will help you plan treatment around the holidays you celebrate, TrimRx includes ongoing provider access alongside treatment.

This information is for educational purposes and is not medical advice. Consult with a healthcare provider before starting any medication. Individual results may vary.