Should acarbose be chewed?

Currently, acarbose is available on the market in two formulations: acarbose tablets and acarbose capsules. The tablet formulation must be chewed with the first bite of a meal, whereas the capsule formulation does not require chewing and can simply be swallowed with the first bite of food. Acarbose is primarily used to lower postprandial blood glucose levels; however, its efficacy is suboptimal for elevated fasting blood glucose. In such cases, combination therapy with other antidiabetic agents—under physician guidance—is recommended. Optimal glycemic control is achieved when acarbose is taken immediately before a meal or chewed together with the first bite of food. However, this medication commonly causes adverse effects such as abdominal distension, diarrhea, and abdominal pain. Rarely, it may cause hepatocellular injury; therefore, periodic monitoring of liver function is required.