Which of the following medications: Vitamin D3, Vitamin C, Bisolvon (Bromhexine), Sulodexide, and Glucosamine sulfate can produce ulcers, particularly in an older adult patient?

Which Medication Can Produce Ulcers?

None of the medications listed (Vitamin D3, Vitamin C, Bisolvon/Bromhexine, Sulodexide, or Glucosamine sulfate) are established causes of peptic ulcers based on current evidence.

Analysis of Each Medication

Vitamin D3 and Vitamin C

• These vitamins have no documented association with ulcer formation in the medical literature 1
• Neither appears in any gastroenterology guidelines as ulcerogenic agents 1

Bisolvon (Bromhexine)

• This mucolytic agent is not classified as an ulcerogenic medication 1
• No evidence links bromhexine to peptic ulcer disease in major gastroenterology guidelines 1

Sulodexide

• Sulodexide is actually used to treat venous leg ulcers, not cause gastrointestinal ulcers 2
• This glycosaminoglycan has antithrombotic and anti-inflammatory properties 2
• The Cochrane review found no significant increase in adverse gastrointestinal events with sulodexide (4.4% vs 3.1% placebo, RR 1.44,95% CI 0.48-4.34) 2
• The evidence quality for adverse events is very low, but there is no signal suggesting ulcer formation 2

Glucosamine Sulfate

• Glucosamine sulfate does not appear in any major gastroenterology guidelines as an ulcerogenic agent 1
• The American Geriatrics Society Beers Criteria, which extensively lists medications causing gastrointestinal harm in older adults, does not include glucosamine 1

Important Context: True Ulcerogenic Medications

For comparison, medications that do cause ulcers include:

• NSAIDs (ibuprofen, diclofenac, naproxen, indomethacin): increase ulcer risk 2.5-5 fold 1
• Aspirin (even low-dose 81mg): increases GI bleeding risk 1.5-3 fold 1
• Corticosteroids: double gastrointestinal event risk when combined with NSAIDs 1
• Anticoagulants (warfarin, DOACs): increase bleeding risk 3-fold, especially when combined with NSAIDs 1, 3

Clinical Pitfall to Avoid

Do not confuse sulodexide (used to treat venous ulcers) with medications that cause gastrointestinal ulcers 2. The similar terminology can be misleading, but sulodexide's mechanism involves improving venous circulation and reducing thrombosis in leg wounds, not damaging the GI mucosa 2.