Which medication in this regimen is most likely associated with causing mouth ulcers?

• A. Ramipril
• B. GTN spray
• C. Paracetamol
• D. Nicorandil

Answer: (D)

Mouth ulcers are a known adverse effect of nicorandil. This drug, used for angina, has a documented risk of causing mucosal ulcers, including oral ulcers, and the ulcers can be painful and sometimes persistent. The exact mechanism isn’t fully clear, but nicorandil’s dual action as a nitrate vasodilator and a potassium ATP channel opener is thought to contribute to mucosal irritation or impaired healing in susceptible individuals. Because of this strong association, nicorandil is the medication most likely to cause mouth ulcers among the options. The other drugs listed (ramipril, GTN spray, and paracetamol) do not have a meaningful tendency to cause oral ulcers in routine use, so they are less likely to be the culprit. If ulcers develop, clinicians may adjust therapy or switch medications and provide supportive oral care.