What medication is most likely responsible for chest burning and difficulty swallowing in an elderly patient?

Alendronate is a bisphosphonate medication commonly used to treat osteoporosis. One of its known side effects is the potential to cause esophageal irritation if it is not taken correctly. In elderly patients, who may have slower esophageal motility or other esophageal issues, the risk of experiencing symptoms such as chest burning and difficulty swallowing is heightened.

For alendronate to be effective and to minimize the risk of adverse effects, it is advised to take it with a full glass of water, remain upright for at least 30 minutes afterward, and avoid eating for a specified period. If patients do not follow these instructions, the medication can irritate the esophagus, leading to the burning sensation in the chest and difficulty swallowing.

The other medications listed do not have the same level of association with esophageal-related symptoms. For instance, lisinopril is primarily an antihypertensive used for managing blood pressure and heart failure and typically does not irritate the esophagus. Metformin is mainly used for diabetes management and may cause gastrointestinal upset but is less likely to produce esophageal symptoms. Simvastatin is a statin used for cholesterol management and does not have a significant link to esophageal irritation or burning.