Nalador (Sulprostone)

• Sulprostone is used in obstetric practice to modulate uterine activity and facilitate delivery.
• Induction of labor: facilitates the onset of uterine contractions to initiate delivery.
• Management of postpartum hemorrhage: enhances uterine tone to reduce bleeding after childbirth.
• Cervical ripening: promotes softening and dilation of the cervix to prepare for labor.

• Sulprostone acts as an agonist at prostaglandin E2 (EP) receptors on uterine smooth muscle. Activation of EP receptors increases intracellular calcium and cyclic AMP, leading to enhanced uterine contractility and promotion of cervical ripening. The drug’s prostaglandin‑mediated pathway complements endogenous mechanisms that prepare the uterus for labor.

Sulprostone may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: transient feeling of sickness.
• Vomiting: occasional emesis during infusion.
• Abdominal pain: mild cramping in the lower abdomen.
• Fever: low‑grade temperature rise.
• Flushing: temporary redness of the skin.
• Headache: mild to moderate head discomfort.

Serious or Rare Side Effects

• Uterine hyperstimulation: excessive contractions that may compromise fetal oxygenation.
• Severe hypotension: marked drop in blood pressure requiring intervention.
• Allergic reaction or anaphylaxis: rash, swelling, or respiratory distress.
• Myocardial ischemia: chest discomfort indicating reduced cardiac blood flow.
• Pulmonary edema: fluid accumulation in the lungs, a medical emergency.

• When using Nalador, clinicians should observe specific safety measures.
• Monitor uterine activity: avoid excessive contractions that could compromise fetal oxygenation.
• Assess maternal hemodynamics: watch for hypotension during infusion.
• Use with caution in patients with cardiovascular disease: risk of tachycardia or arrhythmia.
• Avoid in individuals with known hypersensitivity to sulprostone or other prostaglandins.
• Pregnancy category unknown: administer only under obstetric supervision.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Sulprostone can interact with several medicines; awareness helps prevent adverse outcomes.

Major Interactions (Avoid)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may diminish uterotonic effect.
• Oxytocin: additive uterine stimulation can lead to hyperstimulation.
• Magnesium sulfate: antagonizes uterine contractility, reducing efficacy.
• Antihypertensive agents: increased risk of profound hypotension.

Moderate Interactions (Monitor Closely)

• Beta‑adrenergic agonists: may alter uterine tone.
• Calcium channel blockers: potential reduction in contractile response.
• Anticoagulants: heightened concern for bleeding during obstetric procedures.