Nalador (Sulprostone)

Sulprostone is used in obstetric and gastrointestinal settings where prostaglandin E2 activity is required.

• Induction of labor: facilitates uterine contractions to initiate delivery.
• Cervical ripening: softens and dilates the cervix to prepare for labor.
• Medical abortion: induces uterine activity to complete termination of early pregnancy.
• Treatment of gastric ulcer: promotes mucosal protection and healing through prostaglandin pathways.

• Sulprostone acts as an agonist at prostaglandin E2 receptors EP1 and EP3 on uterine smooth muscle. Activation of these receptors increases intracellular calcium, producing strong uterine contractions and promoting cervical remodeling. In the gastrointestinal tract, EP receptor stimulation enhances mucosal blood flow and mucus secretion, supporting ulcer healing. The combined effect results in accelerated labor progression and protective gastric mucosal effects.

Sulprostone may be associated with several adverse reactions, ranging from mild to severe.

Common Side Effects

• Nausea: feeling of sickness or urge to vomit.
• Vomiting: expulsion of stomach contents.
• Diarrhea: loose or watery stools.
• Abdominal pain: discomfort in the stomach area.
• Fever: elevated body temperature.
• Headache: mild to moderate head pain.

Serious or Rare Side Effects

• Severe uterine hyperstimulation: excessive contractions that may compromise fetal oxygenation.
• Pulmonary edema: fluid accumulation in the lungs.
• Allergic reaction: rash, itching, swelling, or anaphylaxis.
• Hypotension: marked drop in blood pressure.
• Cardiac arrhythmia: irregular heart rhythm.

When using Sulprostone, several precautions should be observed to ensure patient safety.

• Assess uterine activity: monitor contraction frequency and intensity.
• Evaluate fetal status: perform continuous fetal heart rate monitoring.
• Review cardiovascular history: avoid use in patients with heart failure or uncontrolled hypertension.
• Check for hypersensitivity: discontinue if allergic signs appear.
• Avoid in active hemorrhage: risk of increased bleeding.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze.

Sulprostone can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Oxytocin: additive uterine stimulation may cause hyperstimulation.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may reduce prostaglandin synthesis and diminish effect.
• Antihypertensive agents: increased risk of hypotension when combined with vasodilatory effects.

Moderate Interactions (Monitor Closely)

• Magnesium sulfate: may potentiate uterine relaxation, counteracting Sulprostone.
• Beta‑agonists (e.g., terbutaline): may diminish uterine contractile response.
• Anticoagulants: heightened risk of bleeding due to uterine activity.