A straightforward ultrasound-assisted green multicomponent strategy was developed for synthesising benzo[h]pyrimido[4,5-b]quinoline-8,10(7H,9H)-dione derivatives. The protocol involves the condensation of 1-aminonaphthalene, barbituric acid, and various aromatic, aliphatic, and heterocyclic aldehydes under ultrasonic irradiation in aqueous ethanol as a benign solvent system. Ultrasound-promoted acoustic cavitation affords excellent yields, shorter reaction times, and high selectivity under mild, environmentally friendly conditions, in line with green chemistry principles. The synthesised derivatives were fully characterised by spectroscopic techniques. ADMET predictions indicated favourable pharmacokinetic properties. Molecular docking revealed strong binding affinities, particularly for compounds 4(e–o), with docking scores ranging from –7.05 to –9.80 kcal/mol against the progesterone receptor (PDB ID: 4OAR). Density functional theory (DFT) studies, including HOMO–LUMO analysis, provided valuable insights into the electronic structures and reactivity patterns of the molecules. Overall, this work demonstrates ultrasound-assisted multicomponent synthesis as a sustainable strategy for constructing bioactive heterocycles and suggests that the obtained derivatives hold potential for further development as anti-breast cancer agents.