Methotrexate treatment can be given as a single shot or as
several injections. If an ectopic pregnancy continues after 2 or 3 doses of
methotrexate, surgical treatment is needed to remove the ectopic
During the week that you
have methotrexate injections, your pregnancy hormone levels (human chorionic
gonadotropin, or hCG) are tested several times. Your doctor will look for a
drop in hCG levels, which is a sign that the pregnancy is ending (hCG levels
sometimes rise during the first few days of treatment, then drop).
If your hCG levels have dropped enough after 1
week, you are then tested on a weekly basis until they are low enough to
suggest that the pregnancy has safely ended. This usually takes about a month
but can take more than 3 months.
If your hCG levels aren't dropping enough after 1 week, you will
be given another dose of methotrexate. Your hCG levels will be watched as
they were after the first dose.
If your hCG levels continue at
higher levels, or if your doctor becomes concerned about tubal rupture, surgery
will be needed to remove the ectopic growth.
Methotrexate series. Although it
is an uncommon practice, methotrexate can be given every other day until
pregnancy hormone (hCG) blood tests confirm that the pregnancy has ended. On
alternate days, a medicine called
leucovorin (folinic acid) is given by injection to
decrease methotrexate side effects. Treatment time for a methotrexate series
varies from case to case but can take a month or longer.
Why It Is Used
Methotrexate can be used to:
End an early ectopic
Prevent the growth of any embryonic or fetal cells that
are left behind after surgery to end an ectopic pregnancy.
It is also used to treat certain types of cancer,
rheumatoid arthritis, and as part of an induced
How Well It Works
Methotrexate works as well as surgery (salpingotomy) for treating an ectopic pregnancy when:1
You have low pregnancy hormone (hCG) levels (less than 5,000).
The embryo has no heart activity.
The ectopic pregnancy is small with no tubal rupture or bleeding.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine. Severe side effects from methotrexate are most likely to develop with long-term use, such as when it is used for cancer treatment.
Call 911 or other emergency services right away if you have:
Swelling of your face, lips, tongue, or throat.
Call your doctor if you have:
Severe pain in your belly or pelvis.
Signs of unusual bleeding or bruising, such as black and tarry stools or blood in the urine.
Sores in the mouth or on the lips.
Common side effects include:
Mild abdominal (belly) pain. Cramping belly pain is the
most common side effect. It usually occurs during the first 2 to 3 days of
Vaginal bleeding or spotting.
vomiting, and indigestion.
Fatigue, lightheadedness, or
Rare side effects include:
Skin sensitivity to
Inflammation of the membrane covering the
Sore mouth and throat.
Severe low blood counts (bone marrow
Inflammation of the lung (pneumonitis).
Because of the risk of side effects, methotrexate treatment
requires close medical supervision by a doctor who is experienced with this
medicine. During methotrexate treatment, keep your doctor informed of
any symptoms that you have.
Reference for a full list of side effects. (Drug Reference is not available in
What To Think About
You will be advised to avoid the following until your treatment has
folic acid, including prenatal
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Varma R, Gupta J (2009). Tubal ectopic pregnancy, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
How this information was developed to help you make better health decisions.