Methotrexate for ectopic pregnancy

Call us right away if you:

  • Have severe abdominal pain that keeps getting worse
  • Are bleeding enough to soak a maxi pad each hour for 3 hours straight

What is methotrexate?

It is a medicine that can be used to treat an ectopic pregnancy. It stops cells from dividing by interfering with the folic acid in your body.

It is given by injection. You often only need 1 dose. Sometimes you will need a second dose.

You will need to have blood tests to check the level of pregnancy hormone (hCG). You will get your blood drawn 3 separate times the first week. Based on these results we will let you know if you need a second dose. Then you will need your blood drawn once a week until your hCG test is negative.

What are the benefits?

There is a high chance of success. This means you will not need surgery. Your doctor will talk with you about your success rates. About 9 out of 10 people’s tubes stay open after treatment.

How often will I need follow up?

  • Day one is the day you get methotrexate and talk to your provider. We will check several lab values, such as a hCG and blood type. You will get Rhogam® if you have a negative blood type.
  • You need more lab work on:
    • Day 4
      • You will have your HCG level drawn.
      • Your hCG may rise on this day, this is normal.
    • Day 7
      • You will have several labs drawn, including HCG.
      • You will see your provider, to discuss your lab results and your symptoms.
      • Your hCG should drop by at least 15% from your day 4 level.
    • You will get your HCG every 7 days until your blood pregnancy test is negative.

Very important instructions for you to follow:

Do not:

  • Do not take any folic acid or prenatal vitamins. This can be separately or in your multivitamin or prenatal vitamin. It will lower the success of the methotrexate.
  • Do not take any form of progesterone.
  • Do not take any non-steroidal anti-inflammatory medicine for the next 10 days, such as:
    • Ibuprofen
    • Motrin®
    • Advil®
    • Aleve®
    • Orudis®
  • Do not lay in the sun or a tanning bed for at least 7 days.
  • Do not drink alcohol until your hCG level is negative.
  • Do not have sexual intercourse for at least 2 weeks after your last injection. Talk with your doctor before having sex again.


Make sure to use condoms or other contraception until you have 1 normal period after your hCG is negative.

What happens after I get methotrexate?

  • Mild to moderate cramping for 3 to 7 days
    • Take your pain medicine as prescribed.
  • Light vaginal bleeding
    • Your period may not be normal.
    • It may last longer than normal.
  • You may pass some gray-pink tissue called a “cast” from the uterus. This is normal.

What are the side effects?

Common side effects are:

  • Feeling tired
  • Abdominal pain or cramping
  • Nausea and/or vomiting for 24 hours
  • Upset stomach, decreased appetite
  • Diarrhea
  • Sores in your mouth
  • Headache
  • Redness, swelling, or pain at the injection site
  • Having trouble sleeping

Rare side effects are:

  • Hair loss
  • Bone marrow suppression
  • Pneumonitis (inflammation of the lungs)
  • Pleuritis
  • High liver enzymes
  • Dermatitis (skin inflammation)
Last reviewed: 
June 2020

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