Methotrexate for ectopic pregnancy

Care instructions

About methotrexate

Methotrexate is a type of medicine that stops cells from dividing. It can be used as a way (other than surgery) to treat a pregnancy that’s implanted outside the uterus (ectopic pregnancy). It’s given by injection with a needle. Usually you will get just 1 dose given.

You will need to have blood tests to monitor the level of pregnancy hormone in your blood. The methotrexate will stop the pregnancy. The level of pregnancy hormone in your blood should go down over 2 to 4 days. Based on your blood test results, your doctor will tell you if you need another injection of methotrexate.

After getting methotrexate

After you get methotrexate, you may have:

• mild to moderate cramps or pain in the abdomen (belly)
• vaginal bleeding (like a period)

Your doctor will likely want you to have a blood test 2 to 3 times a week, for 2 to 3 weeks. This is to see if the methotrexate worked to stop the pregnancy.

Side effects

Side effects of methotrexate may include:

• feeling sick to your stomach, throwing up, or both (for 24 hours)
• decreased appetite
• sores in the mouth
• headache
• feeling tired
• redness, swelling, or pain where you had the injection
• having trouble sleeping
• diarrhea
• hair loss (rare)

Care at home

If you feel sick to your stomach, sip clear fluids like ginger ale or soup broth. Try to drink often and eat small amounts of dry, starchy food (like soda crackers or dry toast) every 15 minutes.

To help prevent mouth sores:

• gently brush your teeth at least 2 times a day with a soft toothbrush
• rinse your mouth well with club soda or water 4 times a day
• don’t eat hot or spicy foods

If you need to take pain medicine for symptoms like headache or cramping, you can take acetaminophen (Tylenol). If the acetaminophen doesn’t help, talk to your healthcare provider or pharmacist about what medicine you can take for your symptoms.

To help relax the muscles that cause cramping, you can use a hot water bottle or a heating pad. Make sure you put a cloth between your skin and the heat, so you don’t get a burn. Taking hot baths can also help.

When to call for help

Call 911 if you have:

• heavy vaginal bleeding (soaks more than 1 pad an hour) and you’ve fainted (or feel like you’re going to)
• swelling in the face, mouth, or tongue
• trouble breathing

Call your doctor or nurse call line (811 in most provinces or territories) now if you have:

• sudden very bad cramps or pain in your abdomen (belly)
• blood in your pee or stools (looks like black, sticky tar)
• burning when you pee
• yellow skin or the whites of your eyes look yellow
• a bad skin rash
• chills or fever or both (temperature over 38.5 °C)
• any bleeding or bruising that isn’t normal for you
• heavy vaginal bleeding (more than the heaviest period you’ve ever had)
• a sore throat or a cough

What not to do after this medicine

You must not get pregnant for at least 3 months after having a methotrexate injection. If you have sex, you will need to use a reliable method of birth control. Talk to your doctor or healthcare provider if you have questions about birth control.

Washing your hands with soap and water after you go to the bathroom is important. Methotrexate can make your immune system weaker, which means it’s harder for your body to fight infections.

After getting methotrexate, do not have:

• sex until your doctor tells you that the treatment worked
• any alcohol for 1 week

After getting methotrexate, do not take:

• aspirin (ASA) for 2 days
• penicillin, tetracycline, or minocycline for 2 days

To see this information online and learn more, visit MyHealth.Alberta.ca/health/pages/conditions.aspx?Hwid=custom.ab_pregnancy_ectopic_methotrexate_inst.

For 24/7 nurse advice and general health information call Health Link at 811.

Current as of: May 17, 2023

Author: Emergency Medicine, Alberta Health Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.