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Ectopic Pregnancy

Methotrexate for Ectopic Pregnancy: Care Instructions

​​​​What is 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 impla​nted outside the uterus (ectopic pregnancy). It’s given by injection, and usually just 1 dose is given.

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

What will happen after you get methotrexate?

After you get methotrexate, you may have:

  • mild to moderate cramps or pain in the abdomen
  • 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 tell if the methotrexate worked to stop the pregnancy.

What you need to know about this medicine

Side effects of methotrexate may include:

  • nausea and/or vomiting (for 24 hours)
  • decreased appetite
  • sores in the mouth
  • headache
  • feeling tired
  • redness, swelling, or pain at the injection site
  • having trouble sleeping
  • diarrhea
  • hair loss (rare)

How can you care for yourself at home?

If you have nausea, sip clear fluids like ginger ale or soup broth. Try to drink often and eat small amounts of dry, starchy food (like soda crackers) 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 4 times a day with club soda or water
  • don’t eat hot or spicy foods

If you need to take pain medicine (e.g., headache, cramping), you can take acetaminophen (e.g., Tylenol®) or ibuprofen (e.g., Advil®). For 2 days after getting methotrexate, it’s best to take acetaminophen. If the acetaminophen doesn’t help, you can take ibuprofen unless your doctor tells you not to or if you have kidney problems. If you have any questions about medicine, talk to your doctor or pharmacist.

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 should you 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 now if you have:

  • sudden very bad cramps or pain in the abdomen
  • blood in​ the stools (looks like black, sticky tar) or urine
  • burning when you pass urine
  • yellow skin or the whites of your eyes look yellow
  • a bad skin rash
  • chills and/or fever (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 you need to know when you get this medicine

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

Wash your hands with soap and water after you go to the washroom. This is important because methotrexate can make the immune system weaker, which means it’s harder for your body to fight infections.

After getting methotrexate, do not have:

  • intercourse until your doctor tells you that the treatment worked
  • more than 1 drink of alcohol per day for 1 week

After getting methotrexate, do not take:

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

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

Current as of: April 18, 2019

Author: Emergency Medicine, Alberta Health Services