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Methotrexate (ectopic protocol)

Pregnancy & gynaecology-specific. Every dose row is source-referenced; verify against institutional protocols.

Methotrexate (ectopic protocol)Antimetabolite

Regimens checked: 2026-10-17. Each indication has its own preparation, limits and safety checks.

Methotrexate (ectopic protocol): indication-specific regimens
IndicationDoseRouteFrequencyDuration / preparationMaximumMonitoring / cautions
Selected stable unruptured tubal ectopic pregnancy with assured follow-up; NICE selection criteria apply
50 mg/m² body-surface area
IM
Once on day 1; hCG on days 4 and 7
Weekly hCG thereafter until resolution; falling values do not eliminate rupture risk · Record height and weight, calculate BSA and total mg. Cytotoxic pharmacy prepares the dose at the actual product concentration; independently verify prescribed mg and final mL. Do not reuse a fixed vial volume for every patient
  • The NHS GGC protocol had a scheduled review date in September 2026; its local currency must be confirmed. NICE is used for eligibility.
  • If the day-4-to-day-7 fall is inadequate, do not automatically redose: reassess symptoms, hCG trend, eligibility and the need for surgery with a senior clinician.
No automatic repeat dose: <15% day-4-to-day-7 fall, plateau or rise requires senior reassessment for another dose or surgery
Monitor
  • Baseline CBC, liver/renal function and hCG; day-4/day-7 hCG, then weekly
  • Seek emergency care for worsening abdominal/shoulder-tip pain, dizziness, syncope or heavy bleeding
  • Avoid folate supplements, interacting NSAIDs and alcohol as advised; avoid conception for 3 months
Contraindications / cautions
  • Rupture/instability, significant pain, inability to follow up, breastfeeding, significant cytopenia/liver/renal disease
  • NICE: fetal heartbeat, mass ≥35 mm or hCG ≥5000 IU/L favours surgery
Pregnancy safety
INTENDED abortive/teratogenic here - strict eligibility
Lactation
Contraindicated during course
NHS Greater Glasgow and Clyde · Version 4; last reviewed July 2021; scheduled review September 2026summary checkedIN REVIEW