Methotrexate can provide effective medical management of ectopic pregnancy. However, it is a potentially toxic drug that can lead to death of the patient, even in low doses. An alternative therapy should be used if certain contraindications are present.


Contraindications for the use of methotrexate:

(1) past history of hypersensitivity to methotrexate

(2) breastfeeding

(3) renal dysfunction with or without dialysis

(4) acute or chronic liver disease

(5) active pulmonary disease (due to potential risk for interstitial pneumonitis)

(6) peptic ulcer disease

(7) bone marrow dyscrasia (with anemia, thrombocytopenia, leucopenia, hypoplasia, myelodysplasia, etc)

(8) immunodeficiency

(9) evidence of active bleeding



• Simple iron deficiency anemia would probably not be a contraindication.


Relative contraindications:

(1) unlikely to return for followup

(2) gestational sac >= 3.5 cm in diameter

(3) embryonic cardiac motion


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