#高警訊藥品

子宮外孕 Tubal ectopic pregnancy (off-label use)

When used for the medical management of ectopic pregnancy, methotrexate has not been shown to adversely affect fertility or ovarian reserve. Future pregnancies should be delayed until resolution of the ectopic pregnancy has been confirmed and at least 3 months after the last methotrexate dose (ACOG 2018).

Available guidelines contraindicate breastfeeding in patients taking methotrexate for the treatment of tubal ectopic pregnancy

Tubal ectopic pregnancy (off-label use):
1. Single-dose regimen:
IM 50 mg/m2 on day 1. Measure serum hCG levels on days 4 and 7; if hCG decrease is <15%, repeat dose (methotrexate 50 mg/m2) on day 7
2. Two-dose regimen:
IM 50 mg/m2 on day 1. Measure serum hCG levels on day 4 and administer a second dose of methotrexate 50 mg/m2. Measure serum hCG levels on day 7. If hCG decrease is <15%, administer a third dose of methotrexate 50 mg/m2 and measure serum hCG again on day 11; if hCG decrease is <15% on day 11, administer a fourth dose of methotrexate 50 mg/m2 and measure serum hCG levels on day 14.
3. Multidose regimen (in combination with leucovorin):
IM 1 mg/kg on days 1, 3, 5, and 7 alternating with leucovorin calcium on days 2, 4, 6, and 8. Measure serum hCG on each day of methotrexate administration. If serum hCG decreases by >15% from previous measurement, discontinue methotrexate (total treatment may be between 1 and 4 doses). If serum hCG decreases by <15% from previous measurement, administer methotrexate (maximum 4 doses).