What Is Methotrexate Used For In Pregnancy

Methotrexate For Pregnancy Termination

Methotrexate gives women the opportunity to have a termination performed as early as a week prior to missing their period up to 9 weeks from the last menstrual period. Methotrexate is not only used to stop the growth of pregnancy tissue, but it is used to treat different cancers pregnancies which are pregnancies that implant outside of the uterus . Methotrexate stops the rapidly growing embryonic and placental cells of early pregnancy from further developing.

Methotrexate used alone can cause miscarriage in close to 85% of patients that use it prior to 6 weeks or less gestation. It generally takes 3 to 4 weeks to begin having spontaneous bleeding and for the miscarriage to occur. This is why giving Cytotec approximately 48 to 72 hours after taking the Methotrexate by mouth or injection has a success rate of 92 to 98%. Cytotec causes the uterus to begin to contract and leads to bleeding similar to a normal period in most women. Some women experience a little heavier bleeding than their normal period. Patients less than 6 weeks gestation have nearly a 100% success rate with the combination of these medications. Women who do not want surgery and want their abortion experience to be more private and have the support of spouse, family member, or friend, find this method to be more comfortable from a psychological and physical standpoint.

Introduction

Methotrexate Medical Abortion: The Facts

How Does Methotrexate Terminate Pregnancy

What If I Take Too Much

Taking too much methotrexate can cause serious side effects. In some cases it can be fatal.

Store your weekly methotrexate separately, away from any other medicines that you take daily.

Urgent advice: Contact 111 or advice if:

• you have taken more than your prescribed dose of methotrexate
• you have taken your methotrexate daily instead of weekly

Go to111.nhs.ukor call

If you need advice for a child under the age of 5 years, call .

If you need to go toA& E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the methotrexate packet, or the leaflet inside it, plus any remaining medicine with you.

Methotrexate For Ectopic Pregnancy

For ectopic pregnancies, many times you have a choice between taking a medication or having surgery.Right now, there is only one medication used to treat ectopic pregnancies, called methotrexate. This medication stops the growth of cells that are rapidly dividing, such as pregnancy cells. It was originally developed to be a cancer drug, because cancer is also a condition where cells are rapidly dividing. And because it is a cancer drug, it is only given in hospitals and under very careful monitoring circumstances.

choosing methotrexate

Methotrexate for ectopic pregnancy works as well as surgery in certain situations:

• You have low pregnancy hormone levels
• An embryo isnt seen in the pregnancy sac or if the embryo doesnt have a heartbeat yet
• If the ectopic pregnancy is small or isnt even visible on ultrasound.

But if these conditions arent present, the methotrexate has a higher chance of not working. Its important to have a long conversation with your doctor about what the chances are of it working or not working for you.

coming back for blood tests

importance of the testing schedule

One of the reasons that a person might not choose methotrexate for ectopic pregnancy and may choose surgery is because it may be hard for her to come back on the schedule of days for the follow-up. Think about this carefully as youre making this decision as to which kind of treatment you want.

how methotrexate feels

how do you know if methotrexate worked?

Recommended Reading: When Is The Time To Get Pregnant After Periods

Will Abortion Bans Discourage Doctors From Prescribing Methotrexate

While its true that methotrexate is used in certain issues in pregnancy termination, in rheumatology, we warn our patients in advance that this drug can cause fetal malformation and cause damage to the developing fetus. Thats why we make sure that our patients of childbearing age who are on this drug practice contraception, especially if they are sexually active, he says.

Greer says he had an RA patient get pregnant while on methotrexate, and she had to terminate the pregnancy because of the potential fetal damage. Will rheumatologists be more reluctant to prescribe methotrexate to women of childbearing age now because they would no longer have the option to get an abortion in that scenario?

Its definitely a concern among all rheumatologists. We have to have these discussions early on about the risks that the drug carries if a pregnancy occurs, and then continue those discussions throughout our treatment with methotrexate, he says.

Greer continues, I cant speak for all rheumatologists, but there are fears among some who may restrict their prescribing habits in the future. It wont change how I prescribe methotrexate Im going to do whats right for my patients my patients come first.

How And When Is Methotrexate Taken

Methotrexate can be taken as a tablet, liquid or injection.

Methotrexate should be taken on the same day once a week. Youll be given a starting dose of methotrexate while your rheumatologist tries to bring your condition under control, but this might be increased if it isnt helping your symptoms.

Methotrexate tablets come in two strengths: 2.5 mg and 10 mg. To avoid confusion, its recommended you only be given one strength, usually 2.5mg. If you are prescribed both tablet strengths be very careful not to confuse them, as they can look quite similar.

If you are starting methotrexate injections, you’ll usually be given your methotrexate injection by a health professional. They will often show you how to inject yourself using either a syringe or injector pen, so you can do it at home. Let them know if you think you will have difficulty injecting yourself.

You must always wash your hands before and after handling methotrexate.

Recommended Reading: How To Save Sperm To Get Pregnant At Home

Effects Of The Father Taking Methotrexate

Methotrexate can affect the fetus if either parent has been taking it. Males should not take methotrexate when trying for a baby.

People can avoid unplanned pregnancies by using an effective form of birth control. These include condoms, the birth control pill, and intrauterine devices .

According to the FDA, males should stop taking methotrexate at least 3 months before getting a partner pregnant. Females should wait for at least one cycle of ovulation before trying to become pregnant.

According to released by the American College of Rheumatology , people with RA should consider prepregnancy counseling to encourage conception while RA symptoms are dormant. They should also continually speak with their obstetrics/gynecology doctors for all reproductive health issues.

Talk With Your Doctor

If you have RA and are pregnant or planning to become pregnant, talk with your doctor. They can tell you more about the effects of methotrexate on pregnancy. They can also advise you about the best RA treatment for you during pregnancy.

At your appointment, you can discuss concerns and ask questions, such as:

• How might pregnancy affect my RA?
• What RA drug options are safe to use during pregnancy?
• Are there non-drug ways to reduce RA symptoms during pregnancy?

You and your doctor can create a treatment plan for your RA thats safe for you and your pregnancy.

Read Also: When Do You Start Eating More When Pregnant

More Medical Mistrust: Laws Threaten Doctor

These restrictions pose a real threat to the doctor-patient relationship, says Crow. My doctor has known me for two decades, she has cared for me through a pregnancy, grad school, wedding, cross-country moves, traveling around the world, postpartum depression, a car accident, and even more. When she writes me a prescription, it’s because I need it, says Crow. No one should interfere with a doctors recommendations to their patient, she adds.

Safety Of Taking Methotrexate While Pregnant

Methotrexate is a disease-modifying antirheumatic drug used to treat rheumatoid arthritis and certain other rheumatic diseases. The dose used for rheumatoid arthritis is considered low. Comparatively, methotrexate is also used as a high-dose cancer therapy and at high doses to terminate an ectopic pregnancy.

Technically-speaking, methotrexate is a dihydrofolate reductase inhibitor that impairs purine metabolism. That said, it can lead to abnormalities in ribonucleic acid and deoxyribonucleic acid synthesis. Methotrexate is contraindicated in pregnancy and is a known teratogen, which is defined as any substance, organism, or process that causes malformations in a fetus., which is defined as any substance, organism, or process that causes malformations in a fetus. Methotrexate can cause dysmorphic facial features, abnormalities of the skull and limbs, growth deficiency, developmental delays, and mental retardation.

The potential for fetal complications makes the drug a serious concern for those of childbearing age, those planning to become pregnant, and especially those who become pregnant while being treated with methotrexate.

Don’t Miss: Which Health Insurance Is Best For Pregnancy

Mixing Methotrexate With Herbal Remedies And Supplements

Do not take vitamin and mineral supplements or any other products that contain folic acid if you are already taking folic acid prescribed by your doctor. Check the ingredients on the labels of any supplements.

There is not enough information to say whether it’s safe to take other herbal remedies or supplements together with methotrexate. They are not tested in the same way as medicines.

Summary Of Evidence For Methotrexate As A Possible Teratogen

Teratology is a new science and its terminology is being refined. One definition of a teratogenic agent is `one that acts during prenatal life to produce a permanent physical or functional defect in the offspring’ and the following criteria have been proposed to help establish the teratogenicity of a substance: proven exposure to agent at critical time in prenatal development consistent findings by two or more epidemiological studies of high quality careful delineation of the clinical cases, specific defect or syndrome rare environmental exposure associated with rare defect, three or more cases probably required teratogenicity in experimental animals the association should make biological sense proof in an experimental system that the agent acts in an unaltered state. , and or , and are denoted as essential criteria. More recent definitions include the complex effects on growth, functional abnormalities, behavioural abnormalities and transplacental carcinogenesis that may result from fetal exposure.

Even allowing for the fact that the number of unaffected pregnancies complicated by MTX administration may be underestimated by this review, the fetal abnormality rate appears to be significantly higher than the background rate of 2â3.5% a rate which rises to around 5% in childhood as less obvious abnormalities are detected.

Recommended Reading: Is Unisom Safe For Pregnancy

Doses For Inflammatory Conditions

For inflammatory conditions such as psoriasis, rheumatoid arthritis and Crohn’s disease, the dose will vary. This depends on your condition and blood test results. Always follow the instructions from your doctor.

For rheumatoid arthritis, the usual starting dose is 7.5mg, taken once a week. This can be slowly increased up to 20mg or 25mg once a week.

For psoriasis, the usual starting dose is 2.5mg to 10mg, taken once a week. It can be slowly increased up to 30mg once a week.

For Crohn’s disease, the usual dose to prevent flare-ups is 10mg to 25mg, taken once a week. This is often called a “maintenance” dose.

If your child is prescribed methotrexate, the doctor will use their height and weight to work out the right dose.

Tumor Necrosis Factoralpha Antagonists

Medications in the antitumor necrosis factor -alpha class are commonly used in the treatment of RA. These agents have been labeled as class B medications animal studies have shown no harm to the fetus, but thus far, no randomized, blinded, placebo-controlled trials on potential teratogenicity in humans have been completed. Numerous case reports have shown positive outcomes with antiTNF-alpha use in pregnancy, with an incidence of spontaneous abortion and birth defects similar to that in the general population.

Pregnancy outcomes of 495 women on adalimumab, infliximab, etanercept, certolizumab pegol or golimumab were evaluated in a prospective observational multicenter cohort study and compared with 1532 outcomes from a non-exposed random sample. Major birth defects were reported in 5% of the exposed group as compared to 1.5% in nondiseased controls. The risk of preterm birth was increased, but not the risk of spontaneous abortion. Birth weights adjusted for gestational age and sex were significantly lower in the exposed group compared to the non-exposed cohort .

The individual TNF inhibitors differ in terms of placental transfer. Certolizumab may have a safety advantage, as smaller amounts of the drug are known to pass into fetal circulation.

The EULAR guidelines make the following recommendations for use of anti-TNF medications :

BSR-BHPR guidelines include the following recommendations :

Also Check: Can You Get Someone Pregnant With Testicular Cancer

Cautions With Other Medicines

There are many medicines that affect the way methotrexate works.

Children taking methotrexate must not have a “live” flu vaccine . Adults are given an “inactivated” flu vaccine and this usually does not cause problems with methotrexate.

Tell your doctor if you’re taking these medicines before you start methotrexate:

• non-steroidal anti-inflammatories like ibuprofen, or cough and cold remedies containing NSAIDs
• co-trimoxazole,trimethoprimor other antibiotics for bacterial infections
• medicines that make you pee more , such asindapamide andbendroflumethiazide
• epilepsy medicines such asphenytoinorlevetiracetam
• theophylline, a medicine used to treat asthma
• medicines used to treat indigestion, such asomeprazole
• folic acid or vitamin supplements that contain folic acid this is because your doctor may prescribe folic acid to take with your methotrexate

These are not all the medicines that may affect methotrexate.

What Are The Possible Side Effects Of Methotrexate Injection

Get emergency medical help if you have signs of an allergic reaction or a severe skin reaction .

Methotrexate can cause serious or fatal side effects. Call your doctor at once if you have:

• sudden chest pain, wheezing, dry cough, cough with mucus, feeling short of breath
• swollen lymph glands, night sweats, weight loss
• blisters or ulcers in your mouth, red or swollen gums, trouble swallowing
• vomiting, diarrhea, blood in your urine or stools
• skin changes such as redness, warmth, swelling, or oozing
• signs of metabolic acidosis –confusion, vomiting, lack of energy, irregular heartbeats
• low blood cell counts –fever, chills, bruising or bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath
• kidney problems –little or no urination, swelling in your feet or ankles
• liver problems –swelling around your midsection, right-sided upper stomach pain, nausea, loss of appetite, dark urine, jaundice
• nerve problems –confusion, weakness, drowsiness, coordination problems, feeling irritable, headache, neck stiffness, vision problems, loss of movement in any part of your body, seizure or
• signs of tumor cell breakdown –tiredness, muscle cramps, nausea, vomiting, diarrhea, fast or slow heart rate, tingling in your hands and feet or around your mouth.

Common side effects may include:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read Also: Do Your Nipples Hurt When Your Pregnant

Understanding Methotrexate And Rheumatoid Arthritis

Rheumatoid arthritis is a chronic autoimmune condition that causes inflamed joints with pain, swelling, stiffness, and reduced range of motion. It most often affects women.

Symptoms may come and go and may be severe at times. Though theres no cure for RA, medications and other treatments can help keep it under control.

If youre thinking about pregnancy, you likely have many questions. A big one may be, Is the methotrexate I take for RA still safe while Im pregnant?

Methotrexate is commonly prescribed for RA. It belongs to a class of medications called disease-modifying anti-rheumatic drugs .

It reduces inflammation caused by RA by dialing down the hyperimmune response. This action can help prevent further joint damage and ease the symptoms caused by RA.

Methotrexate can help manage your RA, but it can also have dangerous effects on your pregnancy.

The Food and Drug Administration states that methotrexate shouldnt be used in pregnancy.

There are good reasons for the severe restrictions on taking methotrexate during pregnancy. Using methotrexate while pregnant could end your pregnancy or cause severe developmental issues for a fetus.

These irregularities could affect the way your child looks, develops, or functions for the rest of their life.

What Should I Avoid While Receiving Methotrexate Injection

Avoid exposure to sunlight or artificial UV rays , especially if you have psoriasis. Methotrexate can make your skin more sensitive to sunlight and your psoriasis may worsen.

Avoid drinking alcohol. It may increase your risk of liver damage.

Do not receive a “live” vaccine while using methotrexate, or you could develop a serious infection. Live vaccines include measles, mumps, rubella , rotavirus, typhoid, yellow fever, varicella , zoster , and nasal flu vaccine.

Methotrexate may impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you.

Read Also: What Vaccines Should You Get Before Getting Pregnant

Effects Of Pregnancy On Rheumatoid Arthritis

The course of rheumatoid arthritis often changes during pregnancy. Approximately 50% of pregnant women with RA have low disease activity, and 20% to 40% achieve remission by the third trimester however, nearly 20% will have worse or moderate-to-high disease activity during pregnancy that may require further therapeutic intervention.

Postpartum flares of RA may also occur, with studies reporting rates ranging from 39% to 90%. One study reported that disease activity decreased during pregnancy but increased after delivery. The investigators monitored 84 patients with RA for disease activity before conception at each trimester of pregnancy, if possible and at 6, 12, and 26 weeks postpartum. Among patients with at least moderate disease activity in the first trimester, at least 48% had a moderate response during pregnancy, whereas patients with low disease activity in the first trimester reported that their disease activity remained stable during pregnancy. Thirty-nine percent of patients had at least 1 moderate flare postpartum.

No specific guidelines address obstetric monitoring in patients with RA. Because few available data suggest a significantly increased risk for preterm birth, preeclampsia, or fetal growth restriction, no special obstetric monitoring is indicated beyond what is performed for usual obstetric care.

Go to Rheumatoid Arthritis for more complete information on this topic.