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Women's Health: Postpartum Community
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Avatar universal

Methotrextate shots

on 5-22-06 I went in and had my HCG level taken and it was at 284. I went back in today and had another taken and it had went down to 124, so the DR gave me 2 shots of methotrexate (one in each thigh) With my last miscarriage in 0ct 2005, I miscarried onmy own and didnt have to have any shots or anything, but I am wondering if it will be about the same this time around with having the shots?

I have had my tubes tied for 4 years now, so I dont know if my outcome would be any different than others or not.



What all do you need to avoid after having these shots?
The DR didnt tell me to avoid ANYTHING at all...Just to go back Sat and have another HCG test done and then again Next Tues.

As you can tell, we ARENT TTC as I have my tubes tied, it had just happened.

I am going in next month and having them re-tied again though, so I dont have to go through the pain of getting pregnant and not being able to have it.



Good Luck to all




Tawnya
22 Responses
93654 tn?1247499334
Since your not TTC, you're probably not taking prenatal vitamins. But if you take a daily vitamin, make sure it does not contain folic acid, because that works against the methotrexate. I think I have also read that you should avoid alcohol for the next few days, because it can cause liver damage. I experienced very little bleeding after having the shot- most of mine was due to the D&C that I had beforehand. The shot caused some abdominal discomfort for me- much like painful gas. Other than that, I don't recall any other side effects.
93654 tn?1247499334
Sorry, I forgot to mention that I had metho after an ectopic, so that is also why I had little bleeding. When I saw that you had tubal ligation, I assumed that this was an ectopic pregnancy, but that's not necessarily the case. If this pregnancy is in your uterus, you may experience more bleeding than I did.
Avatar universal
On Mon the DR started me on PNV and have just taken them on Mon-tues and today.
No one knows where the  pregnancy is(was) as no U/S or any further action was taken today after the HCG test except  the shots. He just wanted to do something ASAP before anything bad had happened, since I do have my tubes tied.

The thing I dont understand is why didnt he tell me what TO AVOID while this medicine is in my body..Dont make any sence to me.

How long is the Methotrextate in your system?
134578 tn?1602101550
I don't have a lot of patience for doctors who don't tell you what they should.  Are you scheduled for an ultrasound at all, or is he just going by guess?  I don't disagree that the numbers indicate a m/c or an ectopic, but for heaven's sake it's sloppy of them not to want to at least do an ultrasound.
93654 tn?1247499334
My doc did the same thing- no information on precautions or side effects was given to me. His receptionist told me to go to WebMd and look it up. I think medical abortions (methotrexate) is still considered a new treatment. From what I've read, the actual drug is out of your system in a few days. The effects of it (dissolving the pregnancy) will continue after the metho is out of your system.
93532 tn?1349370450
GENERIC NAME: methotrexate
BRAND NAMES: Rheumatrex, Trexall
DRUG CLASS AND MECHANISM: Methotrexate is classified as an antimetabolite drug, which means it is capable of blocking the metabolism of cells. As a result of this effect, it has been found helpful in treating certain diseases associated with abnormally rapid cell growth, such as cancer of the breast and psoriasis. Recently, methotrexate has been shown to be effective in inducing miscarriage, for example in patients with ectopic pregnancy. This effect of methotrexate is attributed to its action of killing the rapidly growing cells of the placenta. It has also been found very helpful in treating rheumatoid arthritis, although its mechanism of action in this illness is not known. It seems to work, in part by altering aspects of immune function which may play a role in causing rheumatoid arthritis.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Injectable: 25mg/ml; Tablet: 2.5mg (Rheumatrex), and 5, 7.5, 10 and 15 mg (Trexall).

STORAGE: Store between 59 and 77degrees F in a sealed container, avoid light.

PRESCRIBED FOR: Methotrexate is used for cancer treatment generally in higher doses than for other uses, and is often administered intravenously or intramuscularly. Methotrexate is used to treat psoriasis, an inflammatory skin disease, as well as the arthritis that occurs in 10 percent of these patients (psoriatic arthritis). It is also used to treat active rheumatoid arthritis in adults and children. It is also used to treat other rheumatic diseases, including polymyositis and systemic lupus erythematosus. Methotrexate has been used to induce miscarriage in patients with ectopic pregnancy.

DOSING: May be taken with or without food. For rheumatoid arthritis and psoriasis, the dose of methotrexate is given WEEKLY, whether by injection or orally. For psoriasis, the weekly dose is often divided into three doses given at 12 hour intervals each week. This has been shown to be more effective, as it relates to the natural growth cycling of the skin.

DRUG INTERACTIONS: Because methotrexate can cause serious liver disease, patients with alcoholism or liver disease should not receive it. Patients should curtail alcohol consumption while taking methotrexate. Methotrexate can suppress the body's immunity. Therefore, any symptoms of infection should be reported to the doctor. Patients with underlying immune deficiency diseases should not receive methotrexate. A dry, non-productive cough can be a result of a rare lung toxicity. Methotrexate can impair fertility, decrease sperm count and cause menstrual dysfunction. Safety and effectiveness has not been established in children.

PREGNANCY: Methotrexate should not be used in pregnancy, as it can be toxic to the embryo and can cause fetal defects and spontaneous abortion (miscarriage). It should be discontinued prior to conception if used in either partner. Male patients should stop taking methotrexate at least 3 months prior to a planned conception and females should discontinue use for at least one ovulatory cycle before conception.

SIDE EFFECTS: Methotrexate can be well tolerated, but also can cause severe toxicity which is usually related to the dose taken. The most frequent reactions include mouth sores, stomach upset, and low white blood counts. Methotrexate can cause severe toxicity of the liver and bone marrow, which require regular monitoring with blood testing. It can cause headache and drowsiness, which may resolve if the dose is lowered. Methotrexate can cause itching, skin rash, dizziness, and hair loss. A dry, non-productive cough can be a result of a rare lung toxicity.


Now interestingly enough, if you research "methotrexate and folic acid" you can find amny sources that say to take them together, BUT that is only in certain instances such as those with cancer.

Andi
Avatar universal
He didnt say anything about an U/S.. I was scheduled for one next Tues along with another HCG test, but  they wanted me to come in today to get a HCG test done.
He said that since I have my tubes tied and that the numbers didnt double since Mon that it was an abnormal pregnancy and then gave me the shots..All he wants to do now is have the HCG done again Sat and then on Tues and he said if they go down then great and if not, then I will have to have another 2 shots of Methorextate..



Sometimes I "HATE" Dr's that just want to get you in and on your way.
134578 tn?1602101550
I would say, ask him directly without hinting around if he will also do an ultrasound.  Tell him you are uncomfortable going forward without him ordering one.  Explain, if he gives you static, that he just administered an anti-cancer drug to you dissolve a presumed abnormal pregnancy with only two blood tests as proof, and gave you no instructions, and you feel this is borderline unprofessional. If he continues to act like asking for an ultrasound is just too much, find another doctor.  I knew someone who switched ob's in her NINTH MONTH because her doctor was being so unresponsive.  If she can do that, you can find someone to follow up on this more professionally with you!  Good luck!
Avatar universal
Make SURE you don't get pregnant. I understand you aren't trying, but be extra careful. Use double protection for 2 months. Methotrexate is bad bad bad for a fetus. After that, you'll beback to normal.
Avatar universal
i am going to go in and have a HSG done to see if the tubes have came untied or what has happened and then get the re-tied again in a few weeks.

I also forgot to add, that I went in today because I was having very very mild cramping  yesterday that didnt last very long, but the other DR i saw on Mon told me if I had any pains to go in..And today, I didnt see the same DR as on Mon. Today I saw the OBGYN SPECIALIST.


I am having a little bit of cramping this evening, but nothing too badly.
In a way, I wish that he would have waited to give me the shots and just tested me again in 3 days and let me miscarry on my own without and Meds.
But he was worried about me NOT doing it on my own and it causing  problems.
93654 tn?1247499334
I'm sorry, but unless your hopes are to find a reason to sue the a$$ of your doctor, I would not ask for the u/s. Switch doctors if you want to, but an u/s at this time is pointless. If a pseudosac is seen (VERY common in ectopics), then you will wonder if you just "went along" with a terminating a pregnancy that could have been viable. I completely understand your frustration at this time. But once the shot is administered, there's no point in pondering the "what if's?"
93654 tn?1247499334
The HSG is a great idea- definitely have it done. Methotrexate is not a perfect answer, and doctors should learn more about it before administering it. But if it prevents a fallopian tube from bursting and you losing your life, then the benefits outweigh the risks.
Avatar universal
I am not persueing an U/S done. I was scheduled next week for one b4 I went to the dr today.He said if he did one today that he wouldnt be able to see much anyways.
He had me as 9 weeks along by my LMP and the DR Mon had me at 3 weeks by the HCG test, so who even knows about that.



Sometimes I wonder about these bandaid stations..LOL
134578 tn?1602101550
I agree with mslkpage and am glad to hear you're getting an HSG.  The only reason I used ultrasound in my example of what one might say to a doctor is because I was thinking he would be able to use it to locate the suspicious mass whether it was in the uterus or elsewhere in the pelvic region.  Or if it wasn't findable at all that would be useful information too.  But an HSG should tell you some of that, at least if there is a mass in a tube.  Certainly the worst I'd ever suggest doing when you are dissatisfied with your doctor is be to switch, life is too short for complaints, and they usually backfire anyway.  Glad you're getting this support.
93532 tn?1349370450
I am absolutely befuddled that a doctor would administer methotrexate without knowing where the sac was. Why introduce something as potentially dangerous as that if it isn't needed? I mean in cases of known ectopics the benefits (dissolving the pregnancy) far outweigh the risk (extreme scar tissue, rupture, removal of tube) But if you don't even know where the embryo is located and haven't checked it seems a bit hasty.

I hope you can get some answers soon and hopefully they come from a competent doctor.

Andi
Avatar universal
The only thing I have gathered is that he did it because my HCG level declined instead of raisied.And wanted to do it before it got too late.
He is an OBGYN Specialist,I figured he knew what he was doing?!? (my 1st time ever seeing this DR)


I really appreciate all your comments and suggestions.

Good luck to all the rest of you that are currently PG or TTC and hope none of you have to go through this or have a DR like I did today.



I was also wondering, If this shot I got today dont work, then whats next?Another shot?Surgery?
Could I still possibly be PG if this dont work?



Thanks again everyone



Tawnya
93654 tn?1247499334
With me, I only needed the one dose. My hcg level was checked 3 days later, and then every week after until it reached 0. Two weeks after it hit 0, AF arrived and the HSG was scheduled on CD 8 or 9.  I have heard of women requiring a second shot, but that's usually if the hcg continues to rise instead of drop. My hcg was rising when I received metho, so the first draw was an increase but the subsequent ones dropped by about 50% each week.
134578 tn?1602101550
If the doctor gave me a serious drug and didn't tell me any precautions or side effects, and all anyone there said was to go to WebMD and look it up, I would be looking for a new doctor. How awful that this happened to you.  Obviously there is information on the web, but you would think that doctors would be interested in communicating clearly to their patients.
93654 tn?1247499334
Fortunately, that's the only time my doc or his staff have been less than helpful. The shot was actually administered by a nurse at the surgery center after my D&C. If I had been more coherent, I would have asked for some info on it then. But, it didn't occur to me until the next day, and that's when I asked my doctor's office about it. I did suggest that they print out the drug information to provide to patients in the future. Other than that, I have no complaints about my doctor, and my TTC/infertility issues go back to February '05.
Avatar universal
I just called out to my Clinic and talked with the LPN (Dr Assistant that gave me the shots yesterday) and she said there isnt anything that I MUST avoid.All she said, was I should have some spotting once the medicine kicks in ( no spotting yet) and not to forget to go back in on Sat to get another HCG test.

It's always nice to be left in the dark and not know what to do isnt it??


At least I got some helpful info from all you wonderful ladies!!




Thank you all~
Good Luck and God Bless everyone on here!!




Tawnya
Avatar universal
Sorry to hear this. I am the one who is going through something simaliar. You are in my thoughts and prayers. When is your test? I am glad to have been able to talk to you on here. Let us know how things go.
Avatar universal
I have another HCG test on Sat, then another on Tues and the DR said he would call me Tues and let me know the results of them.



Your in my prayers as well.



Tawnya
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