Methotrexate and misoprostol for abortion

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Methotrexate and misoprostol for abortion

Examples

methotrexate (MTX)

misoprostol (Cytotec)

How It Works

Methotrexate and misoprostol use is a two-step method.

First, methotrexate tablets are taken orally or an injection of methotrexate

is given by your health professional. Methotrexate interferes with the growth

of the placenta, which allows it to separate from the endometrium. This is an

unlabeled use of methotrexate.

Second, tablets of misoprostol are taken orally or inserted vaginally,

usually 5 to 7 days later. This medication causes uterine contractions so that

your

body passes the uterine contents. This is an unlabeled use of misoprostol. The

pregnancy usually ends at home within a day or two when the tissue from the

uterus is passed.

A medical abortion usually requires 3 visits to your health professional over

3 weeks. Medications are given at the first and second visit. The third visit

is a follow-up appointment to make sure the abortion is complete and no

complications are present.

Oral pain medications also may be used for this procedure.

Why It Is Used

A medical abortion uses medication prescribed by a health professional and

does not usually require surgery. A medical abortion is most effective within

the first 7 weeks of pregnancy.

Methotrexate is also used for treatment of an ectopic pregnancy.

How Well It Works

A medical abortion with methotrexate and misoprostol is effective over 90% of

the time.

Over 60% of pregnancies will end within the first 24 hours after taking

misoprostol. A second dose of misoprostol may be given. However, methotrexate

and

misoprostol may take up to 3 weeks to be effective, which is longer than other

methods.1

Effectiveness of methotrexate with vaginal misoprostol 800 mcg1

Medication dose Pregnancy length Effectiveness

Methotrexate 50 mg by intramuscular injection (IM) with misoprostol 7 days

laterUp to 7 weeks

7 to 8 weeks98%

96% to 99%

Methotrexate 50 mg IM with misoprostol 4 or 5 days laterUp to 9 weeks92% to

93%

Methotrexate 50 mg IM with misoprostol 3 days later7 to 8 weeks

8 to 9 weeks75% to 90%

60%

Methotrexate 75 mg IM with misoprostol 5 or 6 days laterUp to 7 weeks95%

Oral methotrexate 50 mg with misoprostol 5 or 6 days laterUp to 7 weeks91%

Oral methotrexate 25 mg with misoprostol 7 days laterUp to 8 weeks91%

Some studies show that injected methotrexate and vaginal misoprostol are

effective more quickly and have fewer side effects than when both medications

are

taken orally.2

A follow-up evaluation is usually scheduled within 20 days. If a medical

abortion is unsuccessful, a surgical abortion must be done to complete the

process. A fetus may not develop normally after exposure to methotrexate or

misoprostol.

Side Effects

This method of abortion causes symptoms similar to a miscarriage, such as

cramping, nausea, diarrhea, and vaginal bleeding as tissue and clots pass from

the uterus.

Call your health professional for any of the following, more serious symptoms:

Heavy bleeding

Severe pain

Fever

Hot flushes

Headache

Dizziness

See Drug Reference for a full list of side effects. (Drug Reference is not

available in all systems.)

What To Think About

Methotrexate for medical abortions has not been evaluated in women with the

following medical conditions:

Anemia

Human immunodeficiency virus (HIV)

Alcoholism

Bone marrow diseases

Blood clotting disorders

Low white blood cell count (leukopenia)

Thrombocytopenia

Liver or kidney disease

Uncontrolled seizure disorder

Acute inflammatory bowel disease (IBD)

Allergy to methotrexate

Intrauterine device (IUD) in place

Methotrexate can be used in women with asthma.

Over 75% of pregnancies will end within the first 24 hours after taking the

second medication (misoprostol). However, methotrexate and misoprostol may take

up to 3 weeks to be effective, which is longer than other methods.

A medical abortion does not require surgery but must be done in the first 7

weeks of pregnancy to be most effective. If a medical abortion fails (less than

10% of the time), a surgical abortion must be done as follow-up. If the

abortion is not completed, complications can include abnormal development of the

fetus.

Your next regular period may come at any time within 6 weeks after the

abortion. Be sure to contact your health professional if you do not have a

period in

6 weeks.

An abortion rarely affects your fertility, so it is possible to become

pregnant again in the weeks after an abortion. It is important to use birth

control

in the first weeks following the abortion, as well as condoms to prevent

infection.

You may experience different emotional reactions after an abortion.

Choosing a medical or surgical procedure for an abortion will depend on your

medical history, how many weeks pregnant you are, what options are available

where you live, and your personal preferences.

Methotrexate and misoprostol both cause fetal abnormalities, so a surgical

abortion will be done if the medications are not effective in ending the

pregnancy.

Alcohol and aspirin should not be taken while using methotrexate and

misoprostol for a medical abortion.

Folic acid (folate) can interfere with the action of methotrexate so these

supplements should not be taken during a medical abortion involving

methotrexate.

See a list of questions to ask your doctor about medications.

References

Citations

Trupin SR, Moreno C (2001). Medical abortion: Overview and management.

Medscape Women's Health eJournal, 7(1). [Online]. Available:

http://www.medscape.com/viewarticle/429755_1.

M, et al. (1999). A Clinician's Guide to Medical and Surgical Abortion.

New York: Churchill Livingstone.

Credits

Author Jan Nissl, RN, BS

Editor Van Houten, RN, BSN, MBA

Associate Editor Landauer

Primary Medical Reviewer Joy Melnikow, MD, MPH

- Family Practice

Specialist Medical Reviewer Lori A. Boardman, MD, ScM

- Obstetrics and Gynecology

Last Updated November 25, 2002

WebMD with AOL Health - Misoprostol

Misoprostol

Examples

misoprostol

How It Works

Misoprostol:

Softens and dilates the cervix.

Causes uterine contractions.

Induces labor.

Why It Is Used

Misoprostol is a prostaglandin medication used to terminate a pregnancy. It

is more effective when used in combination with methotrexate or mifepristone

than when used alone. This is an unlabeled use of misoprostol.

Misoprostol is also used to prevent stomach ulcers (labeled use) and for

induction of labor in pregnancy (unlabeled use).

How Well It Works

Misoprostol used alone may terminate a pregnancy but is most effective (over

90%) when used with other medications, such as mifepristone or methotrexate,

in first-trimester abortions.1

Misoprostol alone, moistened and used vaginally, is over 90% effective in

terminating first-trimester pregnancies less than 8 weeks.2

Misoprostol alone, dry and used vaginally, is 50% to 67% effective in

terminating first-trimester pregnancies less than 8 weeks.2

Misoprostol may also be used to:

Complete a spontaneous missed abortion.

Start labor in second-trimester abortions. Misoprostol is over 70% effective

in terminating a pregnancy within 48 hours when used for second-trimester

labor induction. It is more effective when used with mifepristone.1

Start labor in third-trimester abortions. Misoprostol is more effective than

oxytocin and other prostaglandins for inducing labor within 24 hours.1

Dilate the cervix 3 to 4 hours before a surgical abortion procedure.

Soften the cervix for induction of labor.

Soften the cervix for special gynecologic tests.

Side Effects

Side effects of misoprostol include:

Nausea.

Vomiting.

Diarrhea.

Abdominal pain.

Chills.

Shivering.

Fever.

What To Think About

Many studies have shown that misoprostol is a safe and effective medication

in abortions.1

Misoprostol is not used in women with any of the following conditions:

Glaucoma

Sickle cell anemia

Mitral valve narrowing (stenosis)

Uncontrolled seizure disorder

Allergy to misoprostol or other prostaglandins

Misoprostol has been shown to be more effective when the tablets are used

vaginally than when taken orally.

Misoprostol can cause fetal abnormalities so a follow-up surgical abortion

will be done to prevent a fetus from developing abnormally.

Misoprostol also has an approved, labeled use. It is used to prevent and

treat gastric ulcers in people taking nonsteroidal anti-inflammatories (NSAIDs)

on

a long-term schedule.

Misoprostol does not have any known drug interactions.

Unlike other prostaglandins, misoprostol does not increase the risk of a

heart attack or bronchospasm.

See a list of questions to ask your doctor about medications.

References

Citations

Goldberg AB, et al. (2001). Misoprostol and pregnancy. New England Journal of

Medicine, 344(1): 3845.

Creinin MD, et al. (2001). Medical management of abortion. ACOG Practice

Bulletin No. 26, pp. 1–13. Washington, DC: American College of Obstetricians

and

Gynecologists.

Credits

Author Jan Nissl, RN, BS

Editor Van Houten, RN, BSN, MBA

Associate Editor Lila Havens

Associate Editor Landauer

Primary Medical Reviewer Joy Melnikow, MD, MPH

- Family Practice

Specialist Medical Reviewer Lori A. Boardman, MD, ScM

- Obstetrics and Gynecology

Specialist Medical Reviewer Philip Darney, MD, MSc

- Obstetrics and Gynecology

Last Updated November 9, 2001

In a message dated 1/17/2005 2:38:04 PM Central Standard Time,

writes:

Date: Mon, 17 Jan 2005 15:30:23 EST

From: kringlemom@...

Subject: Re: MTX, question for the ladies

i was on the pill so mine was controlled. but it was used as an abortion

drug. so anything it did wouldn't surprise me.

kathy in il