Table 2.

Methotrexate Protocols

Day Single-dose protocol Multidose protocol Two-dose protocol

0 Labs (pretreatment) - ß-hCG Labs (pretreatment) - ß- Labs (pretreatment) - ß-hCG
level, CBC, LFTs, creatinine, hCG level, CBC, LFTs, level, CBC, LFTs,
type and screen Methotrexate creatinine, type and screen creatinine, type and screen
50 mg/m2 Rhogam if Rh Methotrexate 1 mg/kg Methotrexate 50
negative Rhogam if Rh negative mg/m2 Rhogam if Rh
negative
1 Leucovorin 0.1mg/kg
2 ß-hCG level Methotrexate
3 Leucovorin
4 ß-hCG level ß-hCG level Methotrexate ß-hCG level Methotrexate
5 Leucovorin
6 ß-hCG level Methotrexate
7 ß-hCG level, CBC, LFTs, Leucovorin ß-hCG level, CBC, LFTs,
creatinine Repeat methotrexate creatinine, Repeat
if <15% decrease in ß-hCG methotrexate if <15%
level from day 4 decrease in ß-hCG level
from day 4
11 ß-hCG level, if repeat dose is ß-hCG level Repeat
given methotrexate if <15%
decrease in ß-hCG level
from day 7
14 ß-hCG level, if repeat dose is ß-hCG level CBC, LFTs,
given creatinine, if repeat dose is
given
Maximum two Continue methotrexate and Maximum four doses of
doses of leucovorin until 15% decrease methotrexate
methotrexate in hCG levels between two
consecutive titers Maximum
four doses of methotrexate

For all protocols, after initial decline in ß-hCG, check weekly levels until undetectable or, in the multidose protocol,
until <15 IU/l.
ß-hCG: ß-human chorionic gonadotropin; CBC: Complete blood count; LFT: Liver-function tests.