Misoprostol vs Methotrexate: What You Need to Know

If you’re looking at medical abortion options, you’ve probably heard the names misoprostol and methotrexate. Both are proven drugs, but they work in different ways and fit different situations. Below we break down the basics, so you can see which one might be right for you.

How the drugs work and typical dosing

Misoprostol is a prostaglandin analogue. It causes the uterus to contract and the cervix to soften, helping the pregnancy tissue pass out. The usual regimen is 800 µg taken buccally or vaginally, often repeated after 24‑48 hours if needed.

Methotrexate, on the other hand, is a folic‑acid antagonist. It stops the rapidly dividing cells of the embryo from growing. Doctors give a single dose of 50 mg/m² intramuscularly, sometimes followed by misoprostol 24‑48 hours later to finish the job.

Success rates, side effects, and when to choose each

When used alone, misoprostol has a success rate of about 85‑90 % for pregnancies up to 9 weeks. Adding methotrexate boosts that number to roughly 95 % because the two drugs complement each other.

Side effects differ too. Misoprostol often brings cramping, nausea, diarrhea, and light bleeding right after the dose. Methotrexate can cause mild flu‑like symptoms, sore gums, and occasional liver irritation. Both drugs are safe when prescribed, but you’ll need a follow‑up ultrasound to confirm the pregnancy has cleared.

Doctors usually pick methotrexate when the pregnancy is a bit later (up to 10‑12 weeks) or when a patient wants to avoid strong uterine cramps early on. Misoprostol alone is common for earlier pregnancies or when a fast, single‑step process is preferred.

Cost can matter, too. In many places misoprostol is cheaper and more readily available. Methotrexate often requires a clinic visit for the injection, which adds a bit of hassle and expense.

Bottom line: if you’re under 9 weeks and want a straightforward at‑home option, misoprostol alone might be enough. If you’re a little further along or want the highest chance of success, the methotrexate‑plus‑misoprostol combo is the go‑to.

Always talk to a qualified clinician before starting any regimen. They’ll check your health, confirm the gestational age, and walk you through what to expect day by day. With the right guidance, both drugs are safe, effective, and give you control over your reproductive choices.