Methotrexate is a folic acid antagonist, it works by inhibiting the dihydrofolate by interfering with the DNA synthesis. Ectopic pregnancy is a life threatening condition that may cause maternal mortality. The main aim of this review to show the efficacy of systemic methotrexate and shows the importance of methotrexate treatment in management of ectopic pregnancy with surgical treatment and dosage regimen with protocol treatment. The selection criteria of candidates in this review is pregnant women with <5000miu/ml, adrenal mass <4cm, presence of peritoneum <100mland no sign of cardiac activity. Data collections are made from most relevant article between the periods of 1987-2020. Ectopic pregnancy is an emergency condition if not timely diagnosed and most of the cases where identified in first trimester.