Introduction: Medical management of ectopic pregnancy may lead to disastrous complication of METHOTREXATE toxicity. Case Report: A 25 year old female presented with 5 wks of amenorrhea. Investigations showed UPT positive, TVS-empty uterine cavity, HCG-1880 mIU/ ml Management: • Diagnosed as Ectopic pregnancy. • Pt was counseled for medical management of Ectopic pregnancy. She did not responded to first dose of METHOTREXATE. After second dose given, repeat  HCG levels elevated to 10,000 mIU/ml. • Surgery was Planned & Laparoscopic removal of ectopic pregnancy done. Follow up: • On 5th POD p/w- Mouth ulcers • On 7th POD p/w–Renal failure and Aplastic anemia • Pt was treated accordingly and discharged in a stable condition. Conclusion: • Feasibility of low dose Methotrexate use & its success is the first line of medical management for Ectopic Pregnancy. • Besides it advantages, it should be used with caution with severe METHOTREXATE toxicity should be kept in mind. • Proper consent should be taken.