Folic Acid with Methotrexate: the Debate
Folic acid & methotrexate: a tug of war
Methotrexate is the most common medicine used to treat Rheumatoid Arthritis. However, some say it is still a mystery exactly how it works. Several sources I’ve read say that, because methotrexate is a folate antagonist, it inhibits the production of harmful cells with Rheumatoid Arthritis in a similar way that it does for some cancers.
This is the reason most doctors prescribe folic acid supplementation with methotrexate. Folic acid supplementation can reduce methotrexate side effects by replacing some folate. If you’re wondering whether that is counter intuitive, you’re not alone. I remember asking my first rheum doc, “Will the methotrexate still be effective? How can that work?” Doc said, “It just does.”
Well, others have also wondered. The Annals of Internal Medicine published a December 1994 study of 79 people with RA. The patients were given folic acid supplements at weekly doses of either 5mg or 27.5 mg. They found that “Folic acid supplementation at either dose did not affect the efficacy of methotrexate therapy as judged by joint indices and patient and physician assessments of disease.”
Conflicting research about folic acid and methotrexate
All studies agree that folic acid reduces methotrexate side effects, but it is uncertain how much, if any, folic acid reduces the effectiveness methotrexate. It appears to be dependent upon what the doses are.
A small study (22 patients) showed that methotrexate is less effective at controlling psoriasis when folic acid is added. The folic acid dose in that study was 5 mg. daily, which is higher than the highest dose in the larger study previously mentioned. Conflicting results like these have prevented the formulation of a recognized guideline for all patients taking methotrexate for Rheumatoid Arthritis or other autoimmune disease. However, the consensus seems to be in favor folic acid supplementation since it is almost universal. Perhaps it will be determined that it is best to use as little folic acid as is necessary to counter methotrexate side effects.
Additional protection of folic acid with methotrexate
Here’s a fascinating statement from one pharmacist writing on the issue: “Clinicians should consider that folic acid supplementation may have the additional benefit of cardiovascular protection due to its ability to prevent MTX-induced hyperhomocysteinemia.” What’s that? According to the Oxford Journal of Rheumatology, “Folate supplements do not appear to significantly reduce the effectiveness of MTX in the treatment of RA. Furthermore, supplemental folic acid offsets the elevation in plasma homocysteine associated with the use of MTX. This may in turn reduce the risk of cardiovascular disease, which is over-represented amongst patients with RA, and for which hyperhomocysteinaemia is now recognized as an independent risk factor.“ If one cause of the elevated homocysteine levels is methotrexate, folic acid could help prevent that.
Folic acid improves “methotrexate survival”
From a medical viewpoint, the most important effect of folic acid is that it improves the rate at which patients continue to use methotrexate or the “methotrexate survival” rate. “The use of supplemental folates, including folic and folinic acid, in RA patients treated with MTX has been shown to improve continuation rates by reducing the incidence of liver function test abnormalities and gastrointestinal intolerance,” Oxford Journal of Rheumatology.
What about leucovorin / folinic acid?
Leucovorin or folinic acid is a more stable and potent form of folic acid. It is used as a rescue drug with chemotherapy in cancer patients. Some Rheumatoid Arthritis patients are prescribed folinic acid if side effects of methotrexate are not relieved by folic acid. Folinic acid also seems to be more popular in some countries.
However, folinic acid may be more likely to reduce the effectiveness of methotrexate. “High-dose leucovorin (folinic acid) supplementation was tested in a prospective, unblinded manner for 4 weeks in 7 rheumatoid arthritis patients who were being treated successfully with low-dose methotrexate (MTX). Nausea caused by MTX disappeared; however, the underlying rheumatic disease worsened in all patients. Subjective clinical assessment, Ritchie articular index, grip strength, erythrocyte sedimentation rate, and levels of C-reactive protein showed statistically significant deterioration. All these parameters improved after the leucovorin was stopped. This is the first direct clinical evidence implying folate antagonism in the action of low-dose MTX therapy in rheumatoid arthritis patients,” Arthritis and Rheumatism.
Bottom line for folic acid supplementation w/ methotrexate?
No, I couldn’t find one. In case you aren’t already confused, a thorough examination of the records of 307 RA patients taking methotrexate and folic acid or folinic acid or neither found:
- No consistent differences in disease activity parameters were observed when comparing placebo and folic or folinic acid at low or high doses, although patients on high dose folinic acid had an increase in the number of tender joints, but not swollen joints.
- Large differences in costs across countries were found, but folinic acid was more expensive in all.
- The results support the protective effect of folate supplementation in reducing MTX side effects related to the oral and GI systems. We could not determine if folic was different from folinic acid.
Brief explanation about folic acid and methotrexate from DrDoc Online
Recommended reading:
- Comparing Risks and Benefits of Rheumatoid Arthritis Medicines
- Methotrexate Injections for Rheumatoid Arthritis
- Methotrexate Injections for Rheumatoid Arthritis, part 2: Needles
- Methotrexate Side Effects
I’ve been on 5mg of folic acid daily (except the day of the shot) with my 10cc’s of MTX for about 8 months now. I couldn’t survive without it.
Originally I was only on 1mg of folic acid and I was barely conscious most of the week and had terrible mouth sores. I would be in the middle of dinner and fall asleep at the table I was to tired. We slowly upped the folic until it was manageable. 5mg was the magic number.
Now I only lose about a day post shot; I take it Friday evenings. I usually crash from Sat afternoon to Sun afternoon. The mouth sores are better. I also take 1,000 iu B12 supplement daily to help with them. With that I rarely got them however I have since also added Arava to my treatment and now the sores are back with a vengence. Seems the folic and B12 can only save me from so much. 🙂
I don’t think that it has reduced the efficacy of the MTX too much. I was told when I started a year ago that I would likely be on 9cc’s. I’m on 10cc’s so that is pretty close. And I am doing well compared to how I was without it. But if my folic was taken away, I don’t think I would be staying on it. The day I lose now, is the day I don’t take the folic (since my dose is Fri night, I don’t take the folic on Sat morning). So I think the folic is a very important part of successful MT treatment.
Thank you for the good info, Steph. Probably most people would not last long on mtx w/out the some folic acid supplement. I’ve been surprised that I bump into people who were not prescribed any folic acid at all; usually they are looking for help regarding hair loss. My doc had said it was a must when I started.
Just a correction to my previous comment. The B12 supplement is 1200mcg daily, not 1000iu daily. Too many supplements with different doses. LOL!
When my mom was prescribed MTX, our rheumy (we have the same one) forgot to tell her about the folic acid. He thought he had but he had forgotten. But he did tell her to talk to me before starting it so I was able to get her on track.
Thank you for this I really enjoyed reading it… I like to delve into the meds sometimes and see how they work why they are there..kudos
Thanks, Shannon. There’s so much for us to learn.
I was ready to give up on MTX because of the side effects, the one that bothered me the most was out of vanity. I was losing my hair in handfulls and the LAST thing I wanted with everything else was to be bald. I spoke to my doctor and he suggested I try Leucovor CA 5mg. as the OTC folic acid was not helping. Wow my hairloss almost stopped completely and many other side effects decreased as well. I really hope that it does not affect how the MTX works because I like how it works for me.
Hi Amy, The OTC folic acid isn’t usually prescribed since OTC vitamins are not regulated in such as way as to guarantee the dose. Folic acid is given by most rheum docs as a prescription to assure that the dose is accurate / sufficient. I don’t know what dose you took OTC, but it might have worked if by prescription.
By the way, if you notice that the mtx is not working as well, maybe they would cut back the leucovorin. Some people do take lower doses.
Whoa, this is an interesting post! I have my ideas about MTX but feel the good it can do out ways the bad the RA can do to me. I was diagnosed last Oct and put on pred right away and waited a week for the blood tests/etc, to start MTX with Folic Acid on the side, YUM:)~ I have experienced many of side effects, from weight gain (alot to do with the pred too) to hair loss (had to cut my shoulder length hair to make it look thicker..I used to have ladies at the salon jealous as to my thick curly hair….sigh) to days lost in a “coma” to what ever (usually doing to much I think but not always)…I have come to grips with not being able to ride my horses like I used to but being around them makes me better…..I take 15 mg of Mtx each week (pills) and take 50,000 Vit D each month and he upped it to 1,000 Vit D daily too along with my weekly Enbrel shot and now can take up to 9 OTC ibuprofren daily…..hmmmm, I still wonder as my feet and hands always hurt. I love my dr and trust what he says, so we are going with another 3 months of the Enbrel and see what happens. What has happened to me has been a total reversal of my thinking, I was studying to be a certified herbalist before RA hit me, there is NO WAY I would try it the “natural” way, too much damage can happen to your body while “testing” out herbs, etc. My dr has no probs with Milk Thistle taken internally every day, even says it could help with the toxins in your liver…Hey you guys, add that into your daily stuff! But to watch the immune boosting herbs….Thanks again Kelly for all you do, I am so happy to not be alone:) Love to all you RA’ers!!!!
Hi Nancy, That sounds very sensible to me. 😀
Sometimes its hard for new people to understand that the RA is more dangerous than any treatment for it. Is it because of something they read that frightened them?
With regard to Leucovorin vs. Folic Acid: I was taking MTX (20 mg) with 1 mg Folic Acid per day with good results. The most significant side effect was fatigue. I mentioned this to my new rheumatologist who made a small change. Instead of Folic Acid, I now take 5 mg of Leucovorin once a week, timed 12 hours after my MTX dose (9am Saturday, MTX; 9pm Saturday, Leucovorin. My energy is better. I’d be interested if anyone else has this instruction to take the Leucovorin 12 hrs after the MTX dose?
The MTX/Folic Acid issue is a delicate balancing act. Thank you for this thread, Kelly:)
Helen, Yes, I think that’s right about the balancing act. I do know a few more people who have it prescribed that way. I hope it keeps helping you more & more. 🙂
Yes the folic acid I take is the prescription version. My B12, Vit D, L-Lysene and Omega 3 are OTC. But I’m in Canada and our monitoring of vitamins is different here.
Just completed a big move to another part of the state. At least I lost about 7lbs. doing way too much. Have a bad flare in my ankles from being on my feet too much. Getting things changed around and getting new docs is a real proceedure. Will now have to drive 70 miles just to see the one and only RA doc around. I have qualms about all the changes. I did try the injections which my last new RA doc advised. Don’t know if others experienced what I called tongue sores, but decided to go back to the pills, and am much better. I take the 20mg of Mtx once a week and only 1mg of the folic acid daily, along with the Omega 3 and B’s, and E, and calcium. There is still a lot I don’t understand, and the docs look at me strangly when I tell them I don’t have morning stiffness. My fingers are the same non-functioning round the clock morning or night. I use a lot of hand lotion to keep them from sticking together.(Cocoa Butter w/ Shea). I still have hair loss, but it is better. My knuckles are more swollen, but I think that may be due to over work with the move. The new pharmacy refilled my RX on the MTX, and now I know what the little yellow pills are that people here have mentioned. My other Mtx were white and oblong. And these cost less than the discount lrg store. I don’t experience the side effect others mention here with the meds, so am relieved that my system seems to handle this well. I do have fatigue, but also do too much and learning to rest is a big chore for me. Never heard of the Leucovorin, but have something new to ask my new RA doc. Thanks Robyn R
If you aren’t having bad side effects, Robyn, then you might not need to worry about Leucovorin. By the way, “morning stiffness” around the clock is what I have too & I’ve heard of other patients who say that – also, I’ve met doctors who don’t “get” that just like you said.
good news, one less pill to take…
Why, Mike?
Well if folic acid has been shown that no significant difference,oops i didnt read far enough 🙂
We propose that folic acid supplements be prescribed routinely to all patients receiving MTX for the treatment of RA. We recommend a pragmatic dosing schedule of 5 mg of oral folic acid given on the morning following the day of MTX administration.
more learning to do….
Starting Methotrexate and Folic Acid treatment for my RI this Thursday…..Nervous!
I never knew any of this. Glad I started paying more attention to the blog again… thanks, Kelly. All I know is that without the leucavor (sp?), I would be so sick that I wouldn’t be able to do much of anything at all.
Oh, and that w/o the metho, I wouldn’t be doing much of anything, AND my psoriasis and RA would be out of control.
Kelly,
I think you are a great gal. So sorry your doctor fired you. I once called a radiologist and he happily talked to me. You are doing a fantastic job, they are most like intimated by your incredible scientific persistent.
I have been on MTX for 10 months. After fiddling around with folic acid etc. I find for me that Taking the MTX at 3-5pm, sleeping pill that night (only) & folic acid 4 mg next am + 2mg each morning except MTX day works best.
I looked into MTX half life (how many hours till half is removed from the body). Although it seems to be about 19 hours there is a lot of variation. I reason that Folic acid will protect from the possibility of being a poor metabolizer of MTX.
What bothers me most is the unpredictable nature of how little or much I can do on a given day.
Thank you for sharing David – you’ve done a great job finding what exactly works for you. The only thing I can add is that sometimes – even after a period of years, response to a med or the disease process itself can change. I’m sure you’ll tweak your program if that happens.
Had to stop Pentaprasole because extends MTX action & greatly increased side effects
Interesting. I have seen that with other combinations but I did not know about this one.
Just came across this post and thought I would contribute a bit to the mystery of MTX and folate. The reason why folate supplements do not seem to affect the efficacy of MTX is because there is now some very strong data that the mechanism of low-dose MTX in RA patients is not primarily through the anti-proliferative effects (as it is for high-dose MTX treatment for cancer), but actually through the upregulation of adenosine. Adenosine is a potent anti-inflammatory molecule and there is a lot of strong data from mouse studies and some circumstantial evidence in humans that this upregulation of adenosine is what is mediating the anti-inflammatory effects of MTX in RA patients.
Hope this sheds a bit of light on this area!
John
Thank you! Thank you! Thank you! For all that you do to help us ‘fellow travelers.’ I’m on MTX for AS and just saw that I am starting to lose hair. I read your article about increasing Folic Acid to counteract this. Gonna try increasing the does of FA because MTX truly seems to be working for me and before I go ‘howling’ of to my Rheummy and he puts me on something else (possibly worse), I want to give the MTX and running chance. Thank you for all of your help and advice. Even though I’m dealing with AS instead of RA, this site has helped me more than I can say! God bless!
One thing I wanted to ask is does anyone else crave a LOT of water after taking MTX? The day I take my shot and the next day, I can’t seem to get enough water. The craving stops after a day. My pharmacist told me to drink a lot of water with MTX, so I’m not really worried, just curious.
When I first start taking MTX orally (many years ago now) I was told to always have it with at least a pint of water. I currently take 22.5mg and then 5mg of FA each day for 5 days between doses of MTX. I have never had any side effects other than tiredness and slight hair loss so sounds like it suits me generally – I do appreciate I am lucky, having read some nasty stories on here! Two months ago I started taking my MTX as s/c injection to boost efficiency,but have not taken the pint of water… I have actually noticed much greater thirst and tiredness for the following 24 hours. THANKS for “connecting the dots” for me! Don’t know why I hadn’t seen it for myself!
I’m on Metho 10 mg per week. Taken on Tue mornings at 7am. Folic Acid 5mg per week didn’t work well – got mouth/lip sores. Dr gave me Folinic Calcium 7.5 mg per week. Been taking it for 2 weeks now and still have sores on bottom lip plus it’s very dry and feels like it’s on fire all the time. I was told to up the dosage to 20mg per week, but very scared to do it as the side effects have not subsided completely. How much folinic acid do I really need to take per week/per day for 10mg of methotrexate weekly for treatment of RA?Please help, sore, burning lips are driving me crazy, plus getting itching scalp and skin occasionally during the day.
I decided to take MTX at supper so the worst side effects are during the night. I use Folic acid 1mg tabs which are OTC. 2tabs each morning except MTX day. If I am having more side effects I increase to 4 tabs the morning after MTX. Haven’t had itchy lips. Did have twice an area that was small raised & jet black it enlarged then shrank & fell off! So not melanoma then, it was a small bleed into the skin which happen from time to time on MTX
I am also taking MTX. Folic acid does help me, although I do not take it hours before the shot and for the day after the shot. Then I take 5 mg of a GOOD quality Folic Acid. When I had the mouth sores, I used Aloe Vera juice to rinse out my mouth. You can also buy the gel to rub on any particular sore. I found that Aloe Vera worked very well for my mouth sores and I also used it for mouth sores when I got my dentures. Make sure you are taking plenty of Vit D.
PS- Keep ‘upping’ your Folic Acid until you become comfortable. If it doesn’t seem that MTX is helping you, then cut the Folic Acid back some. I can’t stress enough the importance of buying a well-reputed, high quality FA. Hope it helps you!
Re “water craving” Yes. I have also monitored my weight which goes up about 5lb for 48 hrs after MTX. I assume this is fluid retention. I like to drink enough water to keep a good output.
My pharmacist told me to drink lots of water on MTX day and the day after to help process it through the kidneys quickly. Seems MTX likes to ‘hang out’ in the kidneys.
On researching taking Folic acid with MTX I read many times the suggestion to take the first dose of folic acid 12 hours after MTX. If you are having problems consider the timing of the dose. If you have a workable regime, best to stick to it.
I’m new to RA. I’m still trying to get over the feeling that I’m now “damaged goods.” I’m 70 years young and before RA I was a long distance hiker and biker with a couple of mountain climbs for the heck of it. I can still hike and ride, but my energy levels are down.
My reason for this post is to caution the use of NSAIDs. Although much of the research deals with osteoarthritis, the conclusions indicate that NSAIDs affect joint cartilage metabolism by blocking the normal growth of chondrocytes – the building blocks of cartilage. May 2002, Agency for Healthcare Research and Quality (AHRQ) http://www.ahrq.gov
I’m so glad I found an RA Warrior. I need all the encouragement I can find.
Hi, I just found your blog and am very interested. I lived with my mother who had arthritis from the time she was 7 and was affected in almost all of her joints. She was bedfast most of my life. I was told as a child not to worry but when I was 40 was diagnosed with RA. As far as the folic acid goes, I cannot go without it. When I was first put on methotrexate I was not told about folic acid. Within a week I could not put two sentences together, felt like my mind was a broken record. I told the Dr. and he said that was impossible, but I stopped taking the methotrexate. Two years later was put on Enbrel and Methotrexate again but this Dr told me about the folic acid. I was 40 when diagnosed and tried several medications. I have had a lot of joint damage but have been on Enbrel for about 20 years now. I guess it has helped, I don’t know how bad I would have been without it. But am glad to connect with other people who have RA. All of my children suffer from other auto immune diseases as well as RA. Thanks for listening. Prudi
Thank you for this post. I am still experimenting with the MTX / folic acid balance. My rheumatologist prescribes the folic acid at 1 per day other than MTX 10 mg day and it was too low. I have increased the folic acid to 3 and it helps with the nausea and fatigue.
I am on Orencia infusions once a month and 10 mg MTX weekly. I take 1800 mcg of Folic Acid on non shot days and 2400 mcg the day before, day of and day after MTX shot. I have noticed markedly increased fatigue the day after the shot and often have much stomach discomfort and diarrea and it just keeps getting worse for up to three days after MTX shot. I wonder if I can up the Folic acid dose or add something else? Side effects seem to be getting worse. Thanks for any help or input in advance!
Deeanna, that might help but please talk to the doc & let her knife what you want to try. Here’s some other suggestions about side effects- https://www.rawarrior.com/drug-side-effects-in-rheumatoid-arthritis-helpful-strategies/
Hello everyone,
I enjoyed reading this article/responses. Although I have never taken MTX, I hear these questions from my patients. MTX side effects will vary from person to person, but there are a few things that you can do to decrease the side effects.
If your side effects are not controlled,
1.) Try to avoid drinking acidic drinks (soft drinks) as they will acidify the urine which may decrease the elimination of MTX.
2.) Stay hydrated! Dehydration can lead to concentrated MTX in the kidney (it can actually crystallize and cause damage to the kidneys). Proper hydration will decrease other side effects as well.
3.) Consult with your doctor about the necessity of NSAIDs (ibuprofen, naproxen, aspirin). While these medications may be necessary for some of you, they carry the risk of increased gastrointestinal side effects. Additionally, they may decrease the elimination of MTX by competing for renal transport with MTX.
4.) Make sure to get blood tests taken regularly to ensure that levels of your blood cells have not decreased to dangerous levels.
It is also important to know that this medication is teratogenic (causes birth defects). Do not take this medication if you are pregnant or planning to become pregnant.
I noticed Kraig posted at 5:50 AM. I found this site at 4 and am fascinated. I have been treated for RA about 8 years now. Symptoms began about 12 years ago. Thought it was just one of the sides of getting older so just accepted the misery. (That’s because I’m a guy and an idiot) Sleep has become a problem. 2 months ago began folic acid. Still not sleeping but my flare-ups have decreased in frequency and intensity. It’s almost to the WOW! level. Same MTX and pred. dose.
I was wondering if MTX and pred could have anything to do with sleeping. And is there something I can do to remedy that. Thinking of getting out front on this so I don’t have to rely on my I’m a guy and an idiot defense.
Hey everybody,
I’ve had RA since 2008 and was recently put on MTX 10mg weekly and FA 5mg daily. I take them together. Is this wrong?
Hey everybody,
I’ve had RA since 2008 and was recently put on MTX 10mg weekly and FA 5mg daily. I take them together. Is this wrong?
Iknow most of you have been talking about folic acid but I was wondering if any of you have had a problem with methotrexate and your menstrual cycle? I was on it for about 6 months,and started having long menstrual cycles with heavy bleeding I told my doctor. He didn’t believe it was the methotrexate, he believed it was the ibuprofen( which I have never had an issue with in the past and have,tak ed n long term) so he took me off both. I went into an extreme flare of course but I had a normal ( 4 day cycle) for the couple of months I was off those meds. This month I asked my doctor if I could try methotrexate again ( my pain was so severe without) And now I have been menstruating for 31 days!!! I have NOT taken any nsaids she since back on methotrexate. I don’t know what to do. I don’t think I can survive without it but how long can i do this, and what else is it doing to me? what alternative is there?
Have been on methotrexate for4 months some improvement but losing lots of hair this is frightening feel better only slightly afraid of this drug but hate the constant pain I live with perhaps I should try something else like embrel any thoughts? Appreciate it
I realize this reply is late but for the sake of future readers:
Wairimu, yes, it’s wrong. Don’t take MTX with folic acid. Wait at least 12 hours.
Vicky, I’m not sure. I never had that side effect.
Tina, you can reduce hair loss by taking folic acid or folinic acid on all the days EXCEPT the day you take your MTX.
To all, I was having hair loss, mouth sores, as well as a mild rash below my nose and on my chin, and severe dry mouth – all side effects from MTX. I now take folinic acid 12 hours after MTX, then folic acid the other 5 days. Also, have changed my diet to be higher ph (more base) and drinking aloe juice. All these together are helping much!
How long does netho take to leave your system?
Hello I am a 63 year olkd female no energy what so ever and always tired.My doctor has me on folic acid which I take 1 a day, methotrexate I take 6 a week, and dulclonox 2 times a day.Can you let me know if theres anything I could take for my energy level even though the doctors tell me my bloodwork is fine.
Hello,
I take B12 daily as well, and I notice that helps my fatigue but sometimes none of it makes any difference and I just need to rest if I can.My pharmacist put me on to the B12, as he said methotrexate drops it.
I began to feel the affects of RA a few months back and along with going through a mastectomy and a few other issues and i can never sleep anymore although i also have mds and i am 70.any suggestions you guys have a lot more info then i.
Dorothy, lots of people have sleep problems due to RA. Here are some pages that might help. There are also comments pages with them.
https://www.rawarrior.com/tag/rheumatoid-arthritis-sleep/
MY WIFE TOOK THIS MTX WITH FOLIC ACID WAS 69 YRS OLD WITHIN ABOUT 15 MONTHS SHE DEVELOPED DEMENTIA AND IT HIT HER LIKE A LEAD BALLOON WITHIN 4 MONTH SHE COULD NOT EVEN DRESS HERSELF AND NOW AFTER 8 MONTHIS SHE HAS LOST 45 POUND AND IS CONFUSED AND LIKE A CHILD. I HAVE READ ALL OVER INTERNET THIS MTX WITH FOLIC ACID IS 87 PERCENT CHANCE OF GETTING DEMENTIA. THIS SHOULD B DISCUSSED WITH ALL PATIENTS BEFORE ADMINISTRATING THIS WICKED DRUG. WHATS SO BAD NOT EVEN ON BLACK BOX SIDE EFFECTS. WORKING DAY AND NIGHT HOPING TO GET A CURE FROM THIS POISON, I WOULD NEVER HAVE GIVE HER THIS SHOT ONCE A WEEK HAD I KNOW OF THIS THEIR SHOULD B A CLASS ACTION LAW SUIET AGAINST ANY DR. OR DRUG COMPANY WHO WOULD SELL THIS FOR DEMENTIA PATIENTS WITHOUT GIVING THEM THIS INFORMATION. MIKE CHEATWOOD MTX RUINS NOT ONLY WIFE LIFE BUT MANY IN FAMILY ITS REALLY DISGUSTING THIS HASNT BEEN CONTROLLED!!