Using divalproex sodium with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Retrieved Oct 23, 2015. Because this medication can be potentially harmful to the fetus, valproate should be considered for women of childbearing potential only after the risks have been discussed. Hemic and Lymphatic System: Ecchymosis. Valproate has been found to be a weak inhibitor of some P450 isozymes, epoxide hydrase, and glucuronosyltransferases.
As we learn more about natural remedies, some alternative treatments may emerge as the best strategies for treating health conditions, while others may lead to severe side effects. That said, this does not mean that natural supplements do not work -- and there are many natural supplements that are safe and effective. Supplements may work differently for some people than for others. You need to pay attention to what works for you and obtain the professional guidance of your doctor. There are no treatments for CJD. Researchers have tested several drugs, but none have been able to slow or stop the disease.
Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Dose is based on body weight and must be determined by your doctor. At first, the usual dose is 10 to 15 milligrams mg per kilogram kg of body weight per day. Your doctor may increase your dose gradually every week by 5 to 10 mg per kg of body weight if needed. However, the dose is usually not more than 60 mg per kg of body weight per day.
Wear a medical alert tag or carry an ID card stating that you take divalproex sodium. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking a seizure medication. HIV or CMV cytomegalovirus infection. Keep out of the reach of children. Other: Allergic reaction, anaphylaxis, developmental delay, bone pain, bradycardia, and cutaneous vasculitis. Store at room temperature away from heat, light and moisture. not store in the bathroom. Keep all away from children and pets.
Doctors use a long, very thin needle to draw some of the fluid out of the spinal column to test for certain proteins. Rarely, this medication has caused serious sometimes fatal liver problems, usually within the first 6 months of starting treatment. Laboratory tests should be performed before you start treatment and periodically during treatment, especially within the first 6 months, to monitor this side effect. Do not use divalproex sodium to prevent migraine headaches if you are pregnant. Short periods of depression can be a sign that a severe phase is coming. The risk of major structural abnormalities is greatest during the first trimester; however, other serious developmental effects can occur with valproate use throughout pregnancy. Avoid exposure to sunlight or tanning beds. Divalproex sodium can make you sunburn more easily. Wear protective clothing and use sunscreen SPF 30 or higher when you are outdoors. Tell your doctor if you are pregnant before using this medication. It is very important that your doctor check your progress closely while you are using divalproex sodium to see if it is working properly and to allow for a change in the dose. Blood tests may be needed to check for any unwanted effects. Haidukewych D, Rodin EA, Zielinski JJ. Derivation and evaluation of an equation for prediction of free phenytoin concentration in patients co-medicated with valproic acid. The results of two multicenter, randomized, double-blind, placebo-controlled clinical trials established the effectiveness of divalproex sodium in the prophylactic treatment of migraine headache. It is not known when during pregnancy cognitive effects in valproate-exposed children occur. Because the women in this study were exposed to antiepileptic drugs throughout pregnancy, whether the risk for decreased IQ was related to a particular time period during pregnancy could not be assessed. It is not known exactly how these medicines affect mood. But experts think they may slow down certain electrical impulses in the that are linked to and mood problems. Take divalproex sodium delayed-release tablets exactly as your healthcare provider tells you. Your healthcare provider will tell you how many divalproex sodium delayed-release tablets to take and when to take them.
Monks A, Richens A. Effect of single doses of sodium valproate on serum phenytoin levels and protein binding in epileptic patients. The presence of other medical problems may affect the use of divalproex sodium. Take divalproex sodium exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To keep blood levels constant, take divalproex sodium at the same time each day and do not miss any doses. Drinking alcohol with this medicine can cause side effects. Divalproex delayed-release tablets are an anticonvulsant. It works by reducing or preventing the number of seizures by controlling the abnormal activity of nerve impulses in the brain and central nervous system. Exactly how it works to treat bipolar disorder and migraine headache is not known. Do not share this medication with others. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. This medication passes into breast milk. Consult your doctor before breast-feeding. Food and Drug Administration FDA has issued a warning on anticonvulsants and the risk of and thoughts. The FDA does not recommend that people stop using these medicines. May also interfere with valproate's metabolism. Valproate was found to inhibit the metabolism of phenobarbital. Metabolic and Nutritional Disorders: Peripheral edema, SGOT increase, and SGPT increase. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. All medicines may cause side effects, but many people have no, or minor, side effects. truvada
Counsel patients, their caregivers, and families that AEDs, including divalproex sodium, may increase the risk of suicidal thoughts and behavior and to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Windorfer A Jr, Sauer W, Gadeke R. Elevation of diphenylhydantoin and primidone serum concentration by addition of dipropylacetate, a new anticonvulsant drug. The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and Drugs. Chiu CT, Wang Z, Hunsberger JG, Chuang DM 2013. PDF. Pharmacol. Rev. American Academy of Child and Adolescent Psychiatry 2007. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 461: 107-125. Macritchie, KA 2006 October 1. Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder. Read the Guide provided by your before you start taking and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist. There is no body of evidence available from controlled trials to guide a clinician in the longer term management of a patient who improves during divalproex sodium delayed-release tablet treatment of an acute manic episode. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of new manic episodes, there are no data to support the benefits of divalproex sodium delayed-release tablets in such longer-term treatment. Although there are no efficacy data that specifically address longer-term antimanic treatment with divalproex sodium delayed-release tablets, the safety of divalproex sodium delayed-release tablets in long-term use is supported by data from record reviews involving approximately 360 patients treated with divalproex sodium delayed-release tablets for greater than 3 months. RxList is part of the WebMD Health Network. The opinions expressed in the WebMD User Reviews are solely those of the User, who may or may not have medical or scientific training, and do not represent the opinions of WebMD. These member reviews have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other purpose except for compliance with our Terms and Conditions. Continue to take divalproex delayed-release tablets even if you feel well. Do not miss any doses. Divalproex delayed-release tablets works best when there is a constant level of it in your body. Valproate can cause decreased IQ scores following in utero exposure. Published epidemiological studies have indicated that children exposed to valproate in utero have lower cognitive test scores than children exposed in utero to either another antiepileptic drug or to no antiepileptic drugs. Women who intend to become pregnant should switch to a different medication if possible, or decrease their dose of valproate. Women who become pregnant while taking valproate should be warned that it causes birth defects and cognitive impairment in the newborn, especially at high doses although valproate is sometimes the only drug that can control seizures, and seizures in pregnancy could have even worse consequences. Anderson Gail D. Chapter 42: Pharmacokinetics and Drug Interactions. Ask a family member of friend for support. They can help you keep up with your appointments and medications. The following list provides information about the potential for an influence of several commonly prescribed medications on valproate pharmacokinetics. The list is not exhaustive nor could it be, since new interactions are continuously being reported. gamno.info alfuzosin
Uchida, Hiroshi; Maruyama, Tetsuo; Arase, Toru; Ono, Masanori; Nagashima, Takashi; Masuda, Hirotaka; Asada, Hironori; Yoshimura, Yasunori 2005. "Histone acetylation in reproductive organs: Significance of histone deacetylase inhibitors in gene transcription". Reproductive Medicine and Biology. Concomitant administration of topiramate with valproate has also been associated with hypothermia in patients who have tolerated either drug alone. Anyone considering prescribing divalproex sodium or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated. Do not drink alcohol or use medicines that may cause drowsiness eg, sleep aids, muscle relaxers while you are using divalproex sprinkle capsules; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure as required. Acta Neurol. Scand. Suppl. Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms. Yoon HW, Giraldo EA, Wijdicks EF. Valproic acid and warfarin: an underrecognized drug interaction.
Do not stop taking divalproex sodium delayed-release tablets without first talking to your healthcare provider. Stopping divalproex sodium delayed-release tablets suddenly can cause serious problems. The dosage is based on your medical condition and response to treatment. In children, the dosage is also based on age and weight. Use divalproex delayed-release tablets with caution in the ELDERLY; they may be more sensitive to its effects, especially drowsiness. Birth defects may occur even in children born to women who are not taking any medicines and do not have other risk factors. Know the medicines you take. Keep a list of them and show it to your healthcare provider and pharmacist each time you get a new medicine. Although the mechanism of action of valproate is not fully understood, traditionally, its anticonvulsant effect has been attributed to the blockade of voltage-dependent sodium channels and increased brain levels of GABA. The GABAergic effect is also believed to contribute towards the anti-manic properties of valproate. Carlson GA, Meyer SE 2009. Early-onset bipolar disorder. Divalproex sodium was statistically significantly superior to placebo on all three measures of outcome. Valproate can cause fetal harm when administered to a pregnant woman. Using divalproex sodium with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Store at room temperature away from moisture and heat. What happens if I miss a dose? This information should not be used to decide whether or not to take divalproex sprinkle capsules or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about divalproex sprinkle capsules. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to divalproex sprinkle capsules. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using divalproex sprinkle capsules. Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day to keep the amount of medication in your constant. Narayanaswamy, Sudha November 2010. MAO Inhibitors and tricyclic antidepressants cause both drug toxicity. The tablets are intended for oral administration only. They should be swallowed whole with water and not crushed or chewed. norethisterone generic otc
If pancreatitis is diagnosed, divalproex sodium should ordinarily be discontinued. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. Wen X, Wang JS, Kivisto KT, Neuvonen PJ, Backman JT. In vitro evaluation of valproic acid as an inhibitor of human cytochrome P450 isoforms: preferential inhibition of cytochrome P450 2C9 CYP2C9. Lamotrigine is known as an anticonvulsant or antiepileptic drug. In patients over two years of age who are clinically suspected of having a hereditary mitochondrial disease, divalproex sodium delayed-release tablets should only be used after other anticonvulsants have failed. This older group of patients should be closely monitored during treatment with divalproex sodium delayed-release tablets for the development of acute liver injury with regular clinical assessments and serum liver testing. Valproate in elderly people with dementia caused increased sleepiness. More people stopped the medication for this reason. Additional side effects of weight loss and decreased food intake was also associated in one half of people who become sleepy. Grogginess in morning has always been there, could be meds for Fibromyalgia. Overall this mixture of meds has been a lifesaver! bisoprolol online canada
Wyllie's Treatment of Epilepsy: Principles and Practice, 5th Ed. 2011. If you have any questions about divalproex delayed-release tablets, please talk with your doctor, pharmacist, or other health care provider. Chateauvieux S, Morceau F, Dicato M, Diederich M 2010. PDF. J. Biomed. Biotechnol. Depakote ER 500mg. Within 2 months, it seemed to reduce my headaches to functioning level but I was always hungry. October 10, 2009 American Cancer Society. Valproic Acid. The concomitant use of valproate and propofol may lead to increased blood levels of propofol. Reduce the dose of propofol when coadministering with valproate. Monitor patients closely for signs of increased sedation or cardiorespiratory depression. Taking this medication during pregnancy can cause birth defects and may lower your child's IQ. Women of childbearing age should discuss the risks and benefits of this medication, other treatment options, and use of reliable forms of birth control with their doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor. If you are taking divalproex sodium only to prevent migraine headaches, this medication must not be used during pregnancy. Published epidemiological studies have indicated that children exposed to valproate in utero have lower IQ scores than children exposed to either another antiepileptic drug in utero or to no antiepileptic drugs in utero. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. Depakote divalproex sodium US prescribing information. AbbVie Inc. Abnormal function of the or gland. These side effects can increase the risk of falling. II study has supported its efficacy.
Lonergan E, Luxenberg J 2009. PDF. Cochrane Database Syst Rev 3: CD003945. This is given by injection into a vein as directed by your doctor, usually every 8 hours. Do not start, stop, or change the dosage of any medicine before checking with them first. In addition, valproate can cause decreased IQ scores following in utero exposure. Overkill by Kim Thompson, PhD and Debra Fulghum Bruce, PhD. How much of this drug is typically used? Using divalproex sodium while you are pregnant especially during the first trimester can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away. You could have all of these symptoms or some of them. Someone with bipolar disorder can sometimes feel very sad but also full of energy. The surest sign of a phase of depression is that you feel down for a long time -- usually at least 2 weeks. You might have these episodes rarely or several times a year. You may notice undissolved parts of divalproex sprinkle capsules in your stool with some brands of divalproex sprinkle capsules. Contact your doctor if this occurs. Adelaide: The Australian Medicines Handbook Unit Trust. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule. Munster P, Marchion D, Bicaku E, Lacevic M, Kim J, Centeno B, Daud A, Neuger A, Minton S, Sullivan D 2009. PDF. Clin. Cancer Res. Kwan SY 2010. PDF. Acta Neurol Taiwan. macrobid ny
Divalproex sodium delayed-release tablets USP: crospovidone, hypromellose, hypromellose phthalate, iron oxide black, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, povidone, pregelatinized starch, propylene glycol, shellac glaze, silicon dioxide, talc, titanium dioxide, and triethyl citrate. Divalproex sodium delayed-release tablets are administered orally. The recommended starting dose is 250 mg twice daily. Valproate is excreted in human milk. Caution should be exercised when valproate is administered to a nursing woman. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Meador KJ, Baker GA, Finnell RH, Kalayjian LA, Liporace JD, Loring DW, Mawer G, Pennell PB, Smith JC, Wolff MC 2006. The above medicines are taken as tablets or capsules orally. More serious side effects of lithium can include blacking out, slurred speech, and changes in rhythm or a block problems with the heart's electrical signals that cause an abnormal heartbeat. Your doctor may check medicine blood levels and may need to adjust the dose of one or both medicines. Hicks CW, Pandya MM, Itin I, Fernandez HH 2011. "Valproate for the treatment of medication-induced impulse-control disorders in three patients with Parkinson's disease". Parkinsonism Relat. Disord. Cimetidine and ranitidine do not affect the clearance of valproate. nimodipine
Nervous System: Abnormal dreams, abnormal gait, agitation, ataxia, catatonic reaction, confusion, depression, diplopia, dysarthria, hallucinations, hypertonia, hypokinesia, insomnia, paresthesia, reflexes increased, tardive dyskinesia, thinking abnormalities, vertigo. Vasudev K, Mead A, Macritchie K, Young AH 2012. "Valproate in acute mania: is our practice evidence based? The following list provides information about the potential for an influence of valproate coadministration on the pharmacokinetics or pharmacodynamics of several commonly prescribed medications. The list is not exhaustive, since new interactions are continuously being reported. Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. Divalproex sprinkle capsules has been shown to cause harm to the fetus. If you may become pregnant, discuss other possible treatment options with your doctor. If a decision is made to take divalproex sprinkle capsules, use effective birth control while you are taking it. Talk with your doctor if you are planning to become pregnant, or if you have questions or concerns about this information. Umur AS, Selcuki M, Bursali A, Umur N, Kara B, Vatansever HS, Duransoy YK 2012. "Simultaneous folate intake may prevent adverse effect of valproic acid on neurulating nervous system". Childs Nerv Syst. Henry TR 2003. "The history of valproate in clinical neuroscience". Psychopharmacol Bull.
The effects of race on the kinetics of valproate have not been studied. It is very important to take folic acid before getting pregnant and during early pregnancy to lower chances of harmful side effects to your unborn baby. Ask your doctor or pharmacist for help if you are not sure how to choose a folic acid product. The following adverse reactions have been identified during post approval use of divalproex sodium. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. The estimates cited apply primarily to patients who are not taking drugs that affect hepatic metabolizing enzyme systems. For example, patients taking enzyme-inducing antiepileptic drugs carbamazepine, phenytoin, and phenobarbital will clear valproate more rapidly. Because of these changes in valproate clearance, monitoring of antiepileptic concentrations should be intensified whenever concomitant antiepileptics are introduced or withdrawn. Seizure control is very important during pregnancy. The benefit of preventing seizures may outweigh any risks posed by taking divalproex sodium. There may be other seizure medications that can be more safely used during pregnancy. Follow your doctor's instructions about taking divalproex sodium while you are pregnant. Depakote may cause drowsiness, dizziness, or blurred vision. Patients taking Depakote should not drive, use machinery, or do anything requiring mental alertness until the effects of this drug are known. Kulkarni ML, Zaheeruddin M, Shenoy N, Vani HN 2006. "Fetal valproate syndrome". Indian J Pediatr. Wagner ML, Graves NM, Marienau K, Holmes GB, Remmel RP, Leppik IE. Discontinuation of phenytoin and carbamazepine in patients receiving felbamate. Store at room temperature away from light and moisture. not store in the bathroom. Keep all away from children and pets. Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first. Inflammation of the pancreas is a potentially life-threatening illness associated with divalproex sprinkle capsules. Symptoms include stomach pain, vomiting, or loss of appetite. Contact your doctor at once if any of these symptoms occur. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking divalproex sodium, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. This Medication Guide summarizes the most important information about divalproex sodium delayed-release tablets. If you would like more information, talk with your healthcare provider. You can ask your pharmacist or healthcare provider for information about divalproex sodium delayed-release tablets that is written for health professionals. toprol
The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs. Figure 2 presents the proportion of patients X axis whose percentage reduction from baseline in complex partial seizure rates was at least as great as that indicated on the Y axis in the adjunctive therapy study. Some MEDICINES MAY INTERACT with divalproex sprinkle capsules. Limited research shows that lithium is safe and may be effective in reducing in children. Lab tests, including complete blood cell counts, blood ammonia levels, and liver function, may be performed while you use divalproex delayed-release tablets. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Miles MV, Snead OC 3rd, Thorn MD. Predictability of unbound antiepileptic drug concentrations in children treated with valproic acid and phenytoin. Thus, in a display of this type, the curve for a more effective treatment is shifted to the left of the curve for a less effective treatment. This Figure shows that the proportion of patients achieving any particular level of reduction was consistently higher for high dose valproate than for low dose valproate. For example, when switching from carbamazepine, phenytoin, phenobarbital or primidone monotherapy to high dose valproate monotherapy, 63% of patients experienced no change or a reduction in complex partial seizure rates compared to 54% of patients receiving low dose valproate. Serious negative side effects were uncommon. Get medical help right away if you have any very serious side effects, such as: seizures, unusual weakness. August 10, Review. Seizures Emergencies Overview. This may decrease the effectiveness of hormonal products such as pills, patch, ring. Rossi, S, ed. 2013.
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This medication is given by injection into a muscle or vein as directed by your doctor, usually once or twice daily. If you are using this medication to prevent an infection, it is given by injection into a vein by a health care professional. It is given as directed by your doctor, usually 1 hour before your surgery. Thus, in a display of this type, the curve for an effective treatment is shifted to the left of the curve for placebo. This Figure shows that the proportion of patients achieving any particular level of improvement was consistently higher for valproate than for placebo. If this medication is used for seizures, do not stop taking it without consulting your doctor. Your condition may become worse if the drug is suddenly stopped. Your dose may need to be gradually decreased.
Adab N, Kini U, Vinten J, et al. November 2004. It may harm an unborn baby. Lab tests, including complete blood cell counts, blood ammonia levels, and liver function, may be performed while you use divalproex sprinkle capsules. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, Vestergaard M 2013. How can I watch for early symptoms of suicidal thoughts and actions? Mood stabilizers have been well studied in adults, but there are currently few studies in children.
Kidshealth. Blood test: Valproic Acid. Ask your doctor if you should have regular skin exams. Evidence suggests that folic acid supplementation prior to conception and during the first trimester of pregnancy decreases the risk for congenital neural tube defects in the general population.