ARP [N-(Aminooxyacetyl)-N¡-(D-biotinoyl) hydrazine], biocytin, biotin-alkaline phosphate, biotin cadaverine, biotin nitrilotriacetic acid, biotin NTA , biotin-PEO4-amine, Biotin-PEO2-PPO2-amine, biotin-PEO3-maleimide, biotin-PEO4-propionate succinimidyl ester, biotinidase, coenzyme R, D-biotincis-hexahydro-2-oxo-1H-thieno[3,4-d]-imidazole-4-valeric acid, dUTP biotin, factor alpha, tripotassium salt (BNTA), vitamin Bw, vitamin H, W factor.
Note: This review does not cover the use of biotin in radioimmunotherapy (radioactive therapy) or radio-labeling for diagnostic procedures.
Biotin is an essential water-soluble B vitamin. The name biotin is taken from the Greek word bios meaning "life." Without biotin, certain enzymes do not work properly and various complications can occur involving the skin, intestinal tract, and nervous system. Metabolic problems including very low blood sugars between meals, high blood ammonia, or acidic blood (acidosis) can occur. Death is theoretically possible, although no clear cases have been reported. Recent studies suggest that biotin is also necessary for processes on the genetic level in cells (DNA replication and gene expression).
Biotin deficiency is extremely rare. This is because daily biotin requirements are relatively small, biotin is found in many foods, and the body is able to recycle much of the biotin it has already used. Significant toxicity has not been reported in the available literature with biotin intake.
Biotin deficiency is extremely rare. Some potential causes of biotin deficiency are: long-term use of certain anti-seizure medications; prolonged oral antibiotic use; intestinal malabsorption (for example short gut syndrome); intravenous feeding (total parenteral nutrition/TPN) without added biotin; and eating raw egg whites on a regular basis. Supplementing with biotin appears helpful for the treatment of this deficiency.
Biotin-responsive inborn errors of metabolism:
Disorders such as multiple carboxylase deficiency can cause inborn errors of metabolism that cause a "functional" biotin deficiency. High-dose biotin is used to treat these disorders. Management should be under strict medical supervision.
Biotin has been suggested as a treatment for brittle fingernails, particularly in women. There is not sufficient scientific evidence to form a clear conclusion.
Cardiovascular disease risk (in diabetics):
A combination of biotin and chromium may help lower cholesterol and decrease the risk of developing clogged arteries (called atherosclerosis) in diabetics. However, other research of biotin alone found that biotin did not affect cholesterol, glucose, or insulin levels, but did decrease triglyceride levels. More research with biotin alone is needed.
Diabetes mellitus (type 2):
In early research, biotin has been reported to decrease insulin resistance and improve glucose tolerance, which are both properties that may be beneficial in patients with types 2 (adult-onset) diabetes. Other research suggests that a combination of biotin and chromium may help improve blood sugar control. However, there is not enough human evidence to form a clear conclusion in this area.
Hepatitis (in alcoholics):
Antioxidant therapy with biotin, vitamins A-E, selenium, zinc, manganese, copper, magnesium, folic acid, Coenzyme Q10 did not improve survival rates in alcoholics with hepatitis. More research with biotin alone is needed.
Marginal biotin deficiency has been found to commonly occur during pregnancy. Biotin supplementation during pregnancy is not currently standard practice, and prenatal vitamins generally do not contain biotin. However, individual patients may be considered for biotin supplementation by healthcare practitioners on a case-by-case basis. Additional study is needed in this area.
Total parenteral nutrition (TPN):
Intravenous feeding solutions (TPN) should contain biotin, in order to avoid biotin deficiency in recipient patients. This applies for patients in whom TPN is the sole source of nutrition. More study is needed in this area to make a firm recommendation.
The U.S. Food and Nutrition Board of the National Academy of Science's Institute of Medicine recommends a daily Adequate Intake (AI) of 30 micrograms in adults 19 years and older (a daily AI of 25 micrograms is recommended in those ages 14-18 years old). In pregnant women older than 14 years, an AI of 30 micrograms is recommended. During breastfeeding, a daily AI of 35 micrograms is recommended. Most healthy non-pregnant individuals with regular diets obtain these amounts of biotin through dietary consumption.
The U.S. Recommended Dietary Allowance (RDA) for biotin is 300 micrograms daily. This is the dose used in many dietary supplements. Toxicity with biotin intake has not been reported in the available literature, and doses as high as 200 milligrams daily have been used in patients with inborn errors of metabolism without significant reported toxicity.
Biotin is available as capsules and tablets in various doses and as lozenges. Treatment for biotin deficiency should be under strict medical supervision. There is disagreement among experts about the proper dose. In adults, intramuscular (injected into the muscle) doses as low as 150-300 micrograms daily have been suggested. Higher doses between 10-40 milligrams of biotin daily have also been recommended (given by mouth, injected into the muscle, or injected into the veins).
The U.S. Food and Nutrition Board of the National Academy of Science's Institute of Medicine recommends a daily Adequate Intake (AI) of 5 micrograms daily (~0.7 micrograms per kilogram) in infants ages 0-6 months old; 6 micrograms daily (~0.7 micrograms per kilogram) in infants ages 7-12 months old; 8 micrograms daily in children ages 1-3 years old; 12 micrograms daily in children ages 4 8 years-old; 20 micrograms daily in children ages 9-13 years old; and 25 micrograms in adolescents ages 14-18 years old.
Treatment for biotin deficiency and biotin-responsive inborn errors of metabolism should be under strict medical supervision. There is disagreement among experts about the proper dose.
Individuals with hypersensitivity to constituents of biotin supplements should avoid these products.
Significant toxicity with biotin intake has not been reported in the available literature, and very high doses have been used in patients with inborn errors of metabolism without reported toxicity. However, doses higher than the U.S. Food and Nutrition Board's recommended daily Adequate Intake (AI) should not be exceeded in healthy individuals unless under medical supervision.
Marginal biotin deficiency has been found to commonly occur during pregnancy. Serious concern has been focused on this finding because biotin deficiency is teratogenic (causes birth defects) in many animals. It has been suggested by some experts that biotin supplements should be considered for widespread use in pregnant women, although there is not enough available scientific information to make this recommendation.
The recommended daily adequate intake (AI) by the U.S. Food and Nutrition Board should not be exceeded unless under medical supervision.
Anti-seizure medications, such as phenytoin (Dilantin®), primidone (Mysoline®), carbamazepine (Tegretol®), phenobarbital (Solfoton®), and possibly valproic acid, have been associated with reduced blood levels of biotin. Patients using these medications should consult with a qualified healthcare professional, including a pharmacist, to see if biotin supplementation may be necessary.
Broad-spectrum antibiotics such as sulfa drugs can alter the normal intestinal bacteria (flora) that make biotin. Biotin supplementation may be necessary if deficiency is found.
Isotretinoin (Accutane®) may reduce biotinidase activity. It is not clear if biotin supplementation may be warranted during long-term use.
Biotin may increase the effects of lipid-lowering medications.
High-doses of pantothenic acid can lead to malabsorption of biotin in the gut and can lower levels of biotin in the body. Caution is advised.
Biotin may increase the effects of lipid-lowering herbs or supplements.
Eating raw egg whites on a regular basis increases the risk of biotin deficiency.
This information was created based on a systematic review of the scientific literature, and was peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Rae Abrams, PharmD (University of Rhode Island); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cynthia Dacey, PharmD (Northeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Christine Ulbricht, BS (University of Massachusetts); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration.
Adhisivam B, Mahto D, Mahadevan S. et al. Biotin responsive limb weakness. Indian Pediatr. 2007 Mar;44(3):228-30.
Albarracin C, Fuqua B, Geohas J, et al. Combination of chromium and biotin improves coronary risk factors in hypercholesterolemic type 2 diabetes mellitus: a placebo-controlled, double-blind randomized clinical trial. J Cardiometab Syndr 2007 Spring;2(2):91-7.
Baumgartner ER, Suormala T. Multiple carboxylase deficiency: inherited and acquired disorders of biotin metabolism. Int J Vitam Nutr Res 1997;67(5):377-384.
Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998:374-389.
Friebel D, von der Hagen M, Baumgartner ER, et al. The first case of 3-methylcrotonyl-CoA carboxylase (MCC) deficiency responsive to biotin. Neuropediatrics 2006 Apr;37(2):72-8.
Geohas J, Daly A, Juturu V, et al. Chromium picolinate and biotin combination reduces atherogenic index of plasma in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Am J Med Sci 2007 Mar;333(3):145-53.
Mock DM, Mock NI, Nelson RP, et al. Disturbances in biotin metabolism in children undergoing long-term anticonvulsant therapy. J Pediatr Gastroenterol Nutr 1998;26(3):245-250.
Mock DM, Stadler DD, Stratton SL, et al. Biotin status assessed longitudinally in pregnant women. J Nutr 1997;127(5):710-716.
Neiva RF, Al-Shammari K, Nociti FH Jr, et al. Effects of vitamin-B complex supplementation on periodontal wound healing. J Periodontol 2005 Jul;76(7):1084-91.
Revilla-Monsalve C, Zendejas-Ruiz I, Islas-Andrade S, et al. Biotin supplementation reduces plasma triacylglycerol and VLDL in type 2 diabetic patients and in nondiabetic subjects with hypertriglyceridemia. Biomed Pharmacother 2006 May;60(4):182-5.
Seymons K, De Moor A, De Raeve H, et al. Dermatologic signs of biotin deficiency leading to the diagnosis of multiple carboxylase deficiency. Pediatr Dermatol 2004;21(3):231-235.
Singer GM, Geohas J. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized trial.
Stewart S, Prince M, Bassendine M, et al. A randomized trial of antioxidant therapy alone or with corticosteroids in acute alcoholic hepatitis. J Hepatol 2007 Aug;47(2):277-83.
Strom CM, Levine EM. Chronic vaginal candidiasis responsive to biotin therapy in a carrier of biotinidase deficiency. Obstet Gynecol 1998;92(4 Pt 2):644-646.
van den BH. Bioavailability of biotin. Eur J Clin Nutr 1997;51 Suppl 1:S60-S61.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.