Biotin (Systemic)


VA CLASSIFICATION
Primary: VT190

Other commonly used names are
vitamin H , coenzyme R, or vitamin Bw . {03}
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Nutritional supplement (vitamin)—
Note: Biotin is a water-soluble B-complex vitamin. {08}



Indications

Accepted

Biotin deficiency (prophylaxis and treatment){07}—The B vitamins are indicated for prevention and treatment of vitamin B deficiency. Vitamin B deficiency may occur as a result of inadequate nutrition or intestinal malabsorption but does not occur in healthy individuals receiving an adequate balanced diet. Simple nutritional deficiency of individual B vitamins is rare since dietary inadequacy usually results in multiple deficiencies. For prophylaxis of biotin deficiency, dietary improvement, rather than supplementation, is advisable. For treatment of biotin deficiency, supplementation is preferred.

—Biotin deficiency may lead to dermatitis, alopecia, hypercholesterolemia, and cardiac abnormalities. {01} {02}

Requirements may be increased and/or supplementation may be necessary in the following conditions (based on documented biotin deficiency):—

• Biotinidase deficiency {03} {09}


• Gastrectomy {03}


• Seborrheic dermatitis of infancy {03}

—Administration of large amounts of the biotin antagonist, avidin, which is found in raw egg whites, has also been found to cause biotin deficiency. {02} {03}

—Some unusual diets (e.g., reducing diets that drastically restrict food selection) may not supply minimum daily requirements of biotin. Supplementation may be necessary in patients receiving total parenteral nutrition (TPN) {03} {10} {11} or undergoing rapid weight loss or in those with malnutrition, because of inadequate dietary intake.

Unaccepted
Biotin has not been proven effective in the treatment of acne, seborrheic eczema, or alopecia. {03}


Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    244.31 {03}

Mechanism of action/Effect:

Biotin is necessary for the proper functioning of enzymes that transport carboxyl units and fix carbon dioxide, {01} and is required for various metabolic functions, including gluconeogenesis, lipogenesis, fatty acid biosynthesis, propionate metabolism, and catabolism of branched-chain amino acids. {01} {03}

Absorption:

Approximately 50%. {02}

Protein binding:

Primarily to plasma proteins. {05}

Elimination:
    Primarily in urine. {02}


Precautions to Consider

Pregnancy/Reproduction

Problems in humans have not been documented with intake of normal daily recommended amounts.

Breast-feeding

Problems in humans have not been documented with intake of normal daily recommended amounts.

Pediatrics

Problems in humans have not been documented with intake of normal daily recommended amounts.


Geriatrics


Problems in humans have not been documented with intake of normal daily recommended amounts.

Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Biotin, plasma or urine{02}    (periodic determinations are recommended to assess biotin status)




Side/Adverse Effects
No side effects have been reported with intakes of biotin as high as 10 mg daily. {01}



Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Biotin (Systemic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Description of use
Description should include function in the body, signs of deficiency, and unproven uses


Importance of diet
Importance of proper nutrition; supplement may be needed because of inadequate dietary intake

Food sources of biotin; effects of processing

Not using vitamins as substitute for balanced diet

Recommended daily intake for biotin

Proper use of this dietary supplement

» Proper dosing
Missed dose: No cause for concern because of length of time necessary for depletion; remembering to take as directed

» Proper storage


General Dosing Information
Because of the infrequency of single B vitamin deficiencies, combinations are commonly administered. Many commercial combinations of B vitamins are available.


For parenteral dosage form only
Biotin is available as part of a multivitamin complex. Manufacturers recommend a dose of 60 mcg a day for adults and 20 mcg a day for children, added to a TPN solution. {12} {13}

Diet/Nutrition
Recommended dietary intakes for biotin are defined differently worldwide.


For U.S.:
The Recommended Dietary Allowances (RDAs) for vitamins and minerals are determined by the Food and Nutrition Board of the National Research Council and are intended to provide adequate nutrition in most healthy persons under usual environmental stresses. In addition, a different designation may be used by the FDA for food and dietary supplement labeling purposes, as with Daily Value (DV), which replaces the previous labeling terminology United States Recommended Daily Allowances (USRDAs). {17}



For Canada:
Recommended Nutrient Intakes (RNIs) for vitamins, minerals, and protein are determined by Health and Welfare in Canada and provide recommended amounts of a specific nutrient while minimizing the risk of chronic diseases. {16}



There is no RDA or RNI established for biotin. Daily recommended intakes for biotin are generally defined as follows {01} {16}:


Infants and children–—
Birth to 3 years of age: 10 to 20 mcg.

4 to 6 years of age: 25 mcg.

7 to 10 years of age: 30 mcg.



Adolescents and adults–—
30 to 100 mcg.


The best sources of biotin include liver, cauliflower, salmon, carrots, bananas, soy flour cereals, and yeast. {01} {02} {03} {04} Additional biotin is added from synthesis by intestinal microorganisms. {01} {03} Processing and preservation of food reduces its biotin content. {03}



Oral Dosage Forms

BIOTIN CAPSULES

Usual adult and adolescent dose
Deficiency (prophylaxis)
Oral, amount based on normal daily recommended intakes of 30 to 100 mcg. {01} {16}

Deficiency (treatment)
Treatment dose is individualized by prescriber based on severity of deficiency.


Usual pediatric dose
Deficiency (prophylaxis)
Oral, amount based on normal daily recommended intakes: {01} {16}

Birth to 3 years of age—10 to 20 mcg.

4 to 6 years of age—25 mcg.

7 to 10 years of age—30 mcg.

Deficiency (treatment)
Treatment dose is individualized by prescriber based on severity of deficiency.


Strength(s) usually available
U.S.—


1000 mcg {04} (1 mg) (OTC)[Generic]

Canada—
Not commercially available.

Note: The strength of this preparation may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs. {18}


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.


BIOTIN TABLETS

Usual adult and adolescent dose
See Biotin Capsules.

Usual pediatric dose
See Biotin Capsules.

Strength(s) usually available
U.S.—


300 mcg (0.3 mg) (OTC)[Generic]


400 mcg{15} (0.4 mg) (OTC)[Generic]


600 mcg (0.6 mg) (OTC)[Generic]


800 mcg{06} (0.8 mg) (OTC)[Generic]

Canada—


250 mcg {18} (0.25 mg) (OTC)[Generic]

Note: The strength of these preparations may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs.


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.



Revised: 04/25/1995



References
  1. National Research Council. Recommended dietary allowances. 10th ed. Washington DC: National Academy Press, 1989: 165-9.
  1. Baily L. Biotin. In: Baumgartner TG, ed. Clinical Guide to Parenteral Micronutrition. Melrose Park, IL: Educational Publications, 1984: 319-27.
  1. Bonjour J. Biotin. In: Machlin LJ, ed. Handbook of Vitamins. New York: Marcel Dekker, Inc., 1991: 393-427.
  1. Redbook 1993. Montvale NJ: Medical Economics Data, 1993: 134.
  1. Roth K. Biotin in clinical medicine—a review. Am J Clin Nutr 1981; 34: 1967-74.
  1. Redbook 1993. Montvale NJ: Medical Economics Data, 1993: 134. (Sundown Vitamin)
  1. Not in 1993 CPS, but phone call to Jamieson/Canada on 9/8/93 confirmed these tablets.
  1. Bonjour J. Biotin in man's nutrition and therapy—a review. Internat J Vit Nutr Res 1977; 47: 107-18.
  1. Wolf B, Grier R, McVoy S, Heard G. Biotinidase deficiency: a novel vitamin recycling defect. J Inher Met Dis 1985; 53(Suppl 1): 53-8.
  1. Mock D, Baswell D, Baker H et al. Biotin deficiency complication parenteral alimentation: diagnosis, metabolic repercussions, and treatment. J Pediatr 1985; 106: 762-9.
  1. Mock D, DeLorimer A, Liebman W, Sweetman L et al. Biotin deficiency: an unusual complication of parenteral alimentation. N Eng J Med 1981; 304(14): 820-3.
  1. MVI-12 product information (Rhone-Poulenc—U.S.) 1991 PDR, p. 1784.
  1. MVI 9 & 4(pediatric) product information (LyphoMed—U.S.), Rev 1/90.
  1. Panelist comment, 1991.
  1. New strength, per phone call to Major, 9/9/93.
  1. Health and Welfare Canada. Nutrition Recommendations, the report of the scientific review committee. Ottawa Canada: Canadian Government Publishing Centre, 1990: 11-12, 128, 204.
  1. Willis JL, editor. Focus on food labeling. FDA Consumer 1993; May: 40-5.
  1. Panel consensus, 1992.
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