Safety, interactions, side effects


Biotin supplementation is considered safe, with rare instances of any adverse effects. However, oral biotin supplements are metabolized via the hepatic cytochrome P450 enzyme chain. In doing so, biotin interacts with anti-epileptic drugs, including carbamazepine, phenobarbital, and phenytoin.9 This interaction reduces the amount of available biotin, which may necessitate biotin supplementation in patients who take anti-epileptic drugs.9

Patients who make their own protein shakes and supplements should be aware that raw egg white aggressively bonds to biotin, making biotin unavailable for metabolism.9 Frequent ingestion of raw egg whites therefore can produce a significant deficiency in biotin.



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Cost, how supplied, dose


Generic biotin and micronutrient supplements are inexpensive, ranging from $10 to $25 per month. Supplements are most often in the form of a tablet or capsule. The recommended dose is 30 to 100 mcg/day for adults and adolescents, ­
30 mcg/day in children aged 7 to 10 years, 25 mcg/day in children aged 4 to 6 years, and 10 to 20 mcg/day for children aged 3 years or less.10

Preconception and prenatal supplementation is highly recommended, although many tables of recommended daily allowances do not indicate special dose considerations for these women.10 Foods high in biotin include liver, cauliflower, salmon, carrots, bananas, cereals, and yeast.10

Summary


Considering the relatively low potential for adverse effects, patients who are contemplating pregnancy or those who smoke, drink, or take anti-epileptic drugs should increase their biotin consumption. The choice of increasing biotin levels by supplement or by ingesting more biotin-rich foods is certainly an individual one, but the end result might prove to be very important.

References


  1. Lin S, Hanson RE, Cronan JE. Biotin synthesis begins by hijacking the fatty acid synthetic pathway. Nature Chem Biol. 2010;6(9):682-688. Available at ncbi.nlm.nih.gov/pmc/articles/PMC2925990

  2. U.S. National Library of Medicine. Compound summary for biotin. September 16, 2004. Available at pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=171548
  3. Zempleni J, Kuroishi T. Biotin. Adv Nutr. 2012;3(2):213-214.

  4. Scheinfeld NS, Freilich SB. Biotin deficiency. Medscape. Updated February 6, 2014. Available at emedicine.medscape.com/article/984803-overview
  5. Higdon J, Drake VJ, Mock D. Biotin. Linus Pauling Institute. Updated August 2008. Available at lpi.oregonstate.edu/infocenter/ ­vitamins/biotin/index.html

  6. Mock DM. Marginal biotin deficiency is common in 
normal human pregnancy and is highly teratogenic in mice. 
J Nutr. 2009;139(1):154-157. Available at ncbi.nlm.nih.gov/pmc/articles/PMC2646213

  7. Sealy WM, Teague AM, Stratton SL, Mock DM. Smoking accelerates biotin catabolism in women. Am J Clin Nutr. 2004;80(4):932-935. Available at ncbi.nlm.nih.gov/pmc/articles/PMC1450014

  8. Maebashi M, Makino Y, Furukawa Y, et al. Therapeutic evaluation of the effect of biotin on hyperglycemia in patients with non-insulin-dependent diabetes mellitus. 
J Clin Biochem Nutr. 1993;14(3):211-218. 
Available at www.jstage.jst.go.jp/article/jcbn1986/14/3/14_3_211/_article

  9. Biotin. In: Natural Medicines Comprehensive Database. Stockton, Calif.: Therapeutic Research Faculty 
(naturaldatabase.therapeuticresearch.com)

  10. Mayo Clinic. Biotin (oral route). Updated September 1, 2014. Available at mayoclinic.org/drugs-supplements/biotin-oral-route/description/DRG-20062359


All electronic documents accessed November 3, 2014.


Sherril Sego, FNP-C, DNP, is a staff clinician at the VA Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas.