What are the dosing guidelines for intramuscular (IM) Biotin 0.5mg/ml in a patient with normal renal function?

Intramuscular Biotin is Not Recommended

Intramuscular biotin administration is not supported by current clinical guidelines and should not be used. The ESPEN guidelines establish oral biotin as first-line treatment for biotin deficiency, with intravenous biotin reserved exclusively for parenteral nutrition-dependent patients 1.

Guideline-Based Route Selection

The evidence clearly delineates appropriate routes of administration:

• Oral biotin is the recommended first-line treatment for biotin deficiency, including cases of malabsorption or short bowel syndrome (requiring increased doses up to 10 mg/day) 1
• Intravenous biotin is reserved exclusively for parenteral nutrition-dependent patients, with doses up to 200 mg/day for 2-3 weeks 1
• Intramuscular administration is notably absent from guidelines—the American Society for Parenteral and Enteral Nutrition does not mention IM biotin administration in its guidelines, despite explicitly discussing IM routes for other micronutrients like vitamin D 1

Standard Dosing for Appropriate Routes

Since IM biotin lacks guideline support, the appropriate alternatives are:

For Oral Administration (Preferred):

• Maintenance dose: At least 30 mcg/day (Grade B recommendation) 1
• Deficiency treatment: 10 mg/day for malabsorption/short bowel cases 1
• Absorption: Nearly complete in humans, even in malabsorption states 2

For IV Administration (PN-dependent patients only):

• Maintenance dose: 60 mcg/day (Grade B recommendation) 1
• Deficiency treatment: Up to 200 mg/day for 2-3 weeks 1

Clinical Pitfalls

Common error: Assuming IM biotin is appropriate because a 0.5 mg/ml formulation exists. The absence of IM biotin from major nutrition society guidelines, despite explicit mention of IM routes for other vitamins, indicates this route is not evidence-based 1.

Safety consideration: While biotin has no established upper limit and no adverse effects reported with doses up to 5 mg/day for prolonged periods 1, 3, this safety profile applies to oral and IV routes only.

Renal Function Considerations

For patients with normal renal function (as specified in your question):

• Standard oral dosing applies without adjustment 1
• Renal replacement therapy may require additional biotin amounts, but this does not apply to your patient 1