IV Biotin Dosing Guidelines
For IV biotin repletion, administer up to 200 mg/day for 2-3 weeks in parenteral nutrition-dependent patients with documented biotin deficiency. 1
Route Selection Algorithm
IV biotin is reserved exclusively for specific clinical scenarios—you should NOT use IV biotin unless the patient meets these criteria:
- Parenteral nutrition (PN)-dependent patients who cannot receive enteral/oral nutrition 1
- Patients with complete intestinal failure requiring total PN 1
Oral biotin is first-line for all other scenarios, including malabsorption and short bowel syndrome, where doses up to 10 mg/day orally are recommended rather than IV administration 1. This is a critical distinction—even severe malabsorption does not automatically warrant IV therapy.
IV Dosing Regimens
Treatment of Deficiency (PN-Dependent Patients)
- Acute repletion dose: Up to 200 mg/day IV for 2-3 weeks 1
- This high-dose regimen is supported by ESPEN guidelines specifically for PN-dependent patients with documented deficiency 1
Maintenance Dosing in Parenteral Nutrition
- Standard PN maintenance: 60 mcg/day IV (Grade B recommendation) 1
- This represents the baseline requirement for patients on long-term PN 1
- One case report demonstrated successful maintenance with 60 mcg/day after initial repletion with 5 mg/day 2
Special Considerations
Renal Replacement Therapy
- Patients on dialysis may require additional biotin supplementation beyond standard PN doses due to dialytic losses 1
- Specific dosing adjustments are not well-established but should be considered 1
Safety Profile
- No upper limit has been established for biotin intake 1, 3
- No adverse effects reported with IV doses up to 5 mg/day for prolonged periods 1, 3
- The 200 mg/day treatment dose is well-tolerated for short-term (2-3 week) repletion 1
Critical Pitfalls to Avoid
Biotin interference with laboratory assays: High-dose biotin (>5 mg/day) interferes with streptavidin-biotin immunoassays, causing falsely abnormal results for troponin, thyroid function tests, beta-hCG, and tumor markers 4. Patients should abstain from biotin for 48 hours before critical laboratory testing 4.
Inappropriate IV use: Do not default to IV biotin for convenience in patients with functional GI tracts—oral absorption is nearly complete even in malabsorption states, though higher oral doses (10 mg/day) may be needed 1, 5.