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Biotin is a cofactor for five carboxylase enzymes critical to metabolism: pyruvate carboxylase, acetyl-CoA carboxylases (1 and 2), propionyl-CoA carboxylase, and 3-methylcrotonyl-CoA carboxylase. True deficiency is rare in developed countries — biotin is widely distributed in foods and produced by gut bacteria.
Populations at risk: pregnant women (accelerated biotin catabolism), individuals on long-term anticonvulsants (carbamazepine, phenytoin), chronic alcohol users, and people consuming large amounts of raw egg whites (avidin binds biotin).
Accelerate biotin metabolism → depletion risk
HIGH-DOSE BIOTIN INTERFERES WITH STREPTAVIDIN-BIOTIN IMMUNOASSAYS — causes FALSE troponin results (may miss heart attack) and FALSE thyroid results
This is biotin's most important safety concern. Biotin at doses ≥1,000mcg interferes with streptavidin-biotin immunoassays used in most clinical laboratories:
The FDA issued a safety communication in November 2017 about this interference. Patients taking high-dose biotin should stop supplementation 72 hours before any blood work.
Not Prohibited
Colombo VE et al. Treatment of brittle fingernails with biotin.
McCarty MF. High-dose biotin as adjuvant to chromium for type II diabetes.
Li D et al. Biotin interference with diagnostic immunoassays. FDA Safety Communication.
Katzman BM et al. Biotin supplementation causes erroneous thyroid function results.
Independently graded against 173,636 indexed supplements with 177 published clinical interactions, sourced from PubMed, FDA CAERS, openFDA, and NIH DSLD | Last updated: April 2026
Not medical advice. Based on published clinical research and systematic reviews.