Biotin × carbamazepine: reverse-direction association with plasma biotin status
research showsOnly the reverse-direction association of carbamazepine with plasma biotin is assessed. An adult 40-person monotherapy subgroup was described as lower than sodium-valproate recipients, but no direct oral-biotin add-on trial or exact contrast/CI was verified. Pediatric nonsignificant serum findings are not pooled, and no effect of biotin on drug AUC, seizures or toxicity is claimed.
ads claimNot evidence for advertising altered drug absorption/effectiveness or a need for supplementation.
Read the illustrated explanation (Korean) →
Four separate assessment dimensions
| Effect direction and size | Only the reverse-direction association of carbamazepine with plasma biotin is assessed. An adult 40-person monotherapy subgroup was described as lower than sodium-valproate recipients, but no direct oral-biotin add-on trial or exact contrast/CI was verified. Pediatric nonsignificant serum findings are not pooled, and no effect of biotin on drug AUC, seizures or toxicity is claimed. |
|---|---|
| Evidence certainty | A directional signal in older observational evidence, not an established causal effect or risk grade. Nonsignificant pediatric results with a different specimen limit generalization. |
| Applicability | Restricted to observational long-term anticonvulsant monotherapy in adults with epilepsy. Added sole oral-biotin coexposure was not directly verified. |
| Safety | Pair-specific supplementation safety and clinical harm remain unverified. Biotin interference with some susceptible assays is a separate risk, not a drug PK/PD effect. Missing reports and nonsignificance do not establish safety; research dose notations are not personal dosing, prescription-change or interruption instructions. |
Grade/score remain null after reviewing current interaction routing and scoring axis-0 applicability. rules/calculator.py was not executed; output/errors/exit code/PASS are null/not executed. Existing ID3158 mapping is reused for the update, but no site deployment was performed in this chat.
Useful facts when choosing a product
- Biotin is the nutrient target; no specific product is recommended.
- Actual sole oral-biotin formulation, molecular form, active dose and total intake were not verified.
- The paper's200 mg carbamazepine notation is a dose-equivalence unit, not a verified daily dose.
Chamgap Semantic Classification Code
Permanent code issued
S.biotin-status-under-carbamazepine.cbz-biotin-route-form-dose-unverified.adult-epilepsy-cbz-monotherapy.chronic-exam-plasma-biotin-nmol-l.valproate-monotherapy-context-separateSupplements and nutraceuticals > Biotin–carbamazepine: drug-to-biotin status > Oral is intended; actual CBZ/additional-biotin route for the 40-person subgroup unverified > Adults with epilepsy on long-term CBZ as the sole anticonvulsant; nutritional adequacy/deficiency unverified > Plasma biotin concentration(nmol/L) during long-term treatment; exact time unreported > Primary VPA monotherapy; pooled 404-versus 112 reference comparison is context only and kept separate
Original ungraded interaction, reverse plasma-marker scope, four nonexecution receipts, 51 uncertainties and full bilingual reports preserved without clinical recalculation. The code identifies the intervention and claim; it never contains the evidence grade, score, or safety result.
Exact Claim Classification
These independent facets prevent evidence from different forms, routes, populations, effects, and comparators from being mixed.
| Intervention class | S · Supplement or nutraceutical |
|---|---|
| Canonical ingredient or intervention | Biotin |
| Source or part used | Nutrient target; actual supplement source/molecular form unverified |
| Formulation or processing | Sole oral biotin is intended; added product/formulation/purity unverified in the core observation |
| Route | Oral is intended; actual CBZ/additional-biotin route for the 40-person subgroup unverified |
| Dose | Unverified; the CBZ200 mg equivalence unit is not an actual prescription |
| Duration | Examination during long-term treatment; exact exposure duration/sampling time null |
| Population | Adults with epilepsy on long-term CBZ as the sole anticonvulsant; nutritional adequacy/deficiency unverified |
| Effect or condition | Reverse-direction carbamazepine-to-biotin-status association |
| Primary endpoint | Plasma biotin concentration(nmol/L) during long-term treatment; exact time unreported |
| Comparator | Primary VPA monotherapy; pooled 404-versus 112 reference comparison is context only and kept separate |
| Duplicate-detection key | biotin|carbamazepine_to_biotin_status|adult_epilepsy_monotherapy|plasma_biotin_nmol_L|chronic_exam_exact_time_unknown|valproate_comparator|oral_addon_unverified |
What the research actually shows
Biotin × carbamazepine: the reverse-direction association with plasma biotin status
TASK-1042 / R01-082 · Separate interaction report · Evidence cutoff: 2026-09-17T19:21:55+09:00 · Update consistency review: 2026-09-20
1. Thirty-second answer
The selected pair is biotin–carbamazepine, the direction is carbamazepine exposure → biotin status, and the primary endpoint is plasma biotin concentration (nmol/L) at an examination during long-term treatment. An older adult epilepsy observational report describes lower plasma biotin in 40 carbamazepine-monotherapy recipients than in sodium-valproate-monotherapy recipients. This is not a trial adding sole oral biotin, and it does not establish an exact carbamazepine-specific effect, confidence interval or time course.[S01]
No conclusion is made that biotin supplementation changes carbamazepine AUC, seizure control, effectiveness or toxicity. A separate pediatric serum study reported no significant biotin differences. Its findings were not pooled with adult plasma data, and nonsignificance was not relabeled equivalence or absence of interaction.[S03] The current conclusion is a limited reverse-direction biochemical association signal, not an established clinical harm rate or indication for supplementation.
Assessment: grade null · score null · not_applicable_or_policy_missing. The current rules/common_research_prompt.md interaction-routing rule does not force efficacy A–F onto this question. This is an update to existing site ID 3158; ID, slug, URLs and first-publication timestamp are preserved. Manuscript status is ready_with_uncertainty and content verification is completed_with_declared_scope; this update has not been applied or deployed to the site in this chat. Document quality A is an editorial self-assessment, not an efficacy grade or independent external certification.[P01][P02]
2. Research question versus the observed evidence
| Boundary | Selection and verified scope |
|---|---|
| One pair | Biotin–carbamazepine. Other drugs are comparators or exclusion boundaries. |
| One direction | Medication-to-nutrient status, separate from nutrient-to-drug PK/PD. |
| One primary endpoint | Plasma biotin concentration in nmol/L. Urinary metabolites, serum biotinidase, seizures, alopecia and assay errors are not merged. |
| Intended route/composition | Sole oral biotin coadministration is the intended question. The core study did not test added biotin. |
| Actual core population | Adult epilepsy subgroup on long-term carbamazepine as the sole anticonvulsant. Overall age range and subgroup characteristics remain distinct. |
| Primary comparison | The reported direction relative to sodium valproate monotherapy in the same paper. This is not a randomized counterfactual comparison without carbamazepine. |
| Contextual comparison | The pooled anticonvulsant cohort versus a reference group provides context only. The 404-person mean is not substituted for the effect in 40 carbamazepine recipients. |
| Actual time | Examination during long-term therapy. Exact subgroup treatment months and time after the last dose are null. |
| Direct coadministration evidence | No verified quantitative comparison satisfied added sole oral biotin, defined carbamazepine exposure and an appropriate matched-background comparator within the 2026-09-17 prior search/access scope. This is not a claim that human evidence is nonexistent. |
The narrow observational boundary was selected because an original adult monotherapy report was accessible and it is distinct from existing efficacy and TSH-interference pages. Unreported route, supplement dose and steady state were not inferred to fill the planned question. This report is an initial, bounded account of reverse-direction evidence and the directness gap, not a definitive interaction-risk table for oral supplementation.[S01][P01]
3. Duplicate boundaries and reuse
The 2026-09-17 prior research compared the supplied 3157-entry index and all 12 complete biotin candidates and found no exactly identical completed claim. This update reused those extractions, search maps, safety information and assay-interference boundaries; it did not perform a new medical search or re-open the primary papers. No completed efficacy grade was inherited.[P03]
| Existing ID | Completed boundary |
|---|---|
| 009 | Biotin; hair loss/hair growth |
| 866 | Biotin; brittle-nail thickness/strength |
| 1639 | High-dose MD1003; progressive-MS disability/walking |
| 3103 | Sole oral biotin; adult AGA non-vellus density |
| 3104 | Sole oral biotin; brittle-nail breakage events |
| 3105 | Sole added oral biotin; type-2-diabetes HbA1c |
| 3106 | Oral biotin; falsely low serum-TSH assay bias |
| 3153 | Oral biotin; atopic-dermatitis severity |
| 3154 | Oral biotin; diabetic peripheral-neuropathy pain |
| 3155 | Oral biotin; confirmed-MCI cognition scales |
| 3156 | Sole oral biotin; fasting triglycerides |
| 3157 | Sole oral biotin; progressive-MS 12-month MFIS |
In the prior research record, only supplied index entries were used for adjacent carbamazepine/valproate/divalproex IDs 1225/1255/988; their full originals were not claimed read. Their outcomes concern seizure remission or mania rather than this biotin-marker comparison. This boundary is preserved in the update.
The 2026-09-17 input/search/verification records are now explicitly separated as previous/history. In the current conversation, the only case confirmed as FULL through site application is 3155; this 3158 update has not yet been applied to the site. Old 77–81/FULL counters are not reused as the current conversation state.
4. Original evidence and numerical boundaries
Core adult evidence [S01]
The numbers and source-access states below are reused from the 2026-09-17 previous_research extraction; the primary papers were not re-opened in this update. The 1985 paper examined404 adults receiving long-term anticonvulsants and 112 reference participants, including40 carbamazepine and 21 sodium-valproate monotherapy recipients. Plasma biotin was measured with a Lactobacillus plantarum microbiological assay. Fig 5 shows monotherapy distributions and means, but no exact printed CBZ mean, dispersion or formal effect coefficient was verified. The PDF figure was inspected in the 2026-09-17 prior research; visual effect estimates and confidence intervals were not fabricated.[S01]
| Number or design item | Verified value and restriction |
|---|---|
| Overall adult age | 20–40 years; exact mean age and sex distribution in the 40-person CBZ subgroup remain unverified. |
| Reference composition | 24 staff volunteers+40 blood donors+48 dermatology patients=112. They are not all healthy randomized controls. |
| Pooled context | Plasma biotin mean(SD)0.90(0.29) versus 1.63(0.49)nmol/L; P<0.0005. These are mixed-anticonvulsant cohort values, not the CBZ effect. |
| CBZ comparison | Authors describe lower values than with sodium valproate; exact difference, ratio, CI and individual P value are null. |
| 200 mg notation | A dose-equivalence conversion unit, not a verified daily prescription or biotin study dose. |
| Three before/after observations | Phenytoin or primidone initiation, not a repeated CBZ time series. |
| Urinary organic-acid subset | A different endpoint; combination CBZ exposure is not reclassified as monotherapy. |
| Support | Partial DFG Kr659/1 support and a vitamin-company-affiliated author; complete funding, supply and independence remain unverified. |
The core report is not a randomized coadministration PK trial with a defined supplement, common diet and standardized sampling window. Treatment selection, epilepsy features, diet/intake, other medication, age and kidney function could influence marker differences. The presence of regression or analysis of variance does not establish a confounder-adjusted causal estimate for this pair. A lower biomarker is not the same as symptomatic deficiency, seizure worsening, drug failure or benefit from prescribing biotin.
Opposing, indirect and access-limited evidence
| Source | Actually verified | Use in this assessment |
|---|---|---|
| S02, 1982 | Abstract reports plasma biotin≤250 ng/L in 74% of 264 anticonvulsant-treated people. | A pooled cross-sectional proportion, not CBZ-specific incidence. Potential overlap with 1985 prevents summing people or independent cohorts. |
| S03, 2011 | 10 CBZ-treated children, 20 valproate-treated children and 75 age/sex-matched healthy controls; no significant serum-biotin or biotinidase differences reported. | Countercontext against extending the adult plasma signal to every age. No exact means/CI or equivalence conclusion; full text inaccessible. |
| S04, 1998 | 13 treated children:7 CBZ and/or phenytoin, 6phenobarbital;16 controls. Urinary biotin/metabolite and organic-acid indicators were partly discordant. | Different specimen, age and mixed exposure; not independent replication of a CBZ-only adult plasma effect. |
| S05, 1997 | Adult anticonvulsant/biotin-catabolism bibliographic identity located; direct content retrieval failed. | Human-study existence is distinct from quantitative extraction. No sample size or effect invented. |
| S06, 1989 | Intestinal biotin transport/anticonvulsant bibliographic and search lead; direct abstract/full text inaccessible. | Mechanistic lead, not verified clinical coadministration evidence. No inhibition constant or human AUC adopted. |
The biotin-treated alopecia observation in the 2011 abstract concerns valproate, a different pair and clinical endpoint. Its response was not transferred to CBZ-related biotin status or seizure outcomes. The publisher's “Review article” label and the abstract's original measurements were both recorded; inaccessible full methods were not converted into a randomized-trial classification.[S03]
5. Molecular form, route, nutrition and actual exposure
In the core observations, biotin is the measured nutrient, not a verified sole oral product with a dose and manufacturer. Manufacturing source, stereoisomer/salt, active content, purity, formulation, excipients, added dose and total intake are therefore unverified separately. “Monotherapy” was read as one anticonvulsant, not absence of every other active medicine or supplement.
Only confirmed details are retained for CBZ product, salt, release formulation, prescribed dose, interval, route and exact subgroup duration. Long-term treatment does not by itself establish steady state at a particular dose, normal kidney function, nutritional adequacy or achieved adherence. Planned oral-product conditions remain null when not verified in actual coadministration evidence.
6. Pharmacokinetics, clinical harm and measurement error are separate
Pharmacokinetics: a biotin value or one anticonvulsant concentration is not carbamazepine AUC. No eligible comparison was verified with total/free drug specification, AUC0–t/AUC0–∞/steady-state AUCτ, Cmax, geometric mean ratio and CI, Tmax, half-life, clearance, drug assay, sampling schedule, washout and sequence effects. No PK effect was calculated.
Clinical harm: defined counts, denominators, time windows, comparator risks and rechallenge observations for seizure worsening, toxicity, hospitalization or treatment failure were unavailable. No absolute/relative risk, number needed to harm, numerical interaction severity or causality probability was fabricated. A biochemical marker and an actual clinical event remain different outcomes.
Measurement: the S01 microbiological assay is not the S04 HPLC/avidin and organic-acid methods. Modern free/total-biotin distinction and metabolite-specific validation were not fully established. The historical assay was not equated automatically with modern biotin–streptavidin immunoassay interference, and complete freedom from interference was not certified. S01 describes gas chromatography or enzyme immunoassay for drug concentrations without assigning every detailed method to every drug, so this information was not promoted to a precise PK analysis.[S01][S04]
7. Safety label and action boundaries
Safety label: Caution. This does not grade the pair as a proven severe clinical hazard. The long-term and special-population safety of adding biotin during CBZ treatment was not established. Separately, biotin can produce misleading results in some susceptible assays. The FDA warning about falsely low results in some troponin assays and existing ID 3106 on TSH interference remain distinct from an in-vivo drug–nutrient interaction.[S07][S08]
Unreported adverse events, nonsignificant comparisons and normal biochemical values do not establish safety. Pregnancy, lactation, pediatric and liver/kidney disease results were not inferred from adults. Other-drug doses or biotin-treated case observations are not instructions for personal supplementation, timing, prescription change, discontinuation or replacement of standard care. Medication/supplement exposure and planned testing are matters to discuss with the treating team and laboratory; this report specifies no individualized interruption interval or initiation regimen.
8. Supplied-rule applicability and original-calculator receipts
The current interaction-routing clause in rules/common_research_prompt.md explicitly prohibits forcing efficacy A–F onto safety, interaction or assay-interference questions. The efficacy axes and fixed anchors are not a validated interaction-risk scale for this reverse-direction nutrient-marker association. No suitable separate numerical rule was supplied. Grade, score and risk grade are all null, and the current format is bounded_narrative_interaction_report.[P01][P02]
In this update, the current-input rules/scoring.md (SHA-256 177ae4d3...d187b) and rules/calculator.py (SHA-256 fdb27bbf...e3744) were read to confirm applicability. No efficacy-calculator function or CLI was executed. A genuine applicability review was completed, not a calculator PASS, zero-error run or exit-code0. Input, execution, raw-output and final-adoption receipts preserve function output, CLI and error lists as null. Here null means nonexecution/nonapplicability, not successful execution without errors.
| Axis | Current disposition |
|---|---|
| Claim type | Medication-to-nutrient-marker association; no forced efficacy A/B/C code. |
| Endpoint | Plasma nutrient concentration; not reversed into clinical treatment success/failure. |
| Replication | Potentially overlapping historical reports and pediatric different-specimen data are not fabricated independent replications. |
| Independence | Partial funding and affiliation are known; no invented complete independence code. |
| Effect | Exact contrast magnitude null. Legacy E0/E+ codes are not adopted for this claim. |
| Precision | Formal CI and clinical threshold null; no invented validated MCID. |
| Bias | Observational comparison, control composition, nutritional/disease confounding, measurement and missingness are discussed without filling unverified B codes. |
no_human_study=false reflects actual related human evidence. Lack of a verified direct oral-biotin coadministration comparison is not absence of all human studies. Neither tasks 77–79 policy gaps nor the prior C/54 nor the prior D/28 was inherited. No failed raw grade, numerical anchor or zero score was adopted.
9. Current-update verification scope versus prior research
Work actually performed in this update was: verify the identity of chamgap_3158_judgment_input.zip; read CURRENT_TASK.md plus current rules/calculator/domain guidance for applicability; correct current-vs-historical identity and manuscript inconsistencies; verify Korean/English MD↔JSON body equality; reuse the existing five PNGs; and package the deliverable. No new medical search, primary-paper access/re-opening, database search, or independent external review was performed.
The current input is 2,114,812 bytes / 71 members / SHA-256 f6ad696ce699cd15882eb8238938a59d07b69496f7ae02b1f76a5cf245d08d8f, recorded in provenance/input_identity.json. Exact bytes/SHA and application roles for current rule files are recorded in provenance/current_rule_application.json; the files actually read are recorded in provenance/read_ledger.json.
The 2026-09-17 source access, search, numerical extraction and access-failure records are preserved as history/previous research, not relabeled as current work. research/search_log.json records zero new searches in this update, while the exact historical query log remains at history/2026-09-17/research/search_log.json.
This self-review is an internal consistency and rule-traceability check, not independent clinical peer review or journal certification. No PASS is asserted for source access, searches, calculator execution or deployment that did not occur.
10. Complete unresolved and nonapplicable fields
The following nulls retain different information states: unreported, inaccessible, unconfirmed within the search and nonapplicable. Every machine-readable entry in research/unresolved.json contains both-language reasons.
| Field | Status | Value and reason |
|---|---|---|
sole_oral_biotin_cotreatment | not_confirmed_within_search | null — No controlled comparison adding sole oral biotin to carbamazepine was verified. |
biotin_molecular_form | not_reported | null — The molecular form, stereoisomer or salt of a coadministered biotin product is not reported. |
biotin_source | not_reported | null — Actual manufacturing source and raw material are not reported. |
biotin_formulation | not_reported | null — Tablet/capsule form, excipients, purity and batch are unverified. |
biotin_active_dose | not_reported | null — Actual added active dose and dosing frequency for this pair are unverified. |
total_biotin_intake | not_reported | null — Total dietary and supplemental intake is not reported. |
baseline_deficiency | not_reported | null — Pretreatment deficiency diagnosis or adequacy was not established. |
diet_and_alcohol | not_reported | null — Subgroup diet, alcohol exposure and intake control are unverified. |
cbz_salt_and_product | not_reported | null — Exact salt, product, manufacturer and batch are unverified. |
cbz_release_form | not_reported | null — Immediate/extended release and dosage form were not verified. |
cbz_route | not_reported | null — The route for the 40-person subgroup was not explicitly verified and was not automatically filled as oral. |
cbz_daily_dose | not_reported | null — 200 mg is an equivalence conversion unit, not an actual daily prescription. |
cbz_duration | not_reported | null — Treatment is described as long-term; exact duration for the 40-person subgroup is not reported. |
coadministration_timing | not_reported | null — The interval between biotin and drug dosing is unverified. |
steady_state_verified | not_reported | null — Long-term use alone does not verify steady state at a defined dose. |
achieved_adherence | not_reported | null — Achieved adherence and missed doses are not reported. |
other_medicines | not_reported | null — Anticonvulsant monotherapy does not establish absence of all other medicines. |
common_management | not_reported | null — Comparable nutritional and other common management was not established. |
renal_function | not_reported | null — Renal function and excretion-related subgroup data are not reported. |
hepatic_function | not_reported | null — Liver-function subgroup data are not reported. |
cbz_subgroup_sex_age | not_reported | null — Overall adult age range is available; sex and precise age distribution for the 40-person subgroup are unverified. |
cbz_subgroup_epilepsy | not_reported | null — CBZ-subgroup epilepsy types, severity and baseline seizure burden are unverified. |
sampling_time | not_reported | null — Postdose/postmeal sampling time and fasting condition are not reported. |
plasma_cbz_group_mean | not_reported | null — Fig 5 displays a mean but not an exact printed number; visual approximation was not promoted to a source value. |
plasma_cbz_sd | not_reported | null — Exact CBZ-subgroup SD or SE was not verified. |
cbz_vs_reference_effect | not_reported | null — The pooled 404-person difference is not the effect for 40 CBZ recipients and was not substituted. |
cbz_vs_valproate_effect | not_reported | null — The reported direction was verified; an exact mean difference or ratio was not. |
cbz_specific_p_value | not_reported | null — The exact pair-specific P value is unverified. |
adjusted_effect | not_reported | null — A confounder-adjusted CBZ-specific effect coefficient was not verified. |
confidence_interval | not_reported | null — A formal CBZ-specific between-group CI is unverified. |
baseline_final_change | not_reported | null — The 40 CBZ participants do not supply paired pretreatment-to-follow-up changes. |
endpoint_analysis_n | not_reported | null — Forty is the reported exposure-subgroup size; missing specimens and a separate endpoint-valid denominator are unverified. |
missing_data_handling | not_reported | null — Attrition and missing-data handling are unverified. |
assay_specificity | not_reported | null — Modern free/total-biotin distinction and metabolite cross-reactivity validation are unverified. |
drug_assay_assignment | not_reported | null — The specific CBZ assay among gas chromatography or enzyme immunoassay is not assigned in accessible details. |
assay_interference_exclusion | not_reported | null — Complete interference experiments for nutrient and drug assays are unavailable; measurement error is not certified absent. |
registration_primary_endpoint | not_reported | null — Prospective registration, original primary endpoint and analysis-plan history were not verified. |
multiplicity_adjustment | not_reported | null — Complete multiplicity adjustment is unverified. |
cohort_overlap_count | not_reported | null — The exact overlap between the 1982 and 1985 reports is not reported. |
complete_funding_and_supply | not_reported | null — Partial public funding and a company-affiliated author are known; complete support and product supply are unverified. |
cbz_specific_adverse_event_risk | not_reported | null — Defined event counts, denominators, exposure window and comparator risk for this pair are unavailable. |
dechallenge_rechallenge | not_reported | null — Clinical dechallenge/rechallenge evidence for this pair was not verified. |
pregnancy_lactation | not_reported | null — Direct coadministration safety in pregnancy or lactation was not verified. |
longterm_supplement_safety | not_reported | null — Pair-specific long-term safety of biotin supplementation was not verified. |
pediatric_fulltext | inaccessible | null — The 2011 full text was inaccessible; dose, duration, dispersion and funding were not filled. |
complete_registry_search | inaccessible | null — A complete native-registry search result and history export were not obtained. |
auc_type_unit_ratio_ci | not_applicable | null — The selected endpoint is not drug AUC and no eligible PK comparison was verified; type, units, geometric ratio and CI are not calculated. |
cmax_tmax_half_life_clearance | not_applicable | null — Drug Cmax, Tmax, half-life and clearance are not inferred from the selected plasma-biotin observations. |
crossover_washout_pairing | not_applicable | null — The core data are not a crossover dosing trial; washout, sequence effects and paired PK are not fabricated. |
mcid_or_response_criterion | not_applicable | null — A biotin-marker association is not converted to efficacy-MCID or clinical-response attainment. |
efficacy_grade_score | not_applicable | null — The interaction is outside the supplied efficacy formula, and no suitable separate numerical rule was supplied. |
11. Current completed update value and revision conditions
The current content deliverable is completed_with_uncertainty, with content_verification_status=completed_with_declared_scope and clinical_todo=[]. Existing site identity is preserved as ID/site_id 3158, slug biotin-carbamazepine-reverse-plasma-biotin-status, URLs /v/3158/, /verdicts/general/biotin-carbamazepine-reverse-plasma-biotin-status/, and /en/verdicts/general/biotin-carbamazepine-reverse-plasma-biotin-status/. The first-publication timestamp remains 2026-09-17T11:22:37+00:00. No new ID is assigned and identity fields are not reset to null.
reports/TASK-1042.json is the current canonical record; verdicts/TASK-1042.json and verdicts/3158.json are current compatibility copies with the same current clinical content. ko/en.body_markdown and ko/en.what_research are byte-equal to the corresponding complete Markdown reports.
No server access, site update or deployment was performed in this chat. This package is therefore a prepared update for existing 3158, not a deployment receipt. In the current conversation, 3155 is the one case confirmed FULL through site application; this 3158 update remains not yet site-applied.
A verified direct coadministration trial, exact pair-specific raw data, newly accessible methods/corrections/retractions, assay validation, or a suitable interaction-specific grading rule may trigger a traceable revision while preserving the same ID, URLs and first-publication timestamp.
Original sources and supplied rules
[S01]: https://epub.ub.uni-muenchen.de/7298/1/krause_klaus-henning_7298.pdf "Biotin status of epileptics" [S02]: https://pubmed.ncbi.nlm.nih.gov/7181453/ "Impaired biotin status in anticonvulsant therapy" [S03]: https://journals.sagepub.com/doi/10.1177/0883073811409227 "The influence of valproic acid and carbamazepine treatment on serum biotin and zinc levels and on biotinidase activity" [S04]: https://pubmed.ncbi.nlm.nih.gov/9523856/ "Disturbances in biotin metabolism in children undergoing long-term anticonvulsant therapy" [S05]: https://pubmed.ncbi.nlm.nih.gov/9371938/ "Biotin catabolism is accelerated in adults receiving long-term therapy with anticonvulsants" [S06]: https://pubmed.ncbi.nlm.nih.gov/2911998/ "Biotin transport in the human intestine: inhibition by anticonvulsant drugs" [S07]: https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/ "Biotin: Fact Sheet for Health Professionals" [S08]: https://www.fda.gov/medical-devices/in-vitro-diagnostics/biotin-interference-troponin-lab-tests-assays-subject-biotin-interference "Biotin Interference with Troponin Lab Tests – Assays Subject to Biotin Interference" [S09]: https://lpi.oregonstate.edu/mic/vitamins/biotin "Biotin, Micronutrient Information Center" [P01]: rules/common_research_prompt.md "Current common research rules; interaction-routing clause" [P02]: rules/scoring.md + rules/calculator.py "Current efficacy score sheet and calculator; applicability reviewed, not executed for this interaction" [P03]: previous_research/provenance/duplicate_boundary.json in the current input, preserved/reused as historical boundary evidence
Why this is classified as Unscored
Current interaction routing and scoring axis 0 were applied without forcing efficacy A–F. Human evidence exists, so this is not a ? case; because the formal efficacy-independence axis is not entered, the funding-unknown I1 fallback is not fabricated. The calculator was not executed. Existing ID3158 identity is preserved and this update was not deployed in this chat.
Counterpoint. The nonsignificant pediatric serum result in 10 CBZ recipients is retained without pooling it with adult plasma.
Rejudgment record. Grade/score null under supplied common section 5, which excludes forcing efficacy scoring onto interactions. Original source and SHA were checked, but functions/CLI were not executed; output, errors, exit code and PASS are null. The current value is completed as a separate bounded narrative report.
Review performed and remaining limitations
A direct trial adding sole oral biotin, exact CBZ-specific effect/CI/timing/dose/route, diet/total intake, deficiency, kidney function, adherence, complete funding/independence, clinical-event risk and some original content/registry history remain unverified. All 51 null fields retain differentiated information states and bilingual reasons.
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| S01: Krause et al.1985, PMID3925859. | Observational adult long-term anticonvulsant-monotherapy subgroup; not a biotin add-on trial. | Overall404, CBZ40, VPA21, reference112; endpoint-valid/missing denominator unverified. | Partial DFG Kr659/1, company-affiliated author; full funding/supply unverified. | Plasma biotin(nmol/L) during chronic therapy, microbiological assay; exact time null. | Described as lower than VPA; exact CBZ contrast/CI null. Pooled404 values are not substituted. | Core reverse-direction association, not randomized causality or a clinical-risk grade. |
| S02: Krause et al.1982, PMID7181453. | Mixed-anticonvulsant observation; abstract access. | Overall264; CBZ-specific denominator unverified. | Indexed non-US research support; complete details unverified. | Proportion with low plasma biotin, not prospective incidence. | Pooled74%≤250ng/L; not adopted as the CBZ effect. | Possible overlap with1985; no participant or independent-replication summation. |
| S03: Castro-Gago et al.2011, PMID21642615. | Abstract describes pediatric comparisons; restricted full text, not a randomized trial. | CBZ10, VPA20,75age/sex-matched healthy controls. | Unverified; affiliation alone does not establish independence. | Serum biotin, separate from adult plasma. | No significant difference; exact means/CI/P null, not equivalence. | Opposing age/specimen context; other-drug alopecia responses excluded. |
| S04: Mock et al.1998, PMID9523856. | Pediatric long-term exposure and urinary markers; abstract access. | 13treated(CBZ/PHT7, PB6),16controls. | Indexed NIH R01DK36823; complete COI unverified. | Urinary biotin/metabolites and organic acids are distinct markers. | Partly discordant indicators, not CBZ-only plasma values. | Measurement/population boundary, not adult clinical replication. |
| S05/S06: PMID9371938/2911998. | Bibliographic leads for adult catabolism/intestinal transport; original content inaccessible. | null — not verified in original content. | null — not directly verified. | Catabolism/transport leads are not equated with the main plasma endpoint. | Quantitative values null; search snippets do not substitute for original-study verification. | Distinguishes related-study existence and access failure; no no-human conclusion. |
Receipt — 9 References
Evidence access cutoff: 2026-09-20. Each citation states its actual access level (full-text transcription, abstract, index, or other) and remaining limitations. Bibliographic checking does not certify the study results or treatment efficacy.
Technical integration by: Codex · Evidence date: 2026-09-20 · Corrections: none
Revision history
2026-09-20: Integrated the current submitted manuscript and paired explanation. The verdict ID, URLs and first publication date are preserved. The current conclusion and limitations are presented in the report above.
Cite this verdict
[Chamgap] Biotin × carbamazepine: reverse-direction association with plasma biotin status — Evidence Grade Unscored. 9 cited sources checked. Source: https://chamgap.com/en/verdicts/general/biotin-carbamazepine-reverse-plasma-biotin-status/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
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