Tanning Tablets
Scientific Name(s): Beta-carotene-4,4'-dione
Common Name(s): Canthaxanthin, Carophyll red, Food Orange 8, Roxanthin red 10, Tanning pill, Tanning tablet
Medically reviewed by Drugs.com. Last updated on Apr 22, 2024.
Clinical Overview
Use
Although they are not recommended for these uses, tanning tablets have been used to give skin a natural-looking tan, prevent photosensitivity in people with inherited erythropoietic protoporphyria, and in the treatment of vitiligo. Canthaxanthin and other carotenoids have also been studied for activity in cancer and Parkinson disease, although evidence is limited.
Dosing
Various dosing regimens are available. Historically, a recommended maximum daily intake of canthaxanthin was 25 mg/kg. However, use of these products cannot be recommended because of unknown safety associated with long-term use.
Contraindications
No longer considered safe.
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use.
Interactions
None well documented.
Adverse Reactions
Some of the adverse effects reported with tanning tablets include discoloration of the stool, palms of the hands, and soles of the feet; GI discomfort; canthaxanthin-induced retinopathy; and at least 1 case of aplastic anemia. In short- and long-term animal studies, the LD50 for canthaxanthin in mice, rats, and dogs has been found to be greater than 10,000 mg/kg.
Toxicology
Both beta-carotene and canthaxanthin are classified as "Generally Recognized As Safe (GRAS)" substances by the FDA. Canthaxanthin is an approved food and drug coloring additive in the United States, Canada, and Europe.
History
A variety of OTC tablets and capsules containing the pigments beta-carotene and canthaxanthin have been available for more than 20 years and have been promoted to give the consumer a natural-looking tan. In the United States, these pigments are approved as color additives for use in food and drugs; although they are unapproved for use as ingested agents intended to color the skin. However, consumers may obtain canthaxanthin from a variety of sources including mail-order houses and tanning salons as an "over-the-counter sun-tanning agent." Due to safety concerns, the agent is no longer approved for tanning in Canada and Australia.(Hulisz 1993, Levit 1985, Windholz 1983)
Chemistry
Canthaxanthin is highly lipid soluble and is found in a variety of sources, including plants, mushrooms, bacteria, sea trout, algae, brine shrimp, crayfish, and bird feathers. The deep red-orange pigment is often the only color in tanning preparations and it is sometimes referred to as Food Orange 8, carophyll red, or roxanthin red 10. The pigment also is used to enhance the appearance of foods, such as pizza, barbecue and spaghetti sauces, soups, salad dressings, fruit drinks, baked goods, pudding, cheeses, and catsup.(Hulisz 1993, Levit 1985, Windholz 1983)
Uses and Pharmacology
Canthaxanthin is a derivative of beta-carotene; however, it is not a precursor of vitamin A. The tanning effect (orange to brownish color) is the result of canthaxanthin accumulation in the epidermis and subcutaneous fatty tissue. Canthaxanthin is not melanogenic or photosensitizing. Depending on the dose, canthaxanthin is deposited in the retina and liver; orange discoloration of plasma has also been documented.(Hulisz 1993)
The typical dietary intake of beta-carotene and canthaxanthin added during food manufacturing is 0.3 and 5.6 mg, respectively.(Fenner 1982) When canthaxanthin is used as a food additive for coloring or for medication, its effectiveness will be improved by formulation with radical inhibitors, such as tocopherols or other hindered phenols.(Mordi 2020)
Antineoplastic effects
Epidemiologic evidence suggests that the incidence of cancers may be slightly lower among individuals with an above-average intake of beta-carotene and other carotenoids. These compounds may deactivate reactive chemical species, such as singlet oxygen and free radicals.(Burton 1984, Esatbeyoglu 2017) They also may have some slight pro-vitamin A effect that may contribute to the neoplastic protectant effect.(Bertram 1991)
Animal data
Mice supplemented with beta-carotene for 5 weeks prior to and 26 weeks after the administration of a nitrosamine derivative to induce bladder cancer developed fewer tumors than unsupplemented mice. Mice receiving canthaxanthin showed no protection.(Mathews-Roth 1991) Mice receiving canthaxanthin, retinyl palmitate, or a combination of both developed fewer cutaneous tumors following exposure to UV irradiation.(Gensler 1990) Dietary supplementation of canthaxanthin inhibited the initiation of experimental breast tumors in mice but did not slow their spread.(Grubbs 1991) Evidence suggests that canthaxanthin is able to induce apoptosis in tumor cells.(Palozza 1998)
Clinical data
Research reveals no clinical data regarding the use of tanning tablets as an antineoplastic. A review of the chemoprotective effects of carotenoids revealed that high doses of beta-carotene do not exhibit chemopreventive activity in clinical trials.(Tanaka 2012)
CNS
Animal data
An inverse association has been suggested for carotenoid intake and Parkinson disease based in animal and in vitro studies.(Takeda 2014)
Clinical data
Clinical trials have evaluated the role of micronutrient intake and the risk of Parkinson disease; however, insufficient data exist for carotenoids in this capacity.(Takeda 2014)
Dermatologic uses
Clinical data
Canthaxanthin has been used for the treatment of vitiligo, a disorder in which the melanocytes cease to synthesize melanin and disappear from the involved areas. In an open study of 56 patients with vitiligo, patients were administered canthaxanthin for 20 days with dosages based on weight. Fifty-four percent of patients were not satisfied, 35% were satisfied, and 10% were very satisfied with the results of canthaxanthin pigmentation.(Gupta 1985, Hulisz 1993)
Low-density lipoprotein
Canthaxanthin’s enrichment of low density lipoprotein (LDL) has the potential to protect cholesterol from oxidation. In addition to its free radical scavenging and antioxidant properties (the induction of catalase and superoxide dismutase), canthaxanthin’s immunomodulatory activity (ie, enhancing the proliferation and function of immune competent cells) and its important role in gap junction communication, as in the induction of the transmembrane protein connexin 43, have been reported. Many studies regarding the potential health benefits of canthaxanthin have been conducted in vitro and should be validated in appropriate in vivo models.(Esatbeyoglu 2017)
Porphyria
Clinical data
Beta-carotene and canthaxanthin administration helped to prevent photosensitivity in people with inherited erythropoietic protoporphyria. This skin disorder is characterized by burning, itching skin often with ulceration following exposure to sunlight. Beta-carotene effectively protects against photosensitivity but does not protect from UV-induced sunburn.(Fenner 1982, Wilson 1991)
Tanning effects
OTC product labeling recommends taking several tablets a day for 2 to 3 weeks, then smaller periodic doses to maintain the coloration. The skin color accumulates over a 2-week period, then fades in about 2 weeks when the product is discontinued. Ingestion of too much pigment can make the palms of the hands turn orange.(Wilson 1985) One brand of tablets contains 4 mg of beta-carotene and 36 mg of canthaxanthin per dose; the resulting daily intake of beta-carotene and canthaxanthin would be 12 to 16 mg and 108 to 144 mg, respectively.(Fenner 1982) Ingestion of these large amounts of pigment results in the accumulation of dyes in adipose tissue with a resultant yellow discoloration of the skin. The "tan" has a distinct orange tinge and affords no protection against sunburn.(Gupta 1985)
Other
From a biotechnological point of view, the ketocarotenoids astaxanthin and canthaxanthin are among the most important pigments widely used in aquaculture and as feed and food additives.(Rebelo 2020) In addition, the canthaxanthin market for personal care products and dietary supplements and additives is growing rapidly.(Rebelo 2020)
Dosing
Various dosing regimens are available. Therefore, review manufacturers' directions before using. Historically, a recommended maximum daily intake of canthaxanthin was 25 mg/kg. However, use of these products cannot be recommended because of unknown safety associated with long-term use.
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
None well documented.
Adverse Reactions
Some of the adverse effects reported with tanning tablets include discoloration of the stool, palms of the hands, and soles of the feet; GI discomfort; canthaxanthin-induced retinopathy(Lamba 2014, Sujak 2009); and at least 1 case of aplastic anemia. In short- and long-term animal studies, the LD50 for canthaxanthin in mice, rats, and dogs has been found to be greater than 10,000 mg/kg.(Gupta 1985)
Toxicology
Beta-carotene and canthaxanthin are classified as generally recognized as safe (GRAS) substances by the FDA.(Esatbeyoglu 2017, Herbert 1991) Canthaxanthin is an approved food and drug coloring additive in the United States, Canada, and Europe.(Gopinath 2020) The conversion of beta-carotene to vitamin A is limited by physiological requirements, and, therefore, the ingestion of these tablets does not pose a threat of hypervitaminosis A. Canthaxanthin is not metabolized to vitamin A in humans, and some question exists as to whether it may interfere with the conversion of carotene to vitamin A.(Fenner 1982)
In short- and long-term animal studies, the LD50 for canthaxanthin in mice, rats, and dogs has been found to be greater than 10,000 mg/kg.(Esatbeyoglu 2017, Gupta 1985)
A small amount of the drug is absorbed and large quantities are excreted in the feces, imparting a brick-red color to the stool, a side effect that may mask the presence of rectal bleeding.(Gupta 1985, Hulisz 1993)
There have been no reports of teratogenicity, carcinogenicity, or histotoxicity.(Esatbeyoglu 2017, Gupta 1985) No toxicity was noted in volunteers who ingested 180 mg/day of beta-carotene for 10 weeks.(Mathews-Roth 1990) These dyes afford no protection against sunburn, and patients should be instructed to take adequate precautions against exposure. Severe orange discoloration of plasma has been noted by blood collection agencies in blood samples obtained from subjects who ingested tanning tablets, although toxic levels of vitamin A were not found in the samples. Orange discoloration of the palms of the hands and soles of the feet also has been reported.(Bareford 1984, Hulisz 1993, Rock 1991)
The most common nondermatologic adverse effects include nausea, cramps, and diarrhea, which occurred in about one third of patients receiving these pigments as treatment for photosensitivity. The FDA has received reports of drug-induced hepatitis and a case of severe itching and welts that may have been related to oral tanning products.(Fenner 1982)
Amenorrhea has been reported among women receiving carotenoid therapy, although with a very low prevalence.(Mathews-Roth 1983)
In a survey of 50 patients who took more than 200 tanning tablets over a period of time, 12% found golden crystalline deposits in the inner layers of the retina and around the macula.(Rousseau 1983) Six of 51 patients ingesting 3.6 to 66 g of canthaxanthine within a 24-month period also developed deposits in the ocular fundus.(Boudreault 1983) In one case report, a patient sustained a branch retinal vein occlusion in the left eye believed to be associated with use of the drug.(Chang 1995) Decreased visual acuity was observed in some patients, but the long-term implications of these deposits are not understood. Deposits have been identified for up to 7 years after discontinuation of canthaxanthin.(Bloomenstein 1996, Hulisz 1993) Retinopathy does not appear to develop in patients taking beta-carotene alone.(Herbert 1991)
A woman 20 years of age died secondary to developing aplastic anemia after ingesting a course of high-dose canthaxanthin-containing tanning tablets. Although supportive measures may have saved the patient, her religious beliefs precluded the use of these interventions.(Bluhm 1990)
References
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This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.
This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.
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