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Pantothenic Acid

Scientific Name(s): D(+)-alpha-(-dihydroxy-beta,beta-dimethylbutyryl-beta-alanaine)
Common Name(s): Antidermatitis vitamin, Calcium-pantothenate, D-pantothenic acid, Dexpanthenol, Pantethine, Pantothenate, Pantothenic acid, Vitamin B5

Medically reviewed by Drugs.com. Last updated on May 2, 2024.

Clinical Overview

Use

Clinical studies are limited. Pantothenic acid and its derivatives may have a role in the management of dyslipidemia and in wound healing.

Dosing

The US recommended dietary allowance (RDA) for pantothenic acid in nutritional supplements and foods is age dependent and ranges from 0.2 mg/kg in infants to 5 mg in adults. The RDA during pregnancy and lactation is slightly higher, at 6 and 7 mg daily, respectively.

Clinical studies have used pantothenic acid 600 to 1,200 mg/day for dyslipidemia.

Contraindications

Avoid use if hypersensitivity to pantothenic acid exists.

Pregnancy/Lactation

Pantothenic acid has been assigned US Food and Drug Administration (FDA) Pregnancy Category A (studies have failed to demonstrate risk). When dosed above the recommended dietary allowance (6 to 7 mg/day), pantothenic acid is designated Category C.

Interactions

None well documented.

Adverse Reactions

In high doses, pantothenic acid may inhibit the absorption of biotin produced by the microflora in the large intestine. Diarrhea may occur with large doses of pantothenic acid. Allergic contact dermatitis has been reported with topical use of dexpanthenol.

Toxicology

A tolerable upper intake level for pantothenic acid has not been set because reports of adverse effects are lacking. An oral median lethal dose of 10 g/kg for mice has been reported.

Source

Pantothenic acid is found in all animal and plant tissues. Common sources of pantothenic acid include liver, queen bee jelly, yeast, rice bran, molasses, peanuts, tree nuts, whole grains, mushrooms, eggs, milk, and potatoes. Pantothenic acid is commercially available as D-pantothenic acid and its synthetic derivatives dexpanthenol and calcium pantothenate. It is frequently included in various vitamin B-complex formulations. Liquid preparations of pantothenic acid are commercially available as D-pantothenyl alcohol or panthenol.Gennaro 2000, Trumbo 2006

History

The name pantothenic acid is derived from the Greek pantothen, meaning "from all sides" or "everywhere." The vitamin was first isolated in 1931, and its role as an essential component in the growth of yeast cells was demonstrated in 1933. The involvement of pantothenic acid in coenzyme A and cellular metabolism was elucidated in the late 1940s and early 1950s.

Knowledge of pantothenic acid resulted from experimentation on microorganisms and chicks. Chick antidermatitis factor was the name given to purified concentrates of this substance, as was vitamin B5, but these terms are now obsolete. Pantothenic acid deficiency is rare. Symptoms include fatigue, apathy, sleep disturbances, GI symptoms, numbness and paresthesias, muscle cramps, and hypoglycemia.(Ames 2005, Gennaro 2000, Trumbo 2006) Pantothenic acid was given to prisoners of war in Asia during World War II to alleviate Grierson-Gopalan syndrome, also known as burning feet syndrome, now essentially unknown and thought to have been due to malnutrition.(Gennaro 2000, Trumbo 2006)

Chemistry

Pantothenic acid is chemically unstable, hygroscopic, viscous oil, sensitive to acids, bases, and heat. It is sweet with a bitter aftertaste. Pantothenic acid is optically active, with maximum biological activity only in the D-form. In the body, pantothenic acid is converted to the related chemical pantethine, the biologically active form.

Pantothenic acid is a member of the B-complex of vitamins and is essential for the biosynthesis of coenzyme A, an important substance involved in energy release from carbohydrates; metabolism of amino acids and fatty acids; syntheses of compounds, including sterols, steroid hormones, and acetylcholine; and other reactions.

The primary marketed supplemental form of pantothenic acid is calcium D-pantothenate (D-calcium pantothenate). Dexpanthenol, considered a provitamin form, is the corresponding alcohol of pantothenic acid. Pantothenic acid, its salts, and its alcohol derivative can be assayed by chemical and microbiological methods.Gennaro 2000, Said 2011, Trumbo 2006, Webb 2004

Uses and Pharmacology

Vitamin B5 (pantothenic acid) supplements are not subject to initial review by the US Food and Drug Administration (FDA). The agency does not have the authority to examine dietary supplement products for safety and effectiveness prior to marketing. Out of all the drugs listed in this indications section, only panthenol and dexpanthenol are approved by the FDA for use in cosmetics. All other indications listed are non-FDA approved.(Sanvictores 2022)

Compared to other B vitamins, the direct effects of vitamin B5 supplementation are limited. Therefore, the impact of B5 must be gathered through its known metabolism that has thus far highlighted cysteamine’s pro-inflammatory properties. Given the importance of coenzyme A, additional studies appear to be warranted to determine their effect on inflammatory processes and cancer. Analysis of pantothenate in the absence of pantetheinase activities, while challenging, may shed light on the more subtle roles of pantetheine in human health.(Peterson 2020)

Dermatological effects

Clinical data

In an older clinical study, acne vulgaris was effectively treated with both oral and topical pantothenic acid in 100 patients.(Leung 1995) Mucocutaneous adverse reactions caused by isotretinoin therapy have been effectively treated with dexpanthenol 5% cream.(Romiti 2002) A pilot study found dexpanthenol 5% as effective as hydrocortisone in atopic dermatitis.(Udompataikul 2012)

Dyslipidemia

Pantothenic acid is converted to pantethine in the body. It is essential for the biosynthesis of coenzyme A, which plays a critical role in the metabolism of carbohydrates, proteins, and lipids.

Animal data

Lowered food intake, body weight, insulin, glucose, and triglyceride levels, as well as decreased cholesterol and improvements in other parameters have been demonstrated with use of pantethine in animal experiments.(Kirilina 1991, Kumerova 1991, Naruta 2001, Sasuga 1990, Tanaka 1989, Tanaka 1992)

Clinical data

One study concluded that pantethine (a derivate of vitamin B5) lowered cardiovascular disease risk markers in low to moderate risk participants. These risk markers include low-density lipoprotein, high-density lipoprotein, and total cholesterol.(Sanvictores 2022) A review of pantethine's use as a nutraceutical option for the treatment of hypertriglyceridemia as well as a meta-analysis of pantethine's efficacy and tolerability covering 28 studies from 1966 to 2002 was published. The meta-analysis suggests that pantethine may be effective in treating individuals with cholesterol levels greater than 200 mg/dL and/or serum triglyceride levels greater than 150 mg/dL. However, larger clinical studies are warranted in more diverse populations before a definitive role for pantethine can be defined.(McRae 2005, Pins 2006)

Ophthalmic effects

Animal data

Limited animal experiments have studied the role of pantethine in lens opacification and light scattering during cataract formation. Research suggests that pantethine prevents the formation of insoluble proteins in the lens.(Clark 1996, Fisher 1997, Hiraoka 1995, Matsushima 1997)

Clinical data

A study evaluated the effect of dexpanthenol 5% following phototherapeutic keratectomy. No significant difference over the placebo ointment was found; however, the study may have been underpowered.(Baumeister 2009)

Wound healing

Many pantothenic acid amides have antimicrobial activity. Pantothenic acid improves surgical wound healing with moisturizing and skin barrier enhancing potential. Its deficiency leads to reduced cortisol production, increased arthritic pain, myalgia, fatigue, headache, depression, insomnia, and widespread "proinflammatory" effects on the immune‐system.(Gheita 2019) Pantothenic acid plays an important role in both anti‐inflammatory and proinflammatory events, due to its importance in regulating the cytokine pathway.(Gheita 2019)

Animal data

In vivo and animal studies have been undertaken to elucidate a potential mechanism of action for the use of pantothenic acid and its derivatives for enhancing wound healing.(Akdeniz 2007, Etensel 2007, Heise 2012)

Clinical data

Dexpanthenol as a pastille and as a spray has been evaluated in small clinical trials for wound healing in postoperative tonsillectomy, endotracheal intubation, and endoscopic sinus surgery.(Celebi 2013, Gulhas 2007, Tantilipikorn 2012) Increased hydration due to dexpanthenol may explain the positive effects, or a possible increase in the number of dermal fibroblasts.(Trumbo 2006) An evidence-based review of the benefit of vitamin supplements for wound healing identified data on the combination of ascorbic acid and pantothenic acid for surgical wounds. Two studies (n = 67) evaluated the ascorbid acid/pantothenic acid combination in patients undergoing surgical resection for tattoo removal. Treatment that was initiated pre-procedure improved mechanical properties of wound scars.(Ellinger 2009) Further studies are warranted.

Other uses

Pantethine stimulates GI motility in laboratory animals.(Kan 1995, Ryokawa 1995) A clinical role for this effect has not been established, and no efficacy in treating ulcerative colitis was found in a small open-label study.(Loftus 1997)

Dexpanthenol has been used intravenously in combination with other micronutrients ("Myers' Cocktail") in fibromyalgia(Ali 2009) and in arthritis in older studies.(Trumbo 2006)

Older studies in animals suggest that pantothenic acid increases levels of coenzyme A and glutathione, protecting against oxygen-radical species and ionizing radiation as well as against induced hepatotoxicity.(Nagiel-Ostaszewski 1990, Slyshenkov 1998)

A role for pantothenic acid in epilepsy therapy(Poverennova 2011) and in exercise performance have not been pursued to any extent in the literature.(Wall 2012)

A small study (n=8) looked at the effective of daily doses of 1.5 g of pantothenic acid combined with an equal amount of L-cysteine. No benefit was seen in exercise performance, muscle coenzyme A levels, or fuel selection.(Wall 2012) In another study, it was seen that a 2-week supplementation with 2 g/day of pantothenic acid translated into better performance for trained distance runners, with a better use of oxygen and less lactic acid accumulation; however, this was not reproduced in another similar study.(Tardy 2020)

In terms of the growth performance of ducks, the results showed that the birds fed a basal diet without pantothenic acid supplementation had the lowest growth performance and breast meat yield, as well as having low plasma pantothenic acid and glucose contents. In addition, all these parameters increased linearly or quadratically as the dietary pantothenic acid levels increased.(Tang 2021)

Substantially lower levels of pantothenic acid are found in several regions of the brain in Parkinson disease, Alzheimer disease and Huntington disease.(Scholefield 2021) Pantothenate deficiency can play a vital role in acetyl choline deficiency, neurodegeneration, myelin loss, and age-related dementias as in Huntington disease. More studies are needed to test the clinical efficacy of vitamin B5 in these conditions.(Sanvictores 2022)

Dosing

The US RDA for pantothenic acid in nutritional supplements and foods is age dependent and ranges from 0.2 mg/kg in infants to 5 mg in adults. The RDA during pregnancy and lactation is slightly higher, at 6 and 7 mg daily, respectively.IOM 1998, Trumbo 2006

Pantothenic acid is available in capsule, liquid, and tablet doseforms from numerous commercial manufacturers. Clinical studies have used pantethine 600 to 1,200 mg/day for dyslipidemia, 200 to 300 mg/day for wound healing, and 1.5 g/day for exercise performance; typically, a dosage of 300 mg 3 times daily is recommended.Chin 2013, Debourdeau 2001, McRae 2005, Pins 2006

acetylcysteine, ascorbic acid, biotin, multivitamin, Dextrose

Pregnancy / Lactation

Pantothenic acid has been assigned US FDA Pregnancy Category A (ie, adequate, well-controlled studies have failed to demonstrate a risk to the fetus). When dosed above the recommended dietary allowance, pantothenic acid is designated Category C (ie, Risk cannot be ruled out. Human studies are lacking, and animal studies are either positive for fetal risk or lacking. However, potential benefits may justify the potential risks). During pregnancy and lactation, the adequate intake is pantothenic acid 6 and 7 mg/day, respectively. Pantothenic acid concentrations in human breast milk weakly correspond with maternal intake.IOM 1998, Trumbo 2006

Interactions

None well documented.

Adverse Reactions

Doses greater than 10mg/day may cause mild diarrhea or mild intestinal distress.(Sanvictores 2022) In high doses, pantothenic acid may inhibit the absorption of biotin produced by microflora in the large intestine; diarrhea may occur. Allergic contact dermatitis has been reported with topical use of dexpanthenol and panthenol cream.(Bregnbak 2016, Chin 2013, Gennaro 2000) A meta-analysis from 1966 to 2002 recorded an adverse reaction rate of 1.4 per 100 subjects. The majority of these events were mild GI complaints.(McRae 2005) A case report of life-threatening eosinophilic pleuropericardial effusion with concomitant use of biotin 10 mg/day and pantothenic acid 300 mg/day exists.(Debourdeau 2001)

Pantothenate side effects (more detail)

Toxicology

Pantothenic acid is considered to be relatively safe. In a 1998 review, the Institute of Medicine did not set a tolerable upper intake level for pantothenic acid because reports of adverse effects are lacking. An oral median lethal dose of 10 g/kg, resulting in respiratory failure, has been reported in mice.IOM 1998, Trumbo 2006

References

Disclaimer

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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