Pantothenic acid

Pantothenic acid (vitamin B5) is essential to all life, and is a component of coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol.

The name pantothenic acid comes from the Greek word pantos, meaning "everywhere," referring to its wide distribution in most plants and animals. Rich food sources include meats, liver, kidney, fish/shellfish, chicken, vegetables, legumes, yeast, eggs, and milk. However, freezing and canning may lead to a loss of much of the pantothenic acid content. Whole grains are also a good source, although refining may degrade much of the pantothenic acid content. In commercial supplement products, vitamin B5 is available as D-pantothenic acid and as the synthetic products dexpanthenol (converted in the body to pantothenic acid) or calcium pantothenate. Pantothenic acid is frequently used in combination with other B vitamins in vitamin B complex formulations. Only the dextrorotatory (D) isomer of pantothenic acid possesses biologic activity.

Pantothenic acid deficiency is exceedingly rare, and likely only occurs only in cases of the most severe life-threatening malnutrition. Most individuals likely obtain sufficient amounts from dietary sources.

Pantothenic acid has been used or studied for numerous health conditions, but has not been clearly demonstrated as beneficial for any. Oral, topical (on the skin), or injected forms have been used.

Synonyms

Calcii pantothenas, calcium pantothenate, C9H17NO5, coenzyme A, D-calcium pantothenate, D (+)- N -(2,4-dihydroxy-3, 3-dimethylbutyryl)-beta-alanine, D-panthenol, D-pantothenic acid, D(+)-pantothenic acid, D-pantothenyl alcohol, dexpanthenol, dexpanthenolum, panthenol, pantoic acid, pantothenic, pantothenic acid, pantothenol, pantothenylol, vitamin B-5.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence	Grade^*
Pantothenic acid deficiency Pantothenic acid deficiency has been very rarely observed in humans. In cases of true pantothenic acid deficiency, oral pantothenic acid therapy is accepted as a treatment. It may also be merited as prevention in select patients at high risk for malnutrition. It should be included in tube feeds or parenteral (intravenous) nutrition formulas for patients unable to eat on their own.	A
Athletic performance There is currently insufficient scientific evidence in this area in order to form a clear conclusion.	C
Attention deficit-hyperactivity disorder (ADHD) There is currently insufficient scientific evidence in this area in order to form a clear conclusion.	C
Burns Vitamin supplementation is often recommended in individuals who have sustained severe burns, due to loss of nutrients and increased metabolic needs. It is unclear if vitamin B5 has specific beneficial effects in burn healing beyond its usual functions in the body.	C
High cholesterol Pantothenic acid itself has not been shown to have any cholesterol-lowering effects. However, a chemical derivative of pantothenic acid called pantethine has been studied for this purpose, with compelling preliminary evidence in humans.	C
Osteoarthritis There is currently insufficient scientific evidence in this area in order to form a clear conclusion.	C
Rheumatoid arthritis It has been reported that pantothenic acid levels are lower in the blood of patients with rheumatoid arthritis compared to healthy individuals. However, it is not clear if this is a cause, effect, or a beneficial adaptive reaction. There is currently insufficient scientific evidence in this area in order to form a clear conclusion.	C
Wound healing In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.	C
Radiation skin irritation Based on one study, topical (skin) application of dexpanthenol, an analog of pantothenic acid, to areas of irradiated skin does not appear to reduce erythema, desquamation, itching, or pain following radiation treatment.	D

*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.

Grading rationale

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acne (topical dexpanthenol), adrenal gland stimulation, alcoholism, allergies, alopecia, Alzheimer's disease, anxiety prevention, asthma, autism, bruxism, burning feet syndrome, candidiasis, heart failure, carpal tunnel syndrome, celiac disease, chronic fatigue syndrome, cold prevention, colitis, conjunctivitis, convulsions, cystitis, dandruff, depression, dermatoses (topical dexpanthenol), diabetic neuropathy, diaper rash (topical dexpanthenol), eczema (topical dexpanthenol), glossitis, gray hair, headache, heart failure, hypertriglyceridemia, hypoglycemia, hypotension (low blood pressure), immune function enhancement, infection prevention, insect bites (topical), insomnia, irritability, itching (topical dexpanthenol), lupus, multiple sclerosis, muscle cramps, muscular dystrophy, neuralgia, obesity, Parkinson's disease, peripheral neuropathy, peristalsis stimulation (injected dexpanthenol), poison ivy (topical dexpanthenol), poison ivy (topical dexpanthenol), postoperative ileus (injected dexpanthenol), premenstrual syndrome (PMS), prostatitis, reducing signs of aging, respiratory disorders, retarded growth, salicylate toxicity, shingles, skin disorders, stomatitis, streptomycin neurotoxicity, stress, thyroid therapy side effect prevention, ulcerative colitis (dexpanthenol enema), vertigo.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older):

Daily adequate intake (AI): Daily adequate intake (AI) of pantothenic acid levels have been established by the Food and Nutrition Board of the U.S. Institute of Medicine, based on estimated dietary intakes in healthy populations. A recommended daily allowance (RDA) has not been set due to insufficient available scientific evidence. For individuals 19 years and older, the daily AI is 5 milligrams per day. For pregnant women of any age the daily AI is 6 milligrams per day; for breastfeeding women of any age the daily AI is 7 milligrams per day.

Oral: As a dietary supplement, 5-10 milligrams of pantothenic acid has been used, although benefits have not been clearly demonstrated in healthy individuals. Pantothenic acid is frequently used in combination with other B vitamins in vitamin B complex formulations.

Topical: Dexpanthenol 2% cream has been used on the skin for various conditions, applied once or twice daily.

Children (younger than 18 years):

Daily adequate intake (AI): Daily adequate intake (AI) levels of pantothenic acid have been established by the Food and Nutrition Board of the U.S. Institute of Medicine, based on estimated dietary intakes in healthy populations. A recommended daily allowance (RDA) has not been set due to insufficient available scientific evidence. For infants ages 0-6 months-old the daily AI is 1.7 milligrams per day; for infants 7-12 months-old the daily AI is 1.8 milligrams per day; for children 1-3 years-old the daily AI is 2 milligrams per day; for children 4-8 years-old the daily AI is 3 milligrams per day; for children ages 9-13 years-old the daily AI is 4 milligrams per day; for adolescents ages 14-18 years-old the daily AI is 5 milligrams per day. For pregnant women of any age the daily AI is 6 milligrams per day; for breastfeeding women of any age the daily AI is 7 milligrams per day.

Other uses: There is insufficient evidence to recommend specific doses or supplementation in children, except in amounts found in foods or multivitamins.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Avoid if allergic to pantothenic acid or dexpanthenol. Use of dexpanthenol on the skin has been associated with skin irritation/contact dermatitis/eczema. Notably, dexpanthenol is found in many cosmetic products.

Side Effects and Warnings

Oral: Pantothenic acid is likely safe when used orally in doses equivalent to the daily adequate intake (AI). Moderate doses have been ingested without significant reported adverse effects. Large amounts of pantothenic acid taken by mouth may cause diarrhea. In theory, nausea and heartburn may occur. It has been noted anecdotally that dexpanthenol may increase bleeding time and therefore potentially increase the risk of bleeding when combined with other agents with similar properties, but there is limited evidence in this area, and this is generally not regarded as a serious potential risk.

Topical: Use of dexpanthenol on the skin has been associated with skin irritation/contact dermatitis/eczema. Notably, dexpanthenol is found in many cosmetic products.

Injected: Some authors advise against the use of injected dexpanthenol in patients with gastrointestinal obstruction.

Pregnancy and Breastfeeding

Daily adequate intake (AI) levels of pantothenic acid have been established by the Food and Nutrition Board of the U.S. Institute of Medicine, based on estimated dietary intakes in healthy populations. Safety of doses beyond AI levels is not known and should be avoided.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

It has been noted that dexpanthenol may increase bleeding time and therefore potentially increase the risk of bleeding when combined with other agents with similar properties. However, there is limited evidence in this area, and this is generally not regarded as a serious potential risk.

In theory, pantothenic acid and dexpanthenol may increase the effects of cholinesterase inhibitor drugs (including multiple Alzheimer's drugs) by increasing production of acetylcholine, leading to potentially dangerous side effects. Examples of cholinesterase inhibitors include: donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl), tacrine (Cognex), neostigmine (Prostigmin), edrophonium chloride (Tensilon), and pyridostigmine bromide (approved by the FDA for use after exposure to the nerve gas Soman). Combining these agents should be avoided unless under strict medical supervision.

Drugs containing estrogen and progestin may increase the daily requirement of pantothenic acid.

Interactions with Herbs and Dietary Supplements

High doses of pantothenic acid may inhibit the absorption of biotin produced by microflora in the large intestine.

It has been noted anecdotally that dexpanthenol may increase bleeding time and therefore potentially may increase the risk of bleeding when combined with other agents with similar properties. However, there is limited evidence in this area, and this is generally not regarded as a serious potential risk. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.