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.
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.
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.
There is currently insufficient scientific evidence in this area in order to form a clear conclusion.
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.
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.
There is currently insufficient scientific evidence in this area in order to form a clear conclusion.
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.
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.
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.
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 Dietary 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.
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.
Dexpanthenol 2% cream has been used on the skin for various conditions, applied once or twice daily.
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 Dietary 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.
There is insufficient evidence to recommend specific doses or supplementation in children, except in amounts found in foods or multivitamins.
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.
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.
Use of dexpanthenol on the skin has been associated with skin irritation/contact dermatitis/eczema. Notably, dexpanthenol is found in many cosmetic products.
Some authors advise against the use of injected dexpanthenol in patients with gastrointestinal obstruction.
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.
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 U.S. Food and Drug Administration (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.
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.
Estrogen and progestin may increase the body's daily requirement for pantothenic acid.
This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Christine Ulbricht, PharmD (University of Massachusetts); Wendy Weissner, BA (Natural Standard Research Collaboration).
Brenner A. The effects of megadoses of selected B complex vitamins on children with hyperkinesis: controlled studies with long-term follow-up. J Learn Disabil 1982;15:258-64.
Food and Nutrition Board, Institute of Medicine. Pantothenic acid. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B-12, Pantothenic Acid, Biotin, and Choline. Washington, D.C.: National Academy Press; 1998:357-373.
Haslam RH, Dalby JT, Rademaker AW. Effects of megavitamin therapy on children with attention deficit disorders. Pediatrics 1984;74:103-1.
Lewis CM, King JC. Effect of oral contraceptives agents on thiamin, riboflavin, and pantothenic acid status in young women. Am J Clin Nutr 1980;33(4):832-838.
Loftus EV Jr, Tremaine WJ, Nelson RA, et al. Dexpanthenol enemas in ulcerative colitis: a pilot study. Mayo Clin Proc 1997 Jul;72(7):616-20.
Lokkevik E, Skovlund E, Reitan JB, et al. Skin treatment with bepanthen cream versus no cream during radiotherapy-a randomized, controlled trial. Acta Onco 1996;35:1021-6.
McCurdy PR. Is there an anemia responsive to pantothenic acid? J Am Geriatr Soc 1973;21(2):88-91.
Nice C, Reeves AG, Brinck-Johnsen T, et al. The effects of pantothenic acid on human exercise capacity. J Sports Med Phys Fitness 1984;24(1):26-29.
Srinivasan V, Belavady B. Nutritional status of pantothenic acid in Indian pregnant and nursing women. Int J Vitam Nutr Res 1976;46(4):433-438.
Verse T, Klocker N, Riedel F, et al. [Dexpanthenol nasal spray in comparison to dexpanthenol nasal ointment. A prospective, randomised, open, cross-over study to compare nasal mucociliary clearance] HNO 2004 Jul;52(7):611-5.
Walsh JH, Wyse BW, Hansen RG. Pantothenic acid content of 75 processed and cooked foods. J Am Diet Assoc 1981;78(2):140-144.
Yates AA, Schlicker SA, Suitor CW. Dietary reference intakes: The new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J Am Diet Assoc 1998;98:699-706.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.