Pantothenic Acid (Systemic)


VA CLASSIFICATION
Primary: VT170

Other commonly used names are
vitamin B 5 and calcium pantothenate .
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

Not commercially available in Canada.



Category:


Nutritional supplement (vitamin)—
Note: Pantothenic acid (vitamin B 5) is a water-soluble vitamin.



Indications

Accepted

Pantothenic acid deficiency (prophylaxis and treatment)—The B vitamins are indicated for prevention and treatment of vitamin B deficiency. Vitamin B deficiency may occur as a result of inadequate nutrition or intestinal malabsorption but does not occur in healthy individuals receiving an adequate balanced diet. {08} Simple nutritional deficiency of individual B vitamins is rare since dietary inadequacy usually results in multiple deficiencies. {02} For prophylaxis of pantothenic acid deficiency, dietary improvement, rather than supplementation, is advisable. For treatment of pantothenic acid deficiency, supplementation is preferred. {20}
—There is no indication for pantothenic acid alone, since deficiency is virtually unknown except with administration of pantothenic acid antagonists, which may result in burning foot syndrome. {01} Requirements may be increased in malabsorption syndromes such as tropical sprue, celiac disease, or regional enteritis.

Unaccepted
Pantothenic acid has not been proven effective for treatment of diabetic neuropathy; preventing gray hair or restoring its color; improvement of mental processes; increasing gastrointestinal peristalsis; prevention of arthritis, Addison's disease, or allergies; prevention of birth defects and some respiratory disorders; relief of itching and healing of minor dermatoses (topical); or treatment of streptomycin and salicylate toxicities. {01} {02}


Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    Calcium pantothenate: 476.54 {17}

Mechanism of action/Effect:

Pantothenic acid is a precursor of coenzyme A and is required for various metabolic functions, including metabolism of carbohydrates, proteins, and lipids. It is also used in the synthesis of steroids, porphyrins, acetylcholine, and other substances. {02} {05} Pantothenic acid may also be necessary for normal epithelial function. {05}

Absorption:

The B vitamins are readily absorbed from the gastrointestinal tract, except in malabsorption syndromes. {04}

Distribution:

Pantothenic acid is distributed into body tissues mainly as coenzyme A. Highest concentrations are found in the liver, adrenal glands, heart, and kidneys. {01}

Biotransformation:

Pantothenic acid is not metabolized.

Elimination:
{01}{05}    Renal, 70% (unchanged).
    Fecal, 30%.


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Problems in humans have not been documented with intake of normal daily recommended amounts. {07}

Breast-feeding

Problems in humans have not been documented with intake of normal daily recommended amounts. {06} {09}

Pediatrics

Problems in pediatrics have not been documented with intake of normal daily recommended amounts.


Geriatrics


Problems in geriatrics have not been documented with intake of normal daily recommended amounts.


Side/Adverse Effects
No side effects have been reported with pantothenic acid.



Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Pantothenic Acid (Vitamin B 5) (Systemic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Description of use
Description should include function in the body, signs of deficiency, and unproven uses


Importance of diet
Importance of proper nutrition; supplement may be needed because of inadequate dietary intake

Food sources of pantothenic acid; effects of processing

Not using vitamins as substitute for balanced diet

Recommended daily intake for pantothenic acid

Proper use of this dietary supplement

» Proper dosing
Missed dose: No cause for concern because of length of time necessary for depletion; remembering to take as directed

» Proper storage


General Dosing Information
Because of the infrequency of single B vitamin deficiencies, combinations are commonly administered. Many commercial combinations of B vitamins are available.

Each 10 mg of calcium pantothenate is equivalent to 9.2 mg of pantothenic acid. {01}

Diet/Nutrition
Recommended dietary intakes for pantothenic acid are defined differently worldwide.


For U.S.:
The Recommended Dietary Allowances (RDAs) for vitamins and minerals are determined by the Food and Nutrition Board of the National Research Council and are intended to provide adequate nutrition in most healthy persons under usual environmental stresses. In addition, a different designation may be used by the FDA for food and dietary supplement labeling purposes, as with Daily Value (DV). DVs replace the previous labeling terminology United States Recommended Daily Allowances (USRDAs). {05} {18}



For Canada:
Recommended Nutrient Intakes (RNIs) for vitamins, minerals, and protein are determined by Health and Welfare Canada and provide recommended amounts of a specific nutrient while minimizing the risk of chronic diseases. {19}



There is no RDA or RNI established for pantothenic acid. The following daily intakes are considered adequate for all individuals {05}:


Infants and children—
Birth to 3 years of age: 2–3 mg.

4 to 6 years of age: 3–4 mg.

7 to 10 years of age: 4–5 mg.



Adolescents and adults—
4–7 mg.
The best dietary sources of pantothenic acid include peas and beans (except green beans), lean meat, poultry, fish, and whole-grain cereals. {04} {10} There is little loss of pantothenic acid from foods with ordinary cooking.





Oral Dosage Forms

CALCIUM PANTOTHENATE TABLETS USP

Note: The dosing and strengths of the dosage forms available are expressed in terms of pantothenic acid (not the calcium salt).


Usual adult and adolescent dose
Deficiency (prophylaxis)
Oral, amount based on normal daily recommended intakes of 4 to 7 mg (base). {05}

Deficiency (treatment)
Dose is individualized by prescriber based on severity of deficiency.


Usual pediatric dose
Deficiency (prophylaxis)—Oral, amount based on normal daily recommended intakes: {05}
Birth to 3 years of age—2–3 mg (base).

4 to 6 years of age—3–4 mg (base).

7 to 10 years of age—4–5 mg (base).

Deficiency (treatment)
Dose is individualized by prescriber based on severity of deficiency.


Strength(s) usually available
U.S.—


10 mg{11} (base) (OTC)[Generic]


25 mg (base) (OTC)[Generic]


50 mg (base) (OTC)[Generic]


100 mg (base) (OTC)[Generic]


218 mg (base) (OTC)[Generic]


250 mg{12} (base) (OTC)[Generic]


500 mg{12} (base) (OTC)[Generic]


545 mg (base) (OTC)[Generic]

Canada—
Not commercially available.

Note: Some strengths of these calcium pantothenate preparations may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs.


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Additional information:
Each 10 mg of calcium pantothenate is equivalent to 9.2 mg of pantothenic acid.


PANTOTHENIC ACID CAPSULES

Usual adult and adolescent dose
See Calcium Pantothenate Tablets USP.

Usual pediatric dose
See Calcium Pantothenate Tablets USP.

Strength(s) usually available
U.S.—


200 mg (OTC)[Generic]{13}


250 mg (OTC)[Generic]{14}

Canada—
Not commercially available.

Note: Some strengths of these pantothenic acid preparations may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs.


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.


PANTOTHENIC ACID ORAL SOLUTION

Usual adult and adolescent dose
See Calcium Pantothenate Tablets USP.

Usual pediatric dose
See Calcium Pantothenate Tablets USP.

Strength(s) usually available
U.S.—


200 mg {13} per 5 mL (OTC)[Generic]

Canada—
Not commercially available.

Note: The strength of this pantothenic acid preparation may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs.


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.


PANTOTHENIC ACID TABLETS

Usual adult and adolescent dose
See Calcium Pantothenate Tablets USP.

Usual pediatric dose
See Calcium Pantothenate Tablets USP.

Strength(s) usually available
U.S.—


50 mg (OTC)[Generic]


100 mg (OTC)[Generic]


200 mg (OTC)[Generic]


250 mg (OTC)[Generic]


500 mg (OTC)[Generic]


1 gram (OTC)[Generic]{13}

Canada—
Not commercially available.

Note: Some strengths of these pantothenic acid preparations may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs.


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.


PANTOTHENIC ACID EXTENDED-RELEASE TABLETS

Usual adult and adolescent dose
See Calcium Pantothenate Tablets USP.

Usual pediatric dose
Dosage form not appropriate for pediatric patients.

Strength(s) usually available
U.S.—


500 mg (OTC)[Generic]
{13}{15}
Canada—
Not commercially available.

Note: The strength of this pantothenic acid preparation may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs.


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer.



Revised: 07/16/1992



References
  1. McEvoy GK, editor. AHFS Drug information 90. Bethesda, MD: American Society of Hospital Pharmacists, 1990: 2115-6.
  1. Drug evaluations subscription. Chicago: American Medical Association, Spring 1990: 1:14.
  1. Council on Scientific Affairs. Vitamin preparations as dietary supplements and as therapeutic agents. JAMA 1987; 257(14): 1929-36.
  1. Gilman AG, Goodman LS, Rall TW, Murad F, editors. Goodman and Gilman's the pharmocological basis of therapeutics. 7th ed. New York: Macmillan, 1985: 1562-3.
  1. National Research Council. Recommended dietary allowances. 10th ed. Washington, DC: National Academy Press, 1989: 169-73.
  1. Song W, Chan G, Wyse B et al. Effect of pantothenic acid status on the content of the vitamin in human milk Am J Clin Nutr. 1984; 40: 317-24.
  1. Expert Panel of the Cosmetic Ingredient Review. Safety assessment for Panthenol, Pantothenic Acid. 9/26/86.
  1. Tarr J, Tamura T, Stokstad E. Availability of vitamin B 6 and pantothenate in an average American diet in man. Am J Clin Nutr 1981; 34: 1328-37.
  1. Johnston L, Vaughan L, Fox H. Pantothenic acid content of human milk. Am J Clin Nutr 1981; 34: 2205-9.
  1. Panelist comment, 1991.
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  1. Redbook 1993. Montvale, NJ: Medical Economics Data, 1993: 426.
  1. Redbook 1993. Montvale, NJ: Medical Economics Data, 1993: 427.
  1. Per phone call (Carlson—US), 11/12/93.
  1. Committee on Nutritional Status during Pregnancy, National Academy of Sciences. Washington, DC: National Academy Press, 1990: 1-23.
  1. Fleeger CA, editor. USP dictionary of USAN and international drug names 1995. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1994: 115.
  1. Food and Drug Administration. Focus on food labeling. FDA Consumer. May, 1993.
  1. Health and Welfare Canada. Nutrition recommendations, the report of the scientific committee. Ottawa, Canada: Canadian Government Publishing Centre, 1990: 5-6, 201.
  1. Nutrition and Electrolytes Advisory panel meeting, 1995.
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