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
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.1, 2
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.1, 2, 3 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 be due to malnutrition.1, 2
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.1, 2, 4, 5
Uses and Pharmacology
Despite positive findings in rodent studies, little positive clinical data exist regarding the use of pantothenic acid in the condition or growth of human hair.
In an older clinical study, acne vulgaris was effectively treated with both oral and topical pantothenic acid in 100 patients.6 Mucocutaneous adverse reactions caused by isotretinoin therapy have been effectively treated with dexpanthenol 5% cream.7 A pilot study found dexpanthenol 5% as effective as hydrocortisone in atopic dermatitis.8
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.
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.9, 10, 11, 12, 13, 14
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.15, 16
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.17, 18, 19, 20
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.21
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.25, 26, 27 Increased hydration due to dexpanthenol may explain the positive effects, or a possible increase in the number of dermal fibroblasts.2 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.39 Further studies are warranted.
Pantethine stimulates GI motility in laboratory animals.28, 29 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.30
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.32, 33
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 for exercise performance, muscle coenzyme A levels, or fuel selection.40
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.2, 36
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.15, 16, 37, 38
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.2, 36
None well documented. A case report of life-threatening eosinophilic pleuropericardial effusion with concomitant use of biotin 10 mg/day and pantothenic acid 300 mg/day exists.37
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.1, 38, 41 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.16
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.2, 36
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