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Pantothenic acid, also known as vitamin B5, is essential to all forms of life (1). Pantothenic acid is found throughout living cells in the form of coenzyme A (CoA), a vital coenzyme in numerous chemical reactions (2).

Function

Coenzyme A

Pantothenic acid is a component of coenzyme A (CoA), an essential coenzyme in a variety of reactions that sustain life. CoA is required for chemical reactions that generate energy from food (fat, carbohydrates, and proteins). The synthesis of essential fats, cholesterol, and steroid hormones requires CoA, as does the synthesis of the neurotransmitter, acetylcholine, and the hormone, melatonin. Heme, a component of hemoglobin, requires a CoA-containing compound for its synthesis. Metabolism of a number of drugs and toxins by the liver requires CoA (3).

Coenzyme A was named for its role in acetylation reactions. Most acetylated proteins in the body have been modified by the addition of an acetate group that was donated by CoA. Protein acetylation affects the 3-dimensional structure of proteins, potentially altering their function. For example, acetylation reactions can alter the activity of peptide hormones. Protein acetylation appears to play a role in cell division and DNA replication and also affects gene expression by facilitating the transcription of mRNA. Additionally, a number of proteins are modified by the attachment of long-chain fatty acids donated by CoA. These modifications are known as protein acylation and appear to play a central role in cell signaling (4).

Acyl-carrier protein

The acyl-carrier protein requires pantothenic acid in the form of 4'-phosphopantetheine for its activity as an enzyme (4, 5). Both CoA and the acyl-carrier protein are required for the synthesis of fatty acids. Fatty acids are a component of some lipids, which are fat molecules essential for normal physiological function. Among these essential fats are sphingolipids, which are a component of the myelin sheath that enhances nerve transmission. Another example of these essential fats is the phospholipids that reside in cell membranes.

Deficiency

Naturally occurring pantothenic acid deficiency in humans is very rare and has been observed only in cases of severe malnutrition. World War II prisoners in the Philippines, Burma, and Japan experienced numbness and painful burning and tingling in their feet; these symptoms were relieved specifically by pantothenic acid (4). Pantothenic acid deficiency in humans has been induced experimentally by co-administering a pantothenic acid antagonist and a pantothenic acid-deficient diet. Participants in this experiment complained of headache, fatigue, insomnia, intestinal disturbances, and numbness and tingling of their hands and feet (6). In a more recent study, participants fed only a pantothenic acid free diet did not develop clinical signs of deficiency, although some appeared listless and complained of fatigue (7). Homopantothenate is a pantothenic acid antagonist with cholinergic effects (similar to those of the neurotransmitter, acetylcholine). It was used in Japan to enhance mental function, especially in Alzheimer's disease. A rare side effect was the development of hepatic encephalopathy, a condition of abnormal brain function resulting from the failure of the liver to eliminate toxins. The encephalopathy was reversed by pantothenic acid supplementation, suggesting but not proving it was due to pantothenic acid deficiency caused by the antagonist (5).

Because pantothenic acid deficiency is so rare in humans, most information regarding the effects of deficiency comes from experimental research in animals. Pantothenic acid deficient rats developed damage to the adrenal glands, while monkeys developed anemia due to decreased synthesis of heme, a component of hemoglobin. Dogs with pantothenic acid deficiency developed low blood glucose, rapid breathing and heart rates, and convulsions. Chickens developed skin irritation, feather abnormalities, and spinal nerve damage associated with the degeneration of the myelin sheath. Pantothenic acid deficient mice showed decreased exercise tolerance and diminished storage of glucose (in the form of glycogen) in muscle and liver. Mice also developed skin irritation and graying of the fur, which was reversed by giving pantothenic acid. This finding led to the idea of adding pantothenic acid to shampoo, although it has not been successful in restoring hair color in humans (4). The diversity of symptoms emphasizes the numerous functions of pantothenic acid in its coenzyme forms.

The Adequate Intake (AI)

The Food and Nutrition Board of the Institute of Medicine felt the existing scientific evidence was insufficient to calculate an RDA for pantothenic acid, so they set an adequate intake level (AI; Table 1). The AI for pantothenic acid was based on estimated dietary intakes in healthy population groups (8).

Table 1. Adequate Intake (AI) for Pantothenic Acid
Life Stage  Age  Males (mg/day)  Females (mg/day) 
Infants  0-6 months  1.7  1.7 
Infants  7-12 months  1.8  1.8 
Children  1-3 years 
Children  4-8 years 
Children  9-13 years 
Adolescents  14-18 years 
Adults  19 years and older 
Pregnancy  all ages  - 
Breast-feeding  all ages  7

Disease Treatment

Wound healing

Administration of oral pantothenic acid and application of pantothenol ointment to the skin have been shown to accelerate the closure of skin wounds and increase the strength of scar tissue in animals. Adding calcium-D-pantothenate to cultured human skin cells given an artificial wound increased the number of migrating skin cells and their speed of migration, effects likely to accelerate wound healing (9). However, there are few data to support accelerated wound healing in humans. A randomized, double-blind study in patients undergoing surgery for tattoo removal found that supplementation with 1,000 mg of vitamin C and 200 mg of pantothenic acid did not significantly improve the wound-healing process (10).

High cholesterol

A pantothenic acid derivative called pantethine has been reported by a number of investigators to have a cholesterol-lowering effect. Pantethine is actually two molecules of pantetheine joined by a disulfide bond (chemical bond between two molecules of sulfur). In the synthetic pathway of coenzyme A (CoA), pantethine is closer to CoA than pantothenic acid and is the functional component of CoA and acyl carrier proteins. Several studies found doses of 900 mg of pantethine daily (300 mg three times daily) to be significantly more effective than placebo in lowering total cholesterol and triglyceride levels in the blood of both diabetic and non-diabetic individuals (11). Pantethine was also found to lower cholesterol and triglyceride levels in diabetic patients on hemodialysis without adverse side effects. The fact that pantethine has few side effects was especially attractive for hemodialysis patients because of the increased risk of drug toxicity in patients with renal (kidney) failure (12). Pantethine is not a vitamin; it is a derivative of pantothenic acid. The decision to use pantethine to treat elevated blood cholesterol or triglycerides should be made in collaboration with a qualified health care provider who can provide appropriate follow-up.

Sources

Food sources

Pantothenic acid is available in a variety of foods. Rich sources of pantothenic acid include liver and kidney, yeast, egg yolk, and broccoli. Fish, shellfish, chicken, milk, yogurt, legumes, mushrooms, avocado, and sweet potatoes are also good sources. Whole grains are good sources of pantothenic acid, but processing and refining grains may result in a 35% to 75% loss. Freezing and canning of foods result in similar losses (8). Large national, nutritional surveys were unable to estimate pantothenic acid intake due to the scarcity of data on the pantothenic acid content of food. Smaller studies estimate average daily intakes of pantothenic acid to be from 5 to 6 mg/day in adults. Table 2 lists some rich sources of pantothenic acid along with their content in milligrams (mg). For more information on the nutrient content of foods, search the USDA food composition database.

Table 2. Some Food Sources of Pantothenic Acid
Food Serving Pantothenic Acid (mg)
Fish, cod (cooked) 3 ounces 0.15
Tuna (light, canned in water) 3 ounces 0.18
Chicken, cooked 3 ounces 0.98
Egg (cooked) 1 large 0.61
Milk 1 cup (8 ounces) 0.83
Yogurt 8 ounces 1.35
Broccoli (cooked) ½ cup (chopped) 0.48
Lentils (cooked) ½ cup 0.63
Split peas (cooked) ½ cup 0.58
Avocado, California 1 whole  1.99
Sweet potato (cooked) 1 medium (½ cup) 0.88
Mushrooms (raw) ½ cup (chopped) 0.52
Lobster (cooked) 3 ounces 0.24
Bread, whole wheat 1 slice 0.19

Intestinal bacteria

The bacteria that normally colonize the colon (large intestine) are capable of making their own pantothenic acid. It is not yet known whether humans can absorb the pantothenic acid synthesized by their own intestinal bacteria in meaningful amounts. However, a specialized process for the uptake of biotin and pantothenic acid was identified in cultured cells derived from the lining of the colon, suggesting that humans may be able to absorb pantothenic acid and biotin produced by intestinal bacteria (13)

Supplements

Pantothenic acid

Supplements commonly contain pantothenol, a more stable alcohol derivative, which is rapidly converted to pantothenic acid by humans. Calcium and sodium D-pantothenate, the calcium and sodium salts of pantothenic acid, are also available as supplements (4).

Pantethine

Pantethine is used as a cholesterol-lowering agent in Europe and Japan and is available in the US as a dietary supplement (14).

Safety

Toxicity

Pantothenic acid is not known to be toxic in humans. The only adverse effect noted was diarrhea resulting from very high intakes of 10 to 20 grams/day of calcium D-pantothenate (15). However, there is one case report of life-threatening eosinophilic pleuropericardial effusion in an elderly woman who took a combination of 10 mg/day of biotin and 300 mg/day of pantothenic acid for two months (16). Due to the lack of reports of adverse effects when the Dietary Reference Intakes (DRI) for pantothenic acid were established in 1998, the Food and Nutrition Board of the Institute of Medicine did not establish a tolerable upper level of intake (UL) for pantothenic acid (8). Pantethine is generally well tolerated in doses up to 1,200 mg/day. However gastrointestinal side effects, such as nausea and heartburn, have been reported (14).

Drug interactions

Oral contraceptives (birth control pills) containing estrogen and progestin may increase the requirement for pantothenic acid (15). Use of pantethine in combination with HMG-CoA reductase inhibitors (statins) or nicotinic acid may produce additive effects on blood lipids (14).

Linus Pauling Institute Recommendation

Little is known regarding the amount of dietary pantothenic acid required to promote optimal health or prevent chronic disease. The Linus Pauling Institute supports the recommendation by the Food and Nutrition Board of 5 mg/day of pantothenic acid for adults. A varied diet should provide enough pantothenic acid for most people. Following the Linus Pauling Institute recommendation to take a daily multivitamin/mineral supplement, containing 100% of the Daily Value (DV), will ensure an intake of at least 5 mg/day of pantothenic acid.

Older adults (>50 years)

Presently there is little evidence that older adults differ in their intake or requirement for pantothenic acid. Most multivitamin/mineral supplements provide at least 5 mg/day of pantothenic acid.


Authors and Reviewers

Originally written in 2000 by: 
Jane Higdon, Ph.D. 
Linus Pauling Institute 
Oregon State University

Updated in May 2004 by: 
Jane Higdon, Ph.D. 
Linus Pauling Institute 
Oregon State University

Updated in April 2008 by: 
Victoria J. Drake, Ph.D. 
Linus Pauling Institute 
Oregon State University

Reviewed in April 2008 by: 
Nora Plesofsky, Ph.D. 
Research Associate 
College of Biological Sciences 
University of Minnesota

Copyright 2000-2015  Linus Pauling Institute


References 

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2.  Tahiliani AG, Beinlich CJ. Pantothenic acid in health and disease. Vitam Horm. 1991;46:165-228.  (PubMed)

3.  Brody T. Nutritional Biochemistry. 2nd ed. San Diego: Academic Press; 1999.

4.  Plesofsky-Vig N. Pantothenic acid. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 1999:423-432.

5.  Bender DA. Optimum nutrition: thiamin, biotin and pantothenate. Proc Nutr Soc. 1999;58(2):427-433.  (PubMed)

6.  Hodges RE, Ohlson MA, Bean WB. Pantothenic acid deficiency in man. J Clin Invest. 1958;37:1642-1657.

7.  Fry PC, Fox HM, Tao HG. Metabolic response to a pantothenic acid deficient diet in humans. J Nutr Sci Vitaminol (Tokyo). 1976;22(4):339-346.  (PubMed)

8.  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.  (National Academy Press)

9.  Weimann BI, Hermann D. Studies on wound healing: effects of calcium D-pantothenate on the migration, proliferation and protein synthesis of human dermal fibroblasts in culture. Int J Vitam Nutr Res. 1999;69(2):113-119.  (PubMed)

10.  Vaxman F, Olender S, Lambert A, et al. Effect of pantothenic acid and ascorbic acid supplementation on human skin wound healing process. A double-blind, prospective and randomized trial. Eur Surg Res. 1995;27(3):158-166.  (PubMed)

11. Gaddi A, Descovich GC, Noseda G, et al. Controlled evaluation of pantethine, a natural hypolipidemic compound, in patients with different forms of hyperlipoproteinemia. Atherosclerosis. 1984;50(1):73-83.  (PubMed)

12.  Coronel F, Tornero F, Torrente J, et al. Treatment of hyperlipemia in diabetic patients on dialysis with a physiological substance. Am J Nephrol. 1991;11(1):32-36.  (PubMed)

13.  Said HM, Ortiz A, McCloud E, Dyer D, Moyer MP, Rubin S. Biotin uptake by human colonic epithelial NCM460 cells: a carrier-mediated process shared with pantothenic acid. Am J Physiol. 1998;275(5 Pt 1):C1365-1371.  (PubMed)

14.  Hendler SS, Rorvik DR, eds. PDR for Nutritional Supplements. Montvale: Medical Economics Company, Inc; 2001

15.  Flodin N. Pharmacology of micronutrients. New York: Alan R. Liss, Inc.; 1988.

16.  Debourdeau PM, Djezzar S, Estival JL, Zammit CM, Richard RC, Castot AC. Life-threatening eosinophilic pleuropericardial effusion related to vitamins B5 and H. Ann Pharmacother. 2001;35(4):424-426.  (PubMed)