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  • Pantothenic acid — also known as vitamin B5 — is a water-soluble vitamin that is a precursor in the synthesis of coenzyme A. Coenzyme A is essential to many biochemical reactions that sustain life. Also, the phosphopantetheinyl moiety of coenzyme A is required for the biological activity of several proteins, including the acyl-carrier protein involved in fatty acid synthesis. (More information)
  • Pantothenic acid is essential to all forms of life. It is ubiquitously found in foods of plant and animal origin, and dietary deficiency is very rare. (More information)
  • The Food and Nutrition Board of the National Academy of Medicine set an adequate intake (AI) of 5 milligrams (mg)/day for adults based on the estimated daily average intake of pantothenic acid. (More information)
  • Evidence from limited intervention studies suggests that pantothenic acid and/or pantothenol (alcohol analog) might improve the healing process of skin wounds. Yet, additional larger studies are warranted. (More information)
  • Treatment with high-dose pantethine — a pantothenic acid derivative — has been shown to lower serum cholesterol and lipid concentrations. Although pantethine therapy appears to be well tolerated, medical supervision is indispensable. (More information)
  • Foods rich in pantothenic acid include animal organs (liver and kidney), fish, shellfish, milk products, eggs, avocados, legumes, mushrooms, and sweet potatoes. (More information)
  • Little or no toxicity has been associated with dietary and supplemental pantothenic acid such that no tolerable upper intake level (UL) has been set. (More information)

Pantothenic acid, also known as vitamin B5, is essential to all forms of life (1). Pantothenic acid is found throughout all branches of life in the form of coenzyme A, a vital coenzyme in numerous chemical reactions (2, 3)


Synthesis of pantothenic acid cofactors

Coenzyme A

Pantothenic acid is a precursor in the biosynthesis of coenzyme A (CoA) (Figure 1), an essential coenzyme in a variety of biochemical reactions that sustain life (see Coenzyme A). Pantothenic acid kinase 2 (PANK2) catalyzes the initial step of phosphorylation of pantothenic acid to 4’-phosphopantothenic acid. Coenzyme A and its derivatives inhibit the synthesis of 4’-phosphopantothenic acid, but the inhibition can be reversed by carnitine, required for the transport of fatty acids into the mitochondria (4). The subsequent reactions in this biosynthetic pathway include the synthesis of the intermediate 4’-phosphopantetheine, as well as the recycling of coenzyme A to 4’-phosphopantetheine (Figure 1). 

Figure 1. Coenzyme A Synthesis from Pantothenic Acid. Pantothenic acid is a precursor in the synthesis of coenzyme A. The initial phosphorylation reaction that converts pantothenic acid into 4'-phosphopantothenic acid is impaired in individuals with an inherited defect in the gene (PANKII) coding for pantothenic acid kinase II.


The 4’-phosphopantetheinyl moiety of coenzyme A can be transferred to enzymes in which 4’-phosphopantetheine is an essential cofactor for their biological activities (see 4’-Phosphopantetheinylation). 

Cofactor and co-substrate function

Coenzyme A

Coenzyme A reacts with acyl groups, giving rise to thioester derivatives, such as acetyl-CoA, succinyl-CoA, malonyl-CoA, and 3-hydroxy-3-methylglutaryl (HMG)-CoA. Coenzyme A and its acyl derivatives are required for reactions that generate energy from the degradation of dietary fat, carbohydrates, and proteins. In addition, coenzyme A in the form of acetyl-CoA and succinyl-CoA is involved in the citric acid cycle; in the synthesis of essential fats, cholesterol, steroid hormones, vitamins A and D, the neurotransmitter acetylcholine; and in the fatty acid β-oxidation pathway. Coenzyme A derivatives are also required for the synthesis of the hormone, melatonin, and for a component of hemoglobin called heme. Further, metabolism of a number of drugs and toxins by the liver requires coenzyme A (5)

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 the coenzyme A thioester derivative, acetyl-CoA. Protein acetylation alters the overall charge of proteins, modifying their three-dimensional structure and, potentially, their function. For example, acetylation is a mechanism that regulates the activity of peptide hormones, including those produced by the pituitary gland (6). Also, protein acetylation, like other posttranslational modifications, has been shown to regulate the subcellular localization, the function, and the half-life of many signaling molecules, transcription factors, and enzymes. Notably, the acetylation of histones plays a role in the regulation of gene expression by facilitating transcription (i.e., mRNA synthesis), while deacetylated histones are usually associated with chromatin compaction and gene silencing. The acetylation of histones was found to result in structural changes of the chromatin, which affect both DNA-protein and protein-protein interactions. Crosstalk between acetylation marks and other posttranscriptional modifications of the histones also facilitate the recruitment of transcriptional regulators to the promoter of genes that are subsequently transcribed (reviewed in 7). 

Finally, a number of signaling molecules are modified by the attachment of long-chain fatty acids donated by coenzyme A. These modifications are known as protein acylation and have central roles in cell-signaling pathways (5)


Specific multi-enzyme complexes, which need to carry out several reactions in an orderly manner, may require the covalent attachment of a 4’-phosphopantetheine arm to a “carrier” domain (or protein). This carrier domain holds substrates or reaction intermediates during the progression through the various enzymatic reactions. In mammals, the transfer of the 4’-phosphopantetheinyl moiety from coenzyme A to a conserved serine residue of a specific carrier domain is catalyzed by one unique phosphopantetheinyl transferase (8). The 4’-phosphopantetheinylation is necessary for the conversion of apo-enzymes into fully active holo-enzymes (see below). 

Acyl-carrier protein

Lipids are fat molecules essential for normal physiological function and, among other types, include sphingolipids (essential components of the myelin sheath that enhances nerve transmission), phospholipids (important structural components of cell membranes), and fatty acids. Fatty acid synthase (FAS) is a multi-enzyme complex that catalyzes the synthesis of fatty acids. Within the FAS complex, the acyl-carrier protein (ACP) requires pantothenic acid in the form of 4'-phosphopantetheine for its activity as a carrier protein (4). A group, such as the 4’-phosphopantetheinyl moiety for ACP, is called a prosthetic group; the prosthetic group is not composed of amino acids and is a tightly bound cofactor required for the biological activity of some proteins (Figure 2). Acetyl-CoA, malonyl-CoA, and ACP are all required for the synthesis of fatty acids in the cytosol. During fatty acid synthesis, the acyl groups of acetyl-CoA and malonyl-CoA are transferred to the sulfhydryl group (-SH) of the 4’-phosphopantetheinyl moiety of ACP. The prosthetic group is used as a flexible arm to transfer the growing fatty acid chain to each of the enzymatic centers of the type I FAS complex. In the mitochondria, 4'-phosphopantetheine also serves as a prosthetic group for an ACP homolog present in mitochondrial type II FAS complex (9)

Figure 2. 4'-Pantetheinylation of Acyl-Carrier Protein (ACP). A prosthetic group – in this case, a 4'-phosphopantetheinyl moiety – is required for the biological function of ACP. The addition of the prosthetic group occurs after ACP synthesis (post-translation) in a reaction catalyzed by 4'-phosphopantetheinyl transferase. The enzyme catalyzes the hydrolysis of coenzyme A to 3',5'-adenosine diphosphate and 4'-phosphopantetheine, and the transfer of the 4'-phosphopantetheinyl moiety to a serine residue at the active site of ACP. ACP, acyl-carrier protein; apo-ACP, biologically inactive ACP; holo-ACP, biologically active ACP.

10-Formyltetrahydrofolate dehydrogenase

The enzyme 10-formyltetrahydrofolate dehydrogenase (FDH) catalyzes the conversion of 10-formyltetrahydrofolate to tetrahydrofolate, an essential cofactor in the metabolism of nucleic acids and amino acids (Figure 3). Similar to ACP, FDH requires a 4’-phosphopantetheine prosthetic group for its biological activity. The prosthetic group acts as a swinging arm to couple the activities of the two catalytic domains of FDH (10, 11). A homolog of FDH in mitochondria also requires 4’-phosphopantetheinylation to be biologically active (12)

Figure 3. 4'-Pantetheinylation of Formyltetrahydrofolate Dehydrogenase (FDH). (a) The generation of TH4 from 10-CHO-TH4 is catalyzed by FDH, an enzyme requiring 4'-phosphopantetheine as a prosthetic group to be biologically active. Of note, 10-CHO-TH4 can also be hydrolyzed to TH4 (and formate) in another reaction catalyzed by formyltetrahydrofolate deformylase. (b) The enzyme 4'-phosphopantetheinyl transferase catalyzes the transfer of a 4'-phosphopantetheinyl moiety from coenzyme A to a specific serine residue of FDH, converting apo-FDH to holo-FDH. FDH, formyltetrahydrofolate dehydrogenase; apo-FDH, biologically inactive FDH; holo-FDH, biologically active FDH; 10-CHO-TH4, 10-formyltetrahydrofolate; TH4, tetrahydrofolate; NADP+/NADPH, nicotinamide adenine dinucleotide phosphate oxidized/reduced.

α-Aminoadipate semialdehyde synthase

4’- Phosphopantetheinylation is required for the biological activity of the apo-enzyme a-aminoadipate semialdehyde synthase (AASS). AASS catalyzes the initial reactions in the mitochondrial pathway for the degradation of lysine — an essential amino acid for humans. AASS is made of two catalytic domains. The lysine-ketoglutarate reductase domain first catalyzes the conversion of lysine to saccharopine. Saccharopine is further converted to a-aminoadipate semialdehyde in a reaction catalyzed by the saccharopine dehydrogenase domain (Figure 4). 

Figure 4. 4'-Pantetheinylation of α-Aminoadipate Semialdehyde Synthase (AASS). AASS is a mitochondrial enzyme responsible for the conversions of lysine to saccharopine, and saccharopine to α-aminoadipate semialdehyde in the mitochondrial pathway for lysine degradation. The first reaction is catalyzed by the lysine-ketoglutarate reductase domain of AASS, and the saccharopine dehydrogenase domain catalyzes the second reaction. Apo-AASS requires 4'-phosphopantetheine as a prosthetic group to be biologically active. The enzyme 4'-phosphopantetheinyl transferase catalyzes the transfer of a 4'-phosphopantetheinyl moiety from coenzyme A to a specific residue of AASS, converting apo-AASS to holo-AASS. The 4'-phosphopantetheinyl arm is thought to serve as a swinging arm that couples the activities of the two enzymatic domains of AASS. AASS, α-aminoadipate semialdehyde synthase.


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 supplementation (5). Pantothenic acid deficiency in humans has been induced experimentally by co-administering a pantothenic acid kinase inhibitor (ω-methylpantothenate; Figure 1) 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 (13). In another study, participants fed only a pantothenic acid-free diet did not develop clinical signs of deficiency, although some appeared listless and complained of fatigue (14)

Calcium homopantothenate (or hopantenate) is a pantothenic acid antagonist with cholinergic effects (i.e., similar to those of the neurotransmitter, acetylcholine). This compound is 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 that it was due to homopantothenate-induced pantothenic acid deficiency (15). Of note, autosomal recessive mutations in the human gene PANK2, which codes for pantothenic acid kinase 2 (Figure 1), result in impaired synthesis of 4'-phosphopantetheine and coenzyme A (see Function). This rare disorder, called pantothenate kinase-associated neurodegeneration (PKAN), is associated with iron accumulation in the brain and characterized by visual and intellectual impairments, dystonia, speech abnormalities, behavioral difficulties, and personality disorders (16-18). Two forms of the disorder have been described: classic PKAN with symptom onset early in life (before age 10 years) and atypical PKAN with symptom onset after age 10, sometimes in early adulthood (19)

Yet, because pantothenic acid is widely distributed in nature and deficiency is extremely rare in humans, most information regarding the consequences of deficiency has been gathered from experimental research in animals (reviewed in 4). Pantothenic acid-deficient rats developed damage to the adrenal glands, while pantothenic acid-deficient 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 that was reversed with pantothenic acid administration. 

The diversity of symptoms emphasizes the numerous functions of pantothenic acid in its coenzyme forms. 

Moreover, some recent case-control studies have documented cerebral pantothenic acid deficiency in patients with Alzheimer’s disease (20) and in those with Huntington’s disease (21)

The Adequate Intake (AI)

Because there was little information on the requirements of pantothenic acid in humans, the Food and Nutrition Board of the Institute of Medicine (now the National Academy of Medicine) set an adequate intake (AI) based on observed dietary intakes in healthy population groups (Table 1) (22)

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

The addition of calcium D-pantothenate and/or pantothenol (Figure 5) to the medium of cultured skin fibroblasts given an artificial wound was found to increase cell proliferation and migration, thus accelerating wound healing in vitro (23, 24). Likewise, in vitro deficiency in pantothenic acid induced the expression of differentiation markers in proliferating skin fibroblasts and inhibited proliferation in human keratinocytes (25). The application of ointments containing either calcium D-pantothenate or pantothenol& — also known as D-panthenol or dexpanthenol — to the skin has been shown to accelerate the closure of skin wounds and increase the strength of scar tissue in animals (4)

The effects of topical dexpanthenol on wound healing in humans are unclear. In a placebo-controlled study that included 12 healthy volunteers, the application of dexpanthenol-containing ointment (every 12 hours for 1 to 6 days) in a model of skin wound healing was associated with an enhanced expression of markers of proliferation, inflammation, and tissue repair (26). However, the study failed to report whether these changes in response to dexpanthenol treatment improved the wound-repair process compared to placebo (26). In a randomized, double-blind, placebo-controlled study, the use of dexpanthenol pastilles (300 mg/day for up to 14 days post surgery) was found to accelerate mucosal healing after tonsillectomy in children (27)

Few studies have explored the effects of oral supplementation with pantothenic acid. Early randomized controlled trials in patients undergoing surgery for tattoo removal found that daily co-supplementation with 1 gram or 3 grams of vitamin C and 200 mg or 900 mg of pantothenic acid for 21 days did not significantly improve the wound-healing process (28, 29)

High cholesterol

Early studies suggested that pharmacological doses of pantethine, a pantothenic acid derivative, might have a cholesterol-lowering effect (30, 31). Pantethine is made of two molecules of pantetheine joined by a disulfide bond (chemical bond between two molecules of sulfur) (Figure 5). Pantethine is structurally related to coenzyme A and is found in the prosthetic group that is required for the biological function of acyl-carrier protein, formyltetrahydrofolate dehydrogenase, and α-aminoadipate semialdehyde synthase (see Function)

In a 16-week, randomized, double-blind, placebo-controlled study, daily pantethine supplementation (600 mg/day for 8 weeks, followed by 900 mg/day for another 8 weeks) significantly improved the profile of lipid parameters in 120 individuals at low-to-moderate risk of cardiovascular disease. After adjusting to baseline, pantethine was found to be significantly more effective than placebo in lowering the concentrations of low-density lipoprotein (LDL) cholesterol and apolipoprotein B (apoB), as well as reducing the ratio of triglycerides to high-density lipoprotein-cholesterol (TG:HDL-C) (32). In a randomized controlled trial of 24 individuals at low-to-moderate cardiovascular risk, pantethine supplementation (600 mg/day of pantethine for 8 weeks, followed by 900 mg for 8 weeks) decreased concentrations of total cholesterol, LDL cholesterol, and non-HDL cholesterol at 16 weeks compared to placebo (33). Although it appears to be well tolerated and potentially beneficial in improving cholesterol metabolism, pantethine is not a vitamin, and the decision to use pharmacological doses of pantethine to treat elevated blood cholesterol or triglycerides should only be made in collaboration with a qualified healthcare provider who provides appropriate follow up. 

Figure 5. Chemical Structures of Some Pantothenic Acid Derivatives.

Graying of hair

Mice that are deficient in pantothenic acid developed skin irritation and graying of the fur, which is reversed by pantothenic acid administration (34). In humans, evidence that taking pantothenic acid as supplements or using shampoos containing pantothenic acid can prevent or restore hair color is lacking. 

Hair loss

A case report of nine patients (35) and two small studies (36, 37) suggested some benefit of intramuscular injections of dexpanthenol in the treatment of alopecia or pattern hair loss; however, placebo-controlled trials would be needed to determine whether the drug has any effects on hair loss. 


Food sources

Pantothenic acid is available in a variety of foods, usually as a component of coenzyme A (CoA) and 4’-phosphopantetheine (see Figure 1). Upon ingestion, dietary coenzyme A and phosphopantetheine are hydrolyzed to pantothenic acid prior to intestinal absorption (4). Animal liver and kidney, fish, shellfish, pork, chicken, egg yolk, milk, yogurt, legumes, mushrooms, avocados, broccoli, and sweet potatoes are good sources of pantothenic acid. Whole grains are also good sources of pantothenic acid; processing and refining grains result in significant losses, up to 55% for wheat and up to 88% for maize (38). Freezing and canning of foods result in similar losses (22). Food preparation and cooking methods don’t substantially affect the vitamin due to its stability, but like other water-soluble vitamins, pantothenic acid can leach into cooking liquids (38).   

Large nutritional surveys in the United States have failed to estimate pantothenic acid intake, mainly because of the scarcity of data on the pantothenic acid content of food (22). Smaller studies estimated average daily intakes of pantothenic acid to be between 4 and 7 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 USDA's FoodData Central

Table 2. Some Food Sources of Pantothenic Acid
Food Serving Pantothenic Acid (mg)
Beef liver (pan fried) 3 ounces* 5.9
Mushrooms (shiitake, cooked) ½ cup 2.6
Sunflower seed kernels (dry-roasted) 1 ounce 2.0
Fish, trout (cooked, dry heat) 3 ounces 1.9
Lobster (cooked, moist heat) 3 ounces 1.4
Yogurt (plain, low-fat) 8 ounces 1.3
Avocado (raw, California) ½ fruit 1.0
Sweet potato (baked, with skin) 1 medium 1.0
Milk (skim) 1 cup (8 fluid ounces) 0.87
Pork (tenderloin, lean, roasted) 3 ounces 0.86
Chicken (light meat, roasted) 3 ounces 0.77
Egg (hard-boiled) 1 large 0.70
Lentils (mature seeds, boiled) ½ cup 0.63
Split peas (mature seeds, boiled) ½ cup 0.59
Broccoli (boiled) ½ cup 0.48
Orange (navel) 1 whole 0.37
Peanuts (dry-roasted) 1 ounce 0.29
Cheese, feta 1 ounce 0.27
Whole-wheat bread 1 slice 0.21
*A 3-ounce serving of meat or fish is about the size of a deck of cards.

Intestinal bacteria

The bacteria that normally colonize the colon (large intestine) are capable of synthesizing pantothenic acid. A specialized transporter 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 (39). However, the extent to which bacterial synthesis contributes to pantothenic acid intake in humans is not known (38, 40).


Pantothenol and pantothenate

Supplements commonly contain pantothenol (panthenol), a stable alcohol analog of pantothenic acid, which can be rapidly converted to pantothenic acid by humans. Calcium D-pantothenate, the calcium salt of pantothenic acid, is also available as a supplement (41)


Pantethine is used as a cholesterol-lowering agent in Japan and is available in the US as a dietary supplement (42)



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 g/day of calcium D-pantothenate (43). 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 (44). 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 (now the National Academy of Medicine) did not establish a tolerable upper intake level (UL) for pantothenic acid (22). 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 (42). Also, topical formulations containing up to 5% of dexpanthenol (D-panthenol) have been safely used for up to one month. Yet, several cases of skin irritation, allergic contact dermatitis, and eczema have been reported with the use of dexpanthenol-containing ointments (45-49)

Nutrient interactions

Large doses of pantothenic acid have the potential to compete with biotin for intestinal and cellular uptake by the human sodium-dependent multivitamin transporter (hSMVT) (39, 50)

Drug interactions

Oral contraceptives (birth control pills) containing estrogen and progestin may increase the requirement for pantothenic acid (43). Use of pantethine in combination with cholesterol-lowering drugs called statins (HMG-CoA reductase inhibitors) or with nicotinic acid (see the article on Niacin) may produce additive effects on blood lipids (42)

Linus Pauling Institute Recommendation

More data are needed to define 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 that contains 100% of the Daily Value (DV) for pantothenic acid will ensure an intake of at least 5 mg/day.

Older adults (>50 years)

There is currently little evidence that older adults differ in their intake of or their 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 August 2002 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

Updated in April 2015 by:
Barbara Delage, Ph.D.
Linus Pauling Institute
Oregon State University

Updated in April 2023 by:
Victoria J. Drake, Ph.D.
Linus Pauling Institute
Oregon State University

Reviewed in July 2015 by:
Robert B. Rucker, Ph.D.
Distinguished Professor Emeritus
Department of Nutrition and School of Medicine
University of California, Davis

Copyright 2000-2024  Linus Pauling Institute


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