Vitamin B5 (Pantothenic Acid)

1. Introduction

Vitamin B5, also known as Pantothenic Acid, is an essential water-soluble B vitamin. Its name is derived from the Greek word “pantos,” meaning “everywhere,” reflecting its ubiquitous presence in nearly all plant and animal foods [1]. It is a crucial nutrient required for various metabolic functions, energy generation, and the synthesis of vital compounds within the body [1, 2].

Chemical/Botanical Basics

Pantothenic acid is a combination of pantoic acid and the amino acid $beta$-alanine. It is a precursor molecule for the biosynthesis of the essential coenzyme, Coenzyme A (CoA). In the body, Vitamin B5 is commonly found in the form of Coenzyme A (CoA) or the Acyl Carrier Protein (ACP) [1].

Mechanism of Action

The primary function of Vitamin B5 is its role as an exclusive precursor in the synthesis of Coenzyme A (CoA) and the Acyl Carrier Protein (ACP) [1, 2].

• Coenzyme A (CoA): CoA is a universal and essential cofactor involved in a myriad of biochemical reactions [3]. It is critical for the metabolism of carbohydrates, fats, and proteins, acting as a carrier for acyl groups (e.g., acetyl-CoA) in the tricarboxylic acid (TCA) cycle, fatty acid oxidation, and the synthesis of cholesterol, steroid hormones, and neurotransmitters like acetylcholine [1, 2].
• Acyl Carrier Protein (ACP): ACP is a component of the fatty acid synthase complex and is essential for the synthesis of fatty acids [1].

Through these roles, Vitamin B5 is integral to energy production, cell growth, and maintaining the optimal function of the nervous system and skin [1].

2. Chemical Composition/Key Bioactive Roles

The key bioactive compound of Vitamin B5 is Coenzyme A (CoA), which is synthesized from pantothenic acid.

Bioactive Compound	Role in the Body	Function Category
Pantothenic Acid (Vitamin B5)	Precursor for Coenzyme A (CoA) and ACP synthesis.	Metabolic Precursor
Coenzyme A (CoA)	Essential cofactor for the transfer of acyl groups in metabolism.	Energy & Lipid Metabolism
Acyl Carrier Protein (ACP)	Essential component for the biosynthesis of fatty acids.	Lipid Synthesis
Pantethine	A stable derivative of pantothenic acid, used in supplements.	Supplement Form/Lipid Modulation

3. Health Benefits

Scientific evidence supports several health benefits of Vitamin B5 and its derivatives, particularly in the areas of lipid metabolism and dermatological health.

• Dyslipidemia and Cardiovascular Health
  Pantethine, a stable dimeric form of pantetheine (a derivative of pantothenic acid), has been studied for its lipid-lowering effects. A meta-analysis of clinical trials found that pantethine supplementation significantly reduced total cholesterol, LDL-cholesterol, and triglycerides, while increasing HDL-cholesterol in subjects with hyperlipidemia [4].
  • Scientific Evidence: One study on patients with low to moderate cardiovascular risk found that administering pantethine at doses between 600 mg/d and 900 mg/d over 16 weeks resulted in a significant decrease in total cholesterol and LDL cholesterol compared to a placebo [1, Ref 10]. The mechanism is thought to involve the inhibition of cholesterol and fatty acid synthesis via CoA-dependent pathways [4].
• Dermatological Health and Wound Healing
  The derivative dexpanthenol (the alcohol analog of pantothenic acid) is widely used topically and orally for its beneficial effects on the skin and mucous membranes.
  • Scientific Evidence: Dexpanthenol cream has been shown to help manage mucocutaneous side effects, such as dry mucous membranes and cheilitis, during isotretinoin therapy for acne [1, Ref 6]. Furthermore, studies suggest that dexpanthenol may be an effective alternative treatment for mild to moderate childhood atopic dermatitis [1, Ref 5]. In wound healing, small clinical trials have shown that dexpanthenol, used as a pastille or spray, can improve clinical outcomes after procedures like tonsillectomy and endoscopic sinus surgery [1, Ref 7, 8, 9].
• Support for Adrenal Function
  As a component of CoA, Vitamin B5 is essential for the synthesis of steroid hormones, including those produced by the adrenal glands. While often cited in popular literature, direct, high-quality clinical evidence supporting high-dose B5 supplementation specifically for “adrenal fatigue” is limited and requires further research [2].

4. Dosage and Usage

Vitamin B5 deficiency is extremely rare due to its widespread presence in food. The recommended intake is generally low, but therapeutic doses for specific conditions are significantly higher.

Population Group	Recommended Dietary Allowance (RDA)
Adults (19+ years)	5 mg/day
Pregnant Women	6 mg/day
Lactating Women	7 mg/day

• Therapeutic Dosage: For dyslipidemia, the derivative pantethine has been studied at dosages ranging from 600 mg/d to 900 mg/d [1, 4]. Supplement strengths can range from 10 mg in multivitamins up to 1,000 mg in B-complex or standalone supplements [1].
• Usage: Pantothenic acid supplements are typically taken orally. It is recommended to take oral supplements with food [1, 2].

Food Sources

Pantothenic acid is abundant in a variety of foods, including [1, 2]:

• Meats: Beef, poultry, seafood, and organ meats (e.g., liver).
• Dairy/Eggs: Eggs and milk.
• Vegetables: Mushrooms (especially shiitake), avocados, potatoes, and broccoli.
• Grains/Legumes: Whole grains (whole wheat, brown rice, oats), peanuts, sunflower seeds, and chickpeas.

5. Safety and Precautions

Vitamin B5 is considered generally safe, and there is no established Tolerable Upper Intake Level (UL) due to the lack of toxicity reports from food or supplements [2].

Side Effects

• Overdose Warning: Doses greater than 10,000 mg (10 g) daily are likely to cause mild gastrointestinal distress, such as upset stomach and diarrhea [1, 2].
• Common Adverse Effects (with high doses): Muscle pain, joint pain, headache, nausea, constipation, and flu-like illness [1].
• Less Common/Serious Adverse Effects: Allergic contact dermatitis (with topical use of panthenol/dexpanthenol), muscle wasting (rhabdomyolysis), and new-onset diabetes mellitus have been reported in some cases [1].

Contraindications

• Hypersensitivity/Allergy: Patients with known hypersensitivity or allergy to pantothenic acid or its derivatives should avoid supplementation [1].

Drug Interactions

Vitamin B5 has been reported to have moderate interactions with certain macrolide antibiotics [1]:

• Azithromycin
• Clarithromycin
• Erythromycin (base, ethyl succinate, lactobionate, stearate)
• Roxithromycin

Serious Warnings

WARNING: Doses exceeding 10 grams (10,000 mg) per day may cause severe gastrointestinal issues, including diarrhea. Patients should be advised to adhere to recommended dosages.

6. References

[1] Sanvictores T, Chauhan S. Vitamin B5 (Pantothenic Acid). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Feb 29. https://www.ncbi.nlm.nih.gov/books/NBK563233/

[2] National Institutes of Health (NIH) Office of Dietary Supplements. Pantothenic Acid – Health Professional Fact Sheet. Last updated March 26, 2021. https://ods.od.nih.gov/factsheets/PantothenicAcid-HealthProfessional/

[3] Leonardi R, Jackowski S. Biosynthesis of Pantothenic Acid and Coenzyme A. EcoSal Plus. 2007 Apr;2(2):1-21. https://journals.asm.org/doi/10.1128/ecosalplus.3.6.3.4

[4] McRae MP. Therapeutic benefits of D-pantethine in the treatment of dyslipidemia: a review. Nutr Res. 2005 May;25(5):517-23. https://pubmed.ncbi.nlm.nih.gov/19351004/