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Monograph

amr
Pantothenic Acid
Gregory S. Kelly, ND
Description
Pantothenic acid (vitamin B5) is a water-soluble B-complex vitamin that was identi ed in 1933, isolated and extracted from liver in 1938, and rst synthesized in 1940.1 R. J. Williams is credited with coining the name from the Greek word panthos, which translates as “from everywhere.” It was given this name because of its widespread presence in food.2 Most vitamin B5, and its derivatives or precursors, added to foods and beverages, or used in dietary supplements, is made by chemical synthesis.2,3 Only the Dextrorotatory (D) isomer of pantothenic acid – D-pantothenic acid – possesses biologic activity. Pure D-pantothenic acid can be used as a dietary supplement: it is water-soluble, viscous, and yellow in color. Because D-pantothenic acid is relatively unstable – it can be destroyed by heat and acid and alkaline conditions – the more stable calcium pantothenate is the form of vitamin B5 usually found in dietary supplements. It is water-soluble, crystalline, and white in color. Ten mg of calcium pantothenate is approximately equivalent to 9.2 mg of pure D-pantothenic acid.2 [Note: A monograph on pantethine was published in volume 15 of Alternative Medicine Review in 2010.5] e disulphide form of pantothenic acid – pantethine – is also available as a dietary supplement. is is considered to be the most active form of vitamin B5 because it contains the sulfhydryl-group needed for biological activity in Coenzyme A (CoA).4 A liquid form of vitamin B5 – dexpanthenol, D-pantothenyl alcohol, D-panthenol, or panthenol – is also available. is is an alcohol pro-vitamin of vitamin B5 (i.e., it is converted into pantothenic acid in the body), which is used primarily as a topical or injected form for cosmetic purposes or wound healing.6 Unless otherwise speci ed, the supplemental form of vitamin B5 used in studies referenced in this monograph is calcium pantothenate.

Dietary Sources and Intake
Foods that are considered to be exceptionally good dietary sources of pantothenic acid include peanut butter (5-8 mg/100 g), liver (5-7 mg/100 g), kidney (4-6 mg/100 g), peanuts (2-3 mg/100 g), almonds (2-3 mg/100 g), wheat bran (2-3 mg/100 g), cheese (1.5 mg/100 g), and lobster (1.5 mg/100 g). e vast majority of vitamin B5 in foods is found already incorporated into Coenzyme A (CoA) and as phosphopantetheine.2 Re ning, freezing, canning and cooking food causes losses of pantothenic acid, so a modern processed food diet would be expected to have lower amounts of vitamin B5 than a whole foods diet.2 e Dietary Reference Intake (DRI) is 5 mg/d of pantothenic acid for males and females 14 years old and over, 6 mg/d during pregnancy, and 7 mg/d during lactation.7 A 1981 study estimated that the average American diet contains about 5.8 mg/d of pantothenic acid.8 A 2010 population study conducted in Japan, using data from the Nation Health and Nutrition Survey, estimated a daily intake of 4.52 mg/d of pantothenic acid.9 While the average intake appears to approximate the DRI, subsets of the population might be at higher risk for insu cient intake. A dietary analysis of healthy adolescents reported that 49 percent of the females and 15 percent of the males consumed less than 4 mg/day of pantothenic acid in their diet.10 A study of Hispanic children, considered to be of low socioeconomic status, conducted in Houston, Texas, indicated that pantothenic acid intake was extremely variable and below recommended intake for many of the studied subjects.11 e diet of residents of a

Gregory S. Kelly, ND – Senior editor for Alternative Medicine Review; consultant for Lifestrive; co-owner of Health Coach; author of the book Shape Shift. Email: gkelly@altmedrev.com

263 Alternative Medicine Review Volume 16, Number 3

Copyright © 2011 Alternative Medicine Review, LLC. All Rights Reserved. No Reprint Without Written Permission.

however. celiac.2. In vivo e ects of pantophorylation of this molecule. vitamin D and bile acids).. e breakSchool reported that neither of the two most down of the pyrimidine bases.g.2 cofactor. C C C acetylated compounds (e. which carry and transfer acetyl and adenosyl group derived from ATP and the phosacyl groups.3 oral contraceptives compared with females who In mammals. cytosine.g.2 e next step is a condensation reaction To elicit severe signs of pantothenic acid with cysteine. Number 3 Alternative Medicine Review 264 . this area formed by a decarboxylation reaction. ubiquinone [CoQ10]. Directly or indirectly. No Reprint Without Written Permission. -inositol.17 which exceeds the biosynthesis of pantothenic acid-dependent their DRI.7 enzymes.. e mean pantothenic 4’-phosphopantothenic acid (4’-PPA)..13 A study conducted in 100 polyketide synthases. hyperlipidemia. reaction rate of this enzymatic step is also increased by the availability of protein-sulfhydryl Biochemistry compounds such as cysteine.2. Mammals for insu ciency. B5. dolichol. sphingenin. endogenous synthesis of CoA and were not. respectively. steroid hormones. and cholesterol). lupus. ulcerative colitis. producing 4’-phosphopantothenoyl de ciency in mice. Monograph Keywords: pantothenic acid..15 e daily mean dietary intake of ACP can begin with pantothenic acid.19 is step acid intake of lactating women was estimated as is considered the most important control step in 7. as well as plasmalogen. anti-aging.20 e nal two steps Pantothenic acid is used in CoA and acyl carrier in the synthesis of CoA involve the addition of an proteins (ACP). conducted at a long-term care facility for the aged CoA is involved in the breakdown of the carbon a liated with the University of Toronto’s Medical skeleton of most of the amino acids. and prostaglandins and prostaglandin-like compounds.75 mg.g. phosphatidylcholine.2 that their Mediterranean-style diet was insu cient Most plants and microorganisms accomplish in pantothenic acid.000 thetic pathway begins with a phosphorylation kcal. obesity. stress. All Rights Reserved.12 A study and ceramide. and commonly fed diet types – unrestricted diet and thymine.2. vitamin B5. treatment with an antibiotic is cysteine. so are acid levels were signi cantly lower in females using unable to synthesize pantothenic acid. alopecia. adrenal. e biosynpregnant women was estimated as 2. acetylcholine]). steroid molecules (e. ergogenic.14 biosynthesis of pantothenic acid by enzymatically Other circumstances might also be risk factors combining pantoic acid with ß-alanine. and free-living elderly individuals in Greece reported nonribosomal peptide synthetases. suggesting that the absence of cient pantothenic acid to ward o signs of severe cysteine as a substrate is a limiting factor in the de ciency is produced by intestinal bacteria.. is also dependent on CoA. acetylated derivatives of amino sugars [e. It is involved in the production of many secondary metabolites such as polyisoprenoid-containing H CH3 compounds (e.3. Presumably this occurs because su accumulate. rheumatoid arthritis. Biosynthesis of phospholipids (e.g.16 is would supply an inadequate amount of reaction catalyzed by a magnesium-dependent pantothenic acid for pregnant women consuming enzyme – pantothenate kinase (also called pantothe low-to-moderate range of recommended thenic acid kinase) – resulting in the formation of calories during pregnancy. SLE.g.3 CoA is an essential cofactor in fatty acid oxidation. lifespan. LLC.2 lactose-free diet – supplied su cient quantities of ACP is involved in fatty acid synthases. Volume 16. osteoarthritis. HOOCCH2CH2NH squalene. -serine.75 mg/1. In the absence of cysteine. pantothenic acid. and fatty acid synthesis. aldehydes.3 e has not been investigated. wounds CH2OH Copyright © 2011 Alternative Medicine Review. require CoA. Both of these thenic acid are generally thought to be a result of enzymatic reactions require magnesium as a its incorporation into these molecules. A study reported that pantothenic lack the enzyme for this synthetic step. 4’-Phosphopantetheine (4’-PP) is then vitamin B5 status in humans. -ethanolamine.18 It’s biosynthesis of pantothenic acid’s down-line possible that intestinal ora contributes to overall metabolites..6 mg/d over a 6-month period. 4’-PPA will necessary.amr northern Utah nursing home had a mean daily -cardiolipin). OH CH3 N-acetylserotonin. lipid elongation. pantothenic acid content of 3.g. N-acetylglucosamine]. chemicals. O acetylated neurotransmitters [e. uracil. lysine synthesis. acne.

poor grooming. and is sodium-dependent and exudation around the eyes. percent.22 Pantothenic acid appears to be is led to pantothenic acid being thought of as an absorbed rapidly following an oral dose. it does not of CoA and pantothenic acid increases signi cantly occur consistently in all animals subjected to the in leukocytes and urine 6-24 hours after oral same degree of de ciency.18 Bioavailability and Pharmacokinetics Early nutritional research indicated that pantoExisting evidence suggests that the bioavailabilthenic acid de ciency produced a loss of fur color in ity of pantothenic acid is in the range of 40-63 brown and black rats and dermatitis in chickens. normal.26 In late-stage de ciency.18. persons eating nutritionally poor diets (i. and decreased plasma concentraPresumably this is a result of (1) pantothenic acid tions of testosterone and corticosterone.29.33. in sperm motility. before adrenal exhaustion occurs).29. LLC.24.28 While in increased tissue levels of CoA and other pantograying of fur can occur.37 being found in a wide variety of foods in adequate An increase in triglycerides might be a nonamounts to prevent de ciency.2. with can enter and leave the brain and cerebral spinal an inability to respond appropriately to stress.17 the response to stress can be improved and e amount of pantothenic acid found in a morphological changes to the adrenals can be 24-hour urine sample appears to accurately re ect reversed. becomes enlarged and there is a described. Even in a single type of animal. Varying the dietary intake of pantothenic paralysis. resulting “anti-gray” and “anti-dermatitis” factor. e synthesis of ACP is not completely elaborated.18 progressive morphological and functional change After pantothenic acid is absorbed and transto the adrenal glands. intake during the past several days in humans. After adrenal exhaustion has occurred. by the series of enzymatic reactions previously speci cally.Monograph amr While CoA accounts for a large proportion of cellular pantothenic acid.22 Levels of phy31. mother the day preceding milk collection.22.35 If pantothenic lactating women. pantothenic acid appears to progressive depletion of ketosteroids from the concentrate in the liver. Antibiotics have also been used in some experiments to inhibit gut micro ora-produced pantothenic acid. signs pantothenic acid signi cantly increased serum and symptoms of other nutrient de ciencies are triglycerides. as in CoA. and blood. Amounts found correlate to the acid is supplied early enough after de ciency is amount of pantothenic acid in the diet of the induced (i. the small intestine.34 uid by saturable transport systems. it does not occur in all thenic acid metabolites within six hours..25 muscles.30 acid – low. the ported into cells. pantothenic acid absorption occurs in loss (or reduced growth). No Reprint Without Written Permission. In early de ciency. semisynthetic diets free of pantothenic acid have been used. 4’-PP has been identi ed as the prosthetic group.30 Other outwardly 23 administration.36 De ciency In male rats.2 humans comes from several sources – prisoners of 265 Alternative Medicine Review Volume 16. In animals. and hind leg saturable.18.8. In rats.31.31 e adrenal cortex. or high doses – has no physiOne of the consistent ndings in animal experiologically signi cant e ect on small intestinal ments of pantothenic acid de ciency has been a uptake. diarrhea. it can be converted to CoA or ACP adrenal gland hypertrophies.32 e eventual Animal experiments suggest that pantothenic acid result of de ciency is adrenal hypofunction. ACP also contains the pantothenic acid molecule. the adrenals atrophy and Pantothenic acid is found in the breast milk of morphological damage occurs.e. reductions appear to occur under usual circumstances.24 zona reticularis and fasciculata.38 produced before pantothenic acid de ciency is Knowledge about pantothenic acid de ciency in evident).33.23 Content animals.36 and the spleen to enlarge. a mild vitamin de ciencies being limiting factors in de ciency produced by a diet low.e. often in combination with drugs that act as pantothenic acid antagonists. hair loss. a pantothenic acid de ciency Outright de ciency of pantothenic acid does not results in increased weight of the testes. however.21 To produce a de ciency in animal experiments. All Rights Reserved.31 e ability 10 dietary intake and urinary excretion. to produce antibody titers against various infectious agents can also be reduced. .29 to intake than levels found in urine and are not De ciency causes the thymus of mice to atroconsidered as reliable an indicator. and (2) other speci c sign of mild de ciency. visible e ects of de ciency in mice include weight In mice.. Number 3 Copyright © 2011 Alternative Medicine Review. but not devoid of.31 Lymphopenia pantothenic acid in erythrocytes correlate with followed by lymphocytosis can occur.29 pantothenic acid administration is no longer Blood pantothenic acid levels respond less readily e ective for these purposes.10.

and hypokalemia. Malnourished prisoners of war during World War II reported numbness and burning sensations in their feet. and was accompanied by a peculiar gait. occasional vomiting.40-43 Administration of pantothenic acid was followed by improvement of the paresthesias and muscle weakness. or response to. It has been suggested that these outcomes might have been produced by a medication-induced pantothenic acid de ciency.45 Copyright © 2011 Alternative Medicine Review. facial pore size had become noticeably smaller. controlled de ciency experiments. abdominal cramps. A less regular occurrence was signs of cardiovascular instability (tachycardia and lability of arterial blood pressure. A loss of the normal eosinopenic response to adrenocorticotropic hormone (ACTH) was the most consistent lab nding. which did not always follow pantothenic acid administration. was used to produce pantothenic acid de ciency in healthy subjects. generally in combination with the drug omega-methyl pantothenate (a pantothenate kinase inhibitor). By eight weeks. infections were common. LLC. the maintenance dose needed to control acne ranged from 1 to 5 g/d of pantothenic acid.40 e triad of fatigue (including apathy and malaise). Volume 16. with a tendency to orthostatic hypotension). a drug antagonist of pantothenic acid.40 One of the key ndings remarked upon by the researchers was that the de ciency results produced were inconsistent between individuals and from experiment to experiment.40 e last mechanism for producing pantothenic acid de ciency in humans was the administration of calcium hopantenate (also called homopantothenate. a pantothenic acid antagonist). which was remedied with pantothenic acid supplementation. In some de ciency experiments.44 Monograph Clinical Indications/Mechanisms Acne vulgaris One hundred cases of acne – 45 males and 55 females of Chinese descent – were treated with high-dose pantothenic acid. decreased and increased cholesterol. reduced secretion of gastric hydrochloric acid and pepsin.amr war. and the rate of new acne eruptions had slowed. or possible other factors might be involved in producing these inconsistencies. Cases of reversible encephalopathy. A severe depletion of pantothenic acid for approximately six weeks was required before clear signs and symptoms of de ciency – many of which mirror the e ects of de ciency in animals – were produced. Number 3 Alternative Medicine Review 266 . Participants were between the ages of 10-30 years of age with most (80 percent) between the ages of 13-23. e face became noticeably less oily and a decrease in facial sebum secretion occurred usually within 2-3 days after initiation of therapy. irty. Other common e ects included gastrointestinal disturbances (nausea.40-43 A diet low in pantothenic acid. existing acne lesions had begun to heal. Less consistent lab ndings among studies of pantothenic acid de ciency include a reduction in the degree of urinary acetylated para-aminobenzoic acid (PABA) and 17-ketosteroids. and epigastric burning sensations). treatment for six months or longer was occasionally needed to control acne. and a Reye-like syndrome were reported in persons receiving this drug. No Reprint Without Written Permission. Several biochemical abnormalities were reported. but fatigue and some degree of irritability persisted. abnormal glucose tolerance. unrecognized variations in the composition of the diet. the activity of. ey suspected biochemical individuality. increased atulence. All Rights Reserved. Participants were also asked to apply a cream to the a ected area 4-6 times daily. and personality changes and emotional disorders. ere was also a prompt correction of the impaired eosinopenic response to ACTH and most of the other clinical symptoms when pantothenic acid was supplied. acne was usually controlled – most acne lesions were gone and new eruptions only occurred occasionally – in cases of moderate severity.ve patients were monitored for 18 months. and muscle cramps and weakness occurred in several subjects. the cream contained 20 percent by weight pantothenic acid. in others they were not. there was a wide variation in normal persons in response to their attempts to induce pantothenic acid de ciency and to corrective doses of pantothenic acid. Impaired motor coordination also occurred in some subjects. hepatic steatosis. and weakness was the most consistent nding. and the unintentional side e ects produced by a pantothenic acid antagonist drug. sleep disturbances. Within two weeks. Paresthesias. daily doses of 15-20 g/d of pantothenic acid would produce a faster response. A total of 10 g/d of pantothenic acid was given in four divided doses. Whatever the reason(s). e same was true for prompt and complete recovery from all symptoms. In the participants with severe acne. burning sensations of the hands and feet. headache. e author noted that in some of the severe cases. increased sensitivity to insulin.39 e most extensive investigations of human pantothenic acid de ciency took place in the mid-to-late 1950s.

000 IU/d) for up to 19 months. Royal jelly was reported to extend the lifespan of Drosophila melanogaster (common fruit y). and PABA improved hair quality and slowed hair loss after four months of use in persons with di use e uvium capillorum and agnogenic structural alterations of hair.8 g/d of a 55%/45% pantethine/pantothenic acid mix) or placebo was given to highly trained cyclists for seven days. e dose used was 100 mg/d for 4-5 months. in mice and rats. e abstract noted that bene ts with calcium pantothenate were not as pronounced as with pantethine. with supplementation capable of reducing cholesterol and triglyceride levels. keratin.58 Hyperlipidemia e pantethine form of vitamin B5 has been reported to have lipid-lowering e ects.500-3.e. addition of pantothenic acid further increased lifespan. No signi cant di erences were observed in cycling performance. as well as the duration of the narcotic action of ethanol..63 Ergogenic Aid (Exercise Performance) Existing evidence is not supportive of pantothenic acid supplementation improving exercise performance.60 Chemical Exposure to Aldehydes and Phenols Abstracts from untranslated Russian research have suggested that pantothenic acid might play a role in protecting against exposure to certain chemicals.53 In humans.47 e only study that used oral pantothenic acid as a sole intervention for di use alopecia in women reported that there was no clear evidence of bene t.61 e combination of pyridoxine.57 Hepatitis A An abstract of an untranslated Russian study suggested that both calcium pantothenate (300600 mg) and pantethine (90-180 mg) could be useful additions to therapy for viral hepatitis A. No Reprint Without Written Permission. . and sodium yeast nucleate extended the lifespan of Drosophila melanogaster.51 In ammatory Bowel Disease ree patients with ulcerative colitis were administered dexpanthenol (1.Monograph amr A single study suggested that a 5-percent dexpanthenol cream could help treat mucocutaneous adverse reactions caused by isotretinoin treatment for acne. No clinical evidence in support of this hypothesis was provided in this letter (i. biotin.5 lactate levels and decreased oxygen consumption during prolonged exercise at 75-percent VO2max in highly trained endurance runners. L-cystine.55 a dose of 1 g/d for two weeks failed to increase run time to exhaustion in highly trained distance runners. Celiac Disease A letter to the editor of the British Medical Journal in 1972 suggested the hypothesis that patients with celiac disease who respond only partially to a gluten-free diet might potentially bene t from the administration of pantothenic acid. One indicated that pantothenic acid (10-15 g/d).52 In animals. While a study reported that 2 g/d of pantothenic acid for two weeks decreased blood 267 Alternative Medicine Review Volume 16. the author did not mention results of any cases of giving pantothenic acid to persons with celiac disease). when taken together with vitamin E (1. All Rights Reserved.62 A dose of 300 mcg/d (approximately 10 mg/kg/d) of calcium pantothenate extended the lifespan of black mice by 19 percent. Pantothenic acid and its derivatives decreased the acute toxicity of acetaldehyde. a combination of vitamins including pantothenic acid helped protect against poisoning from phenol vapors. showed Copyright © 2011 Alternative Medicine Review. pantothenic acid was the primary anti-aging factor isolated from royal jelly.54 Lifespan Extension (Anti-Aging) Several old studies suggested that pantothenic acid supplementation extends the lifespan of animals.49. vitamin B1. yeast.56 A combination of vitamin B1 and pantothenic acid (1. Number 3 Lupus Erythematosus Several reports exist on the use of pantothenic acid for persons with lupus erythematosus from the 1950s. LLC.000 mg) as part of an enema.48 Two studies reported that use of a proprietary product containing pantothenic acid (60 mg/ capsule).46 Alopecia A case study from the early 1950s reported bene ts of using the alcohol pro-vitamin form of pantothenic acid (dexpanthenol) topically for hair loss. pantothenic acid combined with vitamin B1 protected workers engaged in manufacturing of phenol-formaldehyde resins. e treatment was not considered e ective.59 No studies have investigated whether pantothenic acid has lipid-lowering e ects.

Pantothenic acid and several of improved. a progressive morphological and functional change occurs to the adrenal glands when there is a pantothenic acid de ciency. all plasma levels of corticosterone. Matricaria chamomilla.66 nine weeks increased adrenal gland weight. In male rats. e e ects with impact adrenal function.73 cambogia.6 mg of adherence to a strict diet.31-35 its derivatives – phosphopantothenate. before adrenal body fat. in amounts su cient to increase subjectively or objectively between the two blood pantothenic acid levels signi cantly above groups. e eventual result of Obesity de ciency is adrenal hypofunction. and severity exposed to cold stress.2 kg (2. adding dexpanthenol were more pronounced than with the pantothenic acid (0.79 In rats with intact e cacy. basal One hundred individuals of Chinese descent. A signi cant reduction in signi cantly decreases average survival time of rats morning sti ness. weight gain primarily as de ciency has been induced (i.77 Supplementing the of pain was reported for persons taking pantocombination of calcium pantothenate and a small thenic acid.69 control (non-irradiated) levels. pantethine.amr As mentioned in the section on de ciency. A mainteimprove the response to certain types of stress. Administration of of the knees.21-dihydroxy-20-ketosteroids – a sign of Average weight loss was reported to be 1. Ketone bodies in urine were either Results of several animal studies suggest that absent or detected in trace amounts. compared optimizing the response to cold stress.70 amount of hydrocortisone prolonged survival of cold-stressed. and the release of following a calorie-restricted diet that only corticosterone in response to ACTH. All Rights Reserved. normalized these A double-blind study of persons with rheumatoid markers of oxidative stress. were supplemented with mentation also increases urinary excretion of 10 g/d of pantothenic acid in four divided doses.000 calories/d.e. No di erence was observed either dexpanthenol.6 functional activation of the adrenal gland. Garcinia pantothenic acid had no e ect on adrenal weight. with an Aurothioglucose injection into the hypothalamus inability to respond appropriately to stress. e author claimed that no side e ects adrenal weight signi cantly in response to surgical were observed with this protocol. who had not responded to Pantothenic acid appears to be involved in previous drug treatment with salicylates.67 stress. was needed to maintain calcium pantothenate per 100 g of chow increased weight loss. Rosa damascena.76 De ciency also day) with placebo.78 Stress Supplementation of pantothenic acid allowed rats Animal and human evidence suggests that that had undergone removal of the adrenals to pantothenic acid is needed for adrenal function and swim in cold water for as long as rats with intact might be involved in the adrenal response to stress. Dieters did providing supplemental pantothenic acid might not complain of hunger or weakness. In unstressed animals supplementation of A product containing pantothenic acid. Exposure to gamma radiation reduces blood levels of pantothenic acid and its Osteoarthritis and Rheumatoid Arthritis derivatives by about 80 percent.67 that pantothenic acid supplementation improved percent after 60 days of supplementation. degree of disability. Volume 16. adrenals. LLC.03%) to drinking water for other forms of pantothenic acid used. Number 3 Alternative Medicine Review 268 .71 Suppleprovided 1.29. A de ciency the addition of pantothenic acid (500 mg/d initially. Supplementation of pantothenic acid when the dexpanthenol – countered hypothalamic obesity diet is adequate in pantothenic acid also appears to after injection of aurothioglucose.68 the stress response. of pantothenic acid increases the sensitivity of increasing to 500 mg four times daily by the 10th undernourished rats to cold.72 lbs) per week.. If is used as a means to induce hypothalamic obesity pantothenic acid is supplied early enough after – an increase in food intake.75 arthritis patients. and blood sugar and lipid increases – in exhaustion occurs). adrenalectomized rats. along with continued Supplementing the diet of rats with 43. Since adrenal hypertrophy in response to stress is Lavandula o cinalis and Cananga odorata was believed to be an adaptive response. nance dose of 1-3 g/d.74 this suggests reported to produce an average weight loss of 4. It also produces a A double-blind trial compared taking the signi cant increase in oxidative stress – lipid combination of pantothenic acid and L-cysteine peroxidation increases and liver levels of CoA and against placebo in the treatment of osteoarthrosis reduced glutathione decrease. 17. No Reprint Without Written Permission.65 Monograph Copyright © 2011 Alternative Medicine Review.64 Another reported that the combination of oral pantothenic acid and topical dexpanthenol was not e ective. the response to stress can be animal experiments.

90 and streptomycin91 – to inhibit the growth of certain microorganisms under in vitro conditions.81 A report indicated that a high proportion of schizophrenic patients had impaired adrenal function. recovery can sometimes occur after the administration of pantothenic acid. ese anti-metabolites compete for and use enzymes involved in the biosynthesis of CoA and/or ACP.88 Experimental work from the 1950s suggested that pantothenic acid might interfere with the ability of some antibiotics – aureomycin. supplying pantothenic acid overcomes this enzyme inhibition. Number 3 Copyright © 2011 Alternative Medicine Review. compared to presupplementation values. In developing mice.84 Animal experiments suggest that pantothenic acid might help prevent some side e ects of valproic acid (VPA).86 A single study reports that a 5-percent dexpanthenol cream can help treat mucocutaneous adverse reactions caused by using isotretinoin for acne.83 Drug-Nutrient Interactions Pantothenic acid helps prevent cisplatin-induced deafness in guinea pigs when both drugs are administered jointly.95-99 e e ects of exogenous supplementation of pantothenic acid on pantothenamides has not been investigated. no signi cant bene ts were observed with wound healing in a randomized.Monograph amr adrenals.000 mg of vitamin C by mouth during recovery from surgical tattoo removal.46 A theoretical concern exists that pantothenic acid.92-94 Vestibular ototoxicity – nausea. which results in abnormalities in CoA-dependent liver processes.87 Animal research on adrenal function suggests that pantothenic acid supplementation might augment the response to corticosteroids. Wound Healing In animal research. might increase the e ects of acetylcholinesterase inhibitor drugs (i. All Rights Reserved.85 Hepatic failure is a rare.71. side e ect of VPA.82 As mentioned in the section on de ciency. did not indicate a decrease in clinical e cacy when streptomycin was combined with pantothenic acid. oral and topical pantothenic acid have been associated with accelerated closure of skin wounds and increased strength of scar tissue. Pretreatment of pregnant mice with pantothenic acid protects against VPA-induced NTDs. LLC. double-blind study of humans who took 200 mg of pantothenic acid and 1.91 In vivo research. Presumably this side e ect is in part related to a VPA-induced depletion of CoA. however. When pantothenic acid was given to these patients. and vertigo – is an established side e ect of streptomycin. producing biologically inactive analogs. A report indicated that administration of 50 mg pantothenic acid three times daily improved symptoms of vestibular ototoxicity caused by streptomycin in 30 out of 31 persons. 269 Alternative Medicine Review Volume 16.79 A study reported that pantothenic acid levels were signi cantly lower in females using oral contraceptives compared with females who were not. It has been speculated that this might be because these antibiotics inhibit enzymes involved in the biosynthesis of pantothenic acid or its downstream coenzymes (CoA or ACP). In utero exposure to VPA during pregnancy is associated with an increased risk of neural tube defects (NTDs) in animals. adrenal function improved. but possible. two drugs – omega-methyl pantothenate (a pantothenate kinase inhibitor) and calcium hopantenate (a pantothenic acid antagonist) – can produce de ciencies in pantothenic acid. the combination of pantothenic acid and carnitine helped prevent this side e ect.89 erythromycin..e. drugs that inhibit the cholinesterase enzyme and so prevent the breakdown of acetylcholine). another report indicated that adding 150 mg/d of pantothenic acid to the combination of streptomycin and isoniazid failed to prevent symptoms of vestibular ototoxicity. Neither of these medications is currently an FDA-approved drug product for human use. Extracellular availability of pantothenic acid does not appear to prevent the bacterial growth inhibition of pantothenamides under test conditions. . also conducted in the 1950s. and antimetabolites such as N-pentylpantothenamide and N-heptylpantothenamide – have antibiotic activity and are under investigation as potential novel antibiotics.80 Men receiving pantothenic acid (10 g/d for six weeks) had a less pronounced drop in white blood cell counts and vitamin C levels subsequent to cold-water immersion stress.15 Pantothenic acid has been reported to have no estrogenic action itself. cold water. and survive in. supplementation with large amounts of pantothenic acid doubled the length of time they were able to swim in.94 However. When deafness has been previously produced by cisplatin. but enhanced the action of estradiol in rats. since it is involved in the biosynthesis of acetylcholine. No Reprint Without Written Permission.78. vomiting.92 Analogs of pantothenic acid – N-substituted pantothenamide (pantothenamides). e result is an inhibition of bacterial growth.

105 is has led to speculation that high doses of pantothenic acid might inhibit the absorption of biotin in the large intestine.101 ere have been anecdotal reports that dexpanthenol may increase bleeding time. LLC. so information of adverse e ects on humans is limited. and monkeys (200-250 mg/kg). heartburn. Side E ects and Toxicity Data Acute oral LD50 values for pantothenic acid are 10. specialized carrier-mediated system for uptake in colonic epithelial cells.6 amount of weight increase and the food intake less than those of controls. because of this.103 Augmenting a pantothenic acid-de cient diet with ascorbic acid (2 percent of the diet) in female rats resulted in o spring with signi cantly higher blood.112 ere are reported cases of contact urticaria113 and dermatitis114 occurring with the use of hair lotions and conditioners containing dexpanthenol.104 In vitro evidence suggests that biotin and pantothenic acid use the same sodium-dependent.100 However. dogs (50 mg/kg). Adverse e ects typically do not occur until doses exceed 1 gram daily.102. Ascorbic acid also prevented some of the histochemical di erences in the adrenals of the o spring. e condition resolved after the vitamins were stopped.108 ! 1–3 years old: 2 mg/d ! 4–8 years old: 3 mg/d ! 9–13 years old: 4 mg/d ! 14 years old and over: 5 mg/d ! Pregnancy: 6 mg/d ! Lactation: 7 mg/d Copyright © 2011 Alternative Medicine Review. Number 3 Alternative Medicine Review 270 . e addition of ascorbic acid (2 percent of the diet) to a rat diet de cient in pantothenic acid allowed many of the animals to grow normally and prevented signs of de ciency. ese reports have not been substantiated and increased risk of bleeding is not regarded as a serious potential risk. hepatic and tissue pantothenic acid levels compared with the o spring of females fed a diet de cient in pantothenic acid without added ascorbic acid. All Rights Reserved.e. young men did not have a reduction in pantothenic acid excretion when given the sulfonamide. animal reproduction studies have shown an adverse e ect on the fetus and there are no adequate and well-controlled studies in humans.109-111 ere is one reported case of eosinophilic pleuropericardial e usion ( uid around the heart and lungs) in a patient taking 300 mg/d of pantothenic acid in combination with 10 mg/d of biotin for 2 months.106. and hair damage observed. In this experiment. diarrhea. or histopathological changes in rats (dose up to 2. e most commonly reported side e ect is mild transient gastrointestinal disturbance such as nausea. evidence available from clinical studies using high doses of pantothenic acid indicates that intakes considerably in excess of current DRI do not represent a health risk for the general population. whether competitive inhibition occurs under in vivo conditions has not been investigated. but potential bene ts may warrant use of the drug in pregnant women despite potential risks). it has been recommended that pantothenic acid be used with caution in persons taking anticoagulants or other medicines capable of prolonging bleeding time.108 Monograph Nutrient-Nutrient Interactions Ascorbic acid appears to have a pantothenic acid-sparing e ect in rats. No Reprint Without Written Permission.106 Chronic administration for 6 months produced no toxic signs. Pantothenic acid has a Pregnancy category C rating when dosed above the DRI (i.000 mg/kg in mice and rats. weight loss.109 e existing clinical studies on pantothenic acid were not designed to monitor and assess side e ects.6. and diarrhea.amr Sulfonamides reduced the fecal elimination of pantothenic acid and produced marked reductions of pantothenic acid concentrations in the liver of rats.107 Although it is not possible to derive a numerical upper limit for pantothenic acid in humans.106 Calcium pantothenate at 3 percent of the diet was the lowest-observed-adverse-e ect-level (LOAEL) in rats. pantothenic acid caused a concentration-dependent competitive inhibition in biotin uptake.000 mg/kg. Nevertheless. and the Dosing e Dietary Reference Intake (DRI) established by the Institute of Medicine for pantothenic acid is as follows:7.6 however. phthalylsulfathiozole.. with lethal doses producing death by respiratory failure. with enlargement of the testes. Pantothenic acid has an FDA Pregnancy category A rating for doses at or below the DRI level. Volume 16. e no-observed-adversee ect-level (NOAEL) was 1 percent of the diet comprised of calcium pantothenate. What this means is that well-controlled studies have failed to demonstrate a risk to the fetus in the rst trimester of pregnancy (and there is no evidence of risk in later trimesters) for doses at or below the DRI level.

2007:289-305. niacin. 22. McCormick DB. biotin and pantothenate. 25.30:310-317. Am J Clin Nutr 1986. Eur J Biochem 1974. Walsh JH.drugs. Sasaki S. 21. B2. J Am Geriatr Soc 2003. Faulkner RR. Lewis CM. et al.58:427-433. Hansen RG.250:R292-R297. E ects of high-level dietary B-vitamins on performance. 13. Malnutrition in institutionalized seniors: the iatrogenic component. Cheng DW. Optimum nutrition: thiamin.2. Tsuji T.22:339-346. Number 3 Copyright © 2011 Alternative Medicine Review. Fox HM. Ann Nutr Metab 1981. Gitschier J. Pantothenic acid – a vitamin. et al. Dietary intake of seven B vitamins based on a total diet study in Japan. Hansen RG. 34. Butte NF. Morgan AF. McKibbin JM. Wendland BE.34:2205-2209. Dietary intake of free-living elderly in northern Greece.15:279-282. Pantethine and the biosynthetic regulation of the coenzyme of acetylation. Nutr Res 2010. Am J Clin Nutr 1981. J Am Diet Assoc 2009. Ukr Biokhim Zh 1987.27:112-118. . body composition and tissue vitamin contents of growing/ nishing pigs.2:451-462. Webb ME. eds. Vaughan L. e high end has been 10 g/d. Moiseenok AG. E ect of pantothenic acid de ciency upon adrenal cortex. Smith AG. Wyse BW. Metabolic response to a pantothenic acid de cient diet in humans. Am J Clin Nutr 1981.49:1-9.30:171-178.85:192-198 17. Tamura T.Monograph amr 10. the existing studies have often used 3-4 divided doses a day. ribo avin. Taniguchi A. In clinical studies the dose used has varied signi cantly. Tahiliani AG. Pantothenic acid. Pantothenic acid status of pregnant and lactating women. Khomich TI . 14. Diamond JM. Fox HM. 19. and circulating lymphocytes in mice. Urinary excretion of vitamin B1. 32. J Nutr Sci Vitaminol (Tokyo) 2010. [Article in Russian] 24. 33.38:385-400. et al. At higher doses. Hematopoiesis in pantothenic acidde cient rats.34:1328-1337. 4. Eissenstat BR. 6. Metabolism of pantothenic acid and its derivatives in animals de cient in this enzyme.html [Accessed August 1.26:131-146. Grammatikopoulou MG.pdf [Accessed July 29.89:486. 8. and pantothenic acid status in young women. Science 1939. thymus. J Biol Chem 1952. Shibata K. Tsverbaum EA. e properties and regulation of pantothenate kinase from rat heart. Rucker RB.91:6-10. Robishaw JD. Pantothenoylcysteine-4’-phospate decarboxylase from horse liver. Oral supplementation of pantothenic acid has been signi cantly in excess of the DRI for several months or longer.25:178-181. pantothenic acid. 7. Ashburn LL. Nature 1959.21:695-721. spleen. Dosing at the highest levels – 10 g/d – can present adherence issues. LLC.51:85-90. Neely JR. Suttie JW. because of the number of tablets or capsules required to achieve the dose. King JC.edu/Activities/Nutrition/ SummaryDRIs/~/media/Files/ Activity%20Files/Nutrition/DRIs/ RDA%20and%20AIs_Vitamin%20 and%20Elements. 18. Wyse BW. Wilson TA. Greenwood CE. All Rights Reserved. Nat Prod Rep 2004. Gurinovich VA. 3. 20. female Japanese. J Nutr Elder 2006. Proc Soc Exp Biol Med 1951. Taylor DW. Kuo YM. Eksp Med (Riga) 1991. e chemical cytology of the rat’s adrenal cortex in pantothenic acid de ciency. Fisher MN.260:15745-15751. Suemura K. [Article in Russian] No authors listed. Vitam Horm 1991. Beinlich CJ. 30.119:1973-1983. Vopr Med Khim 1981. 29. Biosynthesis of pantothenate. Carbohydrate metabolism and adrenal cortical function in the pantothenic acid-de cient rat. Watanabe T.44:931-937. Melampy RM. J Biol Chem 1985. Rucker RB. 11. B6.46:165-228. Hansen RG. 5. Am J Clin Nutr 1980. Pantothenic acid biotransformation in human vitamin de ciency. Weinberg I. Availability of vitamin B6 and pantothenate in an average American diet in man. E ect of oral contraceptives agents on thiamin.000 mg per capsule/tablet.183:257. Johnston L. http://www. Adolph AL. Stein ED. References 1. J Anim Physiol Anim Nutr (Berl) 2007. In: Zempleni J. Stokstad EL. Bender DA. NY: CRC Press.com/npp/pantothenic-acid. 23. 2. 28. Fry PC.76:24-27. E ects of de ciency of pantothenic acid on oxygen poisoning in the rat. Pantothenic acid content of a nursing home diet 1. and vitamin C correlates with dietary intakes of free-living elderly. Blood 1947.56:279-286. Hay ick SJ. 12. Zakas A.195:583-590. Pantothenic acid in health and disease. Handbook of Vitamins. Moiseenok AG. High potency pantothenic acid supplements are generally in the range of 250-1. Fukuwatari T. Deane HW. Pantethine: Monograph. Song WO. 2011] Tarr JB. Scandura R. Altern Med Rev 2010. folate. Do dietary levels of pantothenic acid regulate its intestinal uptake in mice? J Nutr 1989. J Nutr Sci Vitaminol (Tokyo) 1976. Rybalko MA.109:1012-1021. Northrop LC.33:832-838. Pantothenic acid status of adolescents. Young KW. Roth-Maier DA. Tao HG. Abell C. Williams RJ.59:60-66. 2011] http://iom. 9. J Inherit Metab Dis 2007. No Reprint Without Written Permission. New York. Proc Nutr Soc 1999.27:780-784. Bauerly K. 31. 16. Daft FS. 27. 15. Wyse BW. J Am Diet Assoc 1985. [Article in Russian] 26. Endocrinology 1946. e low end of dosing has generally been 100 mg/d. Barboni E. Pantothenic acid transport and metabolism in the central nervous system. Spector R. Papadopoulou SK. Nutrient adequacy and diet quality in non-overweight and overweight Hispanic children of low socioeconomic status: the Viva la Familia Study. Hurley LS. Böhmer BM. Deprivation of pantothenic acid elicits a movement disorder and azoospermia in a mouse model of pantothenate kinase-associated neurodegeneration. Granata F. Am J Physiol 1986. 271 Alternative Medicine Review Volume 16. Pantothenic acid content of human milk.

21:1177-1181. AMA Arch Derm Syphilol 1954. Toromanyan E. Ohlson MA. J Invest Dermatol 1952. No Reprint Without Written Permission. Monro J. Lupus erythematosus: treatment by combined use of massive amounts of pantothenic acid and vitamin E. et al. 42. Pierchalla P. et al. Med Hypotheses 1995. J Clin Invest 1958. 38. Hodges RE.34:1073-1084. Pantothenic acid and coeliac disease.44:380-384. Pelton RB. e e ects of pantothenic acid on human exercise capacity. Mahboob S. 57. Noll W. Mild pantothenate de ciency in rats elevates serum triglyceride and free fatty acid levels. Nelson RA. Petri H. Folha Med 1951.amr 35. sodium yeast nucleate. Hodges RE. Pediatr Dermatol 2002. e use of Drosophila melanogaster as a screening agent for longevity factors. weakness and ketosis.120:719-725.25:319-333. 37. calcium hopantenate. Rahlfs VW. E ect of pantothenic acid on the longevity of mice. 44. 48. Haslock DI. J Gerontol 1948.11:10-13. [Article in Russian] 53.18:365-367. 56. Welsh AL. J Gerontol 1948. 36. 63.32:121-122. Budde J.34:1085-1091. Pantothenic acid as a weight-reducing agent: fasting without hunger. Omel’ianchik SN. Exp Toxicol Pathol 2001.72:616-620. Pantothenic acid de ciency induced in human subjects. E ects of pantothenic acid supplementation on human exercise. e e ect of pantothenic acid de ciency of gastric secretion and motility. Pantothenic acid in the treatment of osteoarthrosis. Noda S. J Vet Med Sci 2009. Umezaki H. Simms HD. Williams RJ. Dexpanthenol cream signi cantly improves mucocutaneous side e ects associated with isotretinoin therapy. [Article in Russian] 54. et al. Hodges RE. Med Sci Sports Exerc 1985. Farmakol Toksikol 1988. Scherzer H. E cacy of Slim339 in reducing body weight of overweight and obese human subjects.79:1457-1462. Tronnier H.51:82-86. Brzezińska-Wcisło L. [Article in Russian] 59. [Article in Russian] 55.70:181-198. Bleiler R.53:393-398. All Rights Reserved.44:403-405. Bean WB. Reeves AG. J Neurol Neurosurg Psychiatry 1988. Copyright © 2011 Alternative Medicine Review. Schweiz Rundsch Med Prax 1990. ymic weight in pantothenic acid de ciency.89:565-566.71:1427-1432. Tremaine WJ. Yamamoto T. et al. 60. Br Med J 1972. Pantothenic acid de ciency in man.51:582-585. Monograph 58. Amroyan E. 39. Case of baldness treated with pantothenic acid alcohol.24:26-29. Physiological and performance responses to supplementation with thiamin and pantothenic acid derivatives. E ect of a therapeutic and prophylactic diet enriched with thiamine and calcium pantothenate on the acetylating capacity of the body of workers engaged in the manufacture of phenol-formaldehyde resins. Wright V. Spaide J. Bean WB. Hautarzt 1993. Morgan AF. [Article in German] 51. Pan L.20:272-277. Brinck-Johnsen T. Leslie G. e e cacy of drug therapy in structural lesions of the hair and in di use e uvium – comparative double blind study. Gardner TS. Evaluation of vitamin B6 and calcium pantothenate e ectiveness on hair growth from clinical and trichographic aspects for treatment of di use alopecia in women. Wittwer CT. E ects of pantothenic acid on testicular function in male rats. Frei-Kleiner S. Hypolipidemic e ect of pantothenic acid derivatives in mice with hypothalamic obesity induced by aurothioglucose. J Clin Invest 1959. 43. et al. e use of Drosophila melanogaster as a screening agent for longevity factors. [Article in German] 50. J Clin Invest 1955. 61.44:490-492. and pantothenic acid on the life span of the fruit y. Loftus EV Jr. Rheumatol Phys Med 1971. Aslanyan G. Eur J Appl Physiol Occup Physiol 1998.3:1-8. Treatment of hyperlipoproteinemia with pantethine: a review and analysis of e cacy and tolerability. 47. Proc Soc Exp Biol Med 1958. 65.63:5860. Am J Clin Nutr 1971. Ohlson MA. Hodges RE. Dexpanthenol enemas in ulcerative colitis: a pilot study. Volume 16. Gardner TS. 69. 52. pyridoxine. Naruta E.4:112-113.3:9-13. Reye-like syndrome following treatment with the pantothenic acid antagonist. Pozniakovski! VM. Skvortsova RI. Human pantothenic acid de ciency produced by omega-methyl pantothenic acid. LLC. Nice C. Webster MJ. Komar VI. Leung LH. Bean WB. Buko V. [Article in Polish] 49. Systemic therapy of di use e uvium and hair structure damage. Abirached IA. J Clin Invest 1955. Skvortsova RI. Lito D. Vopr Pitan 1977:40-42. Romiti R. Davenport RE. Tronnier H.38:1421-1425. Wiad Lek 2001. e protective e ect of pantothenic acid derivatives and changes in the system of acetyl CoA metabolism in acute ethanol poisoning. Jaroenporn S.37:1642-1657. Daum K. 45. Dorofeev BF. Pozniakovski! VM. McRae MP. the e ects of biotin. Yamamoto K. Med Hypotheses 1995. 66.19:368. Hodges RE. 64. J Sports Med 1984. Nutr Res 2005. 46. An evaluation of various survival rations. 68. 62. Pantothenic acid de ciency as the pathogenesis of acne vulgaris. Adrenal atrophy and senescence produced by a vitamin de ciency. Harrison J. e treatment of lupus erythematosus with calcium pantothenate and panthenol. 40.17:287.99:632-633. Beck S. Moiseenok AG. Cochrane T. Mayo Clin Proc 1997.77:486-491. Vopr Pitan 1981:32-35. e use of pantothenic acid preparations in treating patients with viral hepatitis A. Role of the vitamin factor in preventing phenol poisoning. Bean WB . Peterson M. Romiti N. Science 1939. Nutr Metab 1976. ornton GH. Leung LH. Agarkova IA. Number 3 Alternative Medicine Review 272 . pantothenic acid as a longevity factor in royal jelly.24:513-523. Ter Arkh 1991. 67. 41. Phytother Res 2007.54:11-18. J Nutr 1990.

1:1679-1683. Lockhart W.54:305-311. J Biol Chem 2002. All Rights Reserved. Omelyanchik SN. Frank MW. Dumm ME. Ralli EP. Factors in uencing the response of adrenalectomized rats to stress. No Reprint Without Written Permission. Winn LM. 104. 76. 81. Smith DH.27:158-166. Factors in uencing adrenal weight and adrenal cholesterol in rats following stress. Moiseenok AG.11:200. Amelioration of adverse e ects of valproic acid on ketogenesis and liver coenzyme A metabolism by cotreatment with pantothenate and carnitine in developing mice: possible clinical signi cance. . Johnson HC. E ect of ascorbic acid on rats deprived of pantothenic acid during pregnancy. Laken B. Ortiz A. Gomaa N. 102. Biol Pharm Bull 2008.56:517-531. J Nutr 1953. Emerson GA.277:48205-48209. J Biol Chem 2004. Chung NY.11:133-158. ermal behavior of the subnourished and pantothenic-acid-deprived rat. 82. e clinical trial of streptomycin pantothenate in the treatment of soft tissue infections. E ect of vitamin C on pantothenic-de cient rats. Penman AC. 74. especially reversal of aureomycin inhibition by ribo avin. Selye H. Paschkis KE. Metabolism 1956. Metabolite reversal of antibiotic inhibition.95:963-966. Acta Otolaryngol 1996. De Bias DA. e general-adaptation-syndrome. Freed M.24:894-899. 93. Bunde CA. http://www. Prigot A. erapeutic advantages of the addition of calcium pantothenate to salicylates in the oral treatment of rheumatoid arthritis. Cantarow A. 94. Biotin uptake by human colonic epithelial NCM460 cells: a carriermediated process shared with pantothenic acid.49:373-385. 105.14:1007-1020. Brown RG. Raymond AM. Foster JW. Ralli EP. et al. Int J Vitam Nutr Res Suppl 1983. Neurotoxic symptoms in streptomycin therapy: a pilot trial of treatment with pantothenic acid. Am J Physiol 1998. Tufts M.cfm [Accessed August 5. et al. Schwarz K. 73. 98. Campos A. Monro J. Hauhart RE. 89. Kuhk WJ Jr. et al. 75. Dumm ME. McCloud E. 83. Prevention of certain B vitamin de ciencies with ascorbic acid or antibiotics. Fernández-Cervilla F. 85. Acyl carrier protein is a cellular target for the antibacterial action of the pantothenamide class of pantothenate antimetabolites.66:478-486. Arch Biochem 1947. Cronan JE. Structure-activity relationships and enzyme inhibition of pantothenamidetype pantothenate kinase inhibitors. Getty R.137:523-528.10:380. Ralli EP. Sharaf A. Dawson JE. 273 Alternative Medicine Review Volume 16.31:419-423. 78. Clifton G. Strauss E.212:312-314. Gil llan RF. Leonardi R. E ect of pantothenic acid and ascorbic acid supplementation on human skin wound healing process. Daft FS. Tubercle 1957. Johnston RN. Zhang YM. Dickson I. Vaxman F. Pantothenic acid and coenzyme A in experimental cisplatininduced ototoxia. Zhang YM. Fed Proc 1952. Lichstein HC. Inhibition of pantothenate synthesis by streptomycin. 72.4:755-756. Pantothenic acid in schizophrenia. LaCaille RA. et al. Am J Surg 1958.15:30-46. 90. Pantothenol protects rats against some deleterious e ects of gamma radiation.2:327-342.279:50969-50975. Bioorg Med Chem 2006. LLC. erapeutic action of pantothenic acid. 101. ß-alanine and l-carnosine to inhibitory e ects of erythromycin on growth of Corynebacterium diphtheriae. 100. Am Pract Dig Treat 1953. 2011] 88. Prolonged streptomycin and isoniazid for pulmonary tuberculosis. Comparative e ects of pantothenic acid de ciency and inanition on resistance to cold stress in the rat. Skeggs HR. 92. Antimicrob Agents Chemother 2010. Grundy WE. Number 3 Copyright © 2011 Alternative Medicine Review.15:187-194. Northrop L. Bryant SR. Brit Med J 1964. 79. Am J Med Sci 1946. Fidanza A. e antibiotic activity of N-pentylpantothenamide results from its conversion to ethyldethia-coenzyme A. 77. 91.accessdata. J Comp Physiol Psychol 1957.116:263-268. Fed Proc 1951. Said HM. Crespo PV. Dumm ME. Virga KG. Interrelationship between vitamins of the B-complex group and oestradiol. 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J Pharmacol Exp er 1941. Final report on the safety assessment of panthenol and pantothenic acid.  Learn more or order online:  www. Pantothenic Acid.  This powerful book contains case studies  !"#$#%$"&'#()#*(+. 1984:437-458. Vitamin B12. LLC. Institute of Medicine.4640 Volume 16. Studies on the toxicity and pharmacology of pantothenic acid.10:48.eu/food/fs/ sc/scf/out80k_en. Contact Dermatitis 1984. 109.6:139-162. Sasaki R. Report of the European Commission: Health and consumer protection directorategeneral 2002SCF/CS/NUT/UPPLEV/61 Final:1-6 (http://ec. 111. No Reprint Without Written Permission.pdf) [Accessed July 27. Greslin JG. Folate. Shibata K. Schalock PC.”  Mark Hyman. Handbook of Vitamins.51:385-391. These functional medicine case studies are the next best  thing to being a master’s apprentice. Washington. www. Djezzar S. Contact urticaria from panthenol in hair conditioner. New York. 113. and Choline.metametrix. 108. Nutritional. et al. 2011] 107. Unna K. Monograph 112. Dietary Reference Intakes for iamin. NY: Dekker.35:424-426. Biotin. Hair lotion dermatitis with sensitization to d-panthenyl ethyl ether. day‐to‐day clinical practice. Scienti c Committee on Food: Opinion of the Scienti c Committee on Food on the tolerable upper intake level of pantothenic acid. MD Chairman. Vitamin B6. example and case  histories. Fukuwatari T. J Nutr Sci Vitaminol (Tokyo) 2005.43:223. Morrison L.com · 800. Fox HM. Ann Pharmacother 2001. 110. In: Machlin LJ. Number 3 Alternative Medicine Review 274 . Case Studies in Integrative  and Functional Medicine  illustrates patients achieving satisfying  outcomes through robust clinical  assessment and treatment programs.amr 106. ed. Niacin.221. Estival JL.europa. E ects of excess pantothenic acid administration on the other water-soluble vitamin metabolisms in rats. Contact Dermatitis 2000.com/csifm2 “Doctors must learn through apprenticeship. Life-threatening eosinophilic pleuropericardial e usion related to vitamins B5 and H.metametrix. van Ketel WG. All Rights Reserved. Debourdeau PM. Storrs FJ. Takahashi C. Institute for Functional Medicine Copyright © 2011 Alternative Medicine Review. Cosmetic Ingredient Review. Pantothenic acid. DC: National Academy Press. Biochemical and Clinical Aspects. J Am Coll Toxicol 1987.!/!'0#%'1'*/!2'#()# real‐life. Ribo avin. a window in the thinking behind  the practical application of functional medicine. 1998:367-368.73:85-90. 114.-'.