Vitamin B5

Vitamin B5 is a natural supplement belonging to the supplement category of the water-soluble B group vitamin class.

Vitamin B5 is also known as pantothenic acid.

A deficiency of vitamin B5 may lead to Goplan's burning foot syndrome or Nutritional melalgia. Nutritional melalgia is a condition with symptoms including tiredness, apathy, sleep difficulties, GI symptoms, numbness and paresthesias, muscular cramps, and hypoglycemia which is considered to have been caused by malnutrition. Age-related dementias such as Huntington's disease, neurodegeneration, myelin loss, and Ach deficiencies can all be significantly affected by pantothenate deficiency.

Egg yolk, broad beans, legumes, meats (particularly liver), and potatoes are the most concentrated sources of vitamin B5. Other foods, including whole grains, milk, peanuts, broccoli, avocado, mushrooms, and apricots, also contain it. Royal jelly from bees also offers significant amounts.

Vitamin B5 is extensively absorbed from the small intestine through active transport at low doses and passive transport at high amounts. CoA is formed from pantothenate through the catalytic action of pantothenate kinase. The compounds acetyl-CoA and succinyl-CoA are essential elements of the citric acid cycle. For excretion via urine, CoA can be degraded to pantothenate.

Vitamin B5 is vital for the metabolism of fatty acids and energy creation. It is essential for producing acyl carrier protein and coenzyme A (CoA), both necessary for synthesizing and breaking fatty acids. It also helps the body's numerous anabolic and catabolic processes.

The common side effects of vitamin B5 include nausea, abdominal pain, headache, muscle pain, joint pain and dizziness.

Vitamin B5 is available in the form of tablets.

Biochemical action of vitamin B5

Vitamin B5 is used only as a precursor in coenzyme A (CoA) production. CoA is crucial for several metabolic processes in the human body that affect neurotransmitter synthesis, intermediate metabolism, and cell development. A carbonyl-activating component found in the structure of CoA is essential for activating and transferring acyl groups during metabolic activities. As an acyl group carrier, CoA accelerates the activities involved in synthesizing critical chemicals, including cholesterol, hormones, and neurotransmitters, as well as the creation of energy from carbohydrates and fatty acid metabolism. As a result, vitamin B5's activity in CoA production is crucial for the functioning of several cellular activities.

Vitamin B5 belonging to the water-soluble vitamins, acts through its ability to increase cellular adenosine triphosphate; vitamin B5 enhances indirect antioxidant actions—this more effective defence of cells from peroxidative damage results in higher amounts of free glutathione.

Vitamin B5 is available in the form of tablets.

• Vitamin B5 can be used as a supplement support for several biological functions, including ATP synthesis, immune system function, tissue repair, and general growth, particularly the health of the skin, nails, and hair.
• Vitamin B5 used as a supplement, support the metabolism of carbohydrates, proteins, and lipids. It increases the life expectancy of red blood cells, helps with fatty acid oxidation, and activates pyridoxine and folate, essential for synthesising and metabolising neurotransmitters.
• Pantothenic acid, used as a supplement, is also essential for development and growth, especially during breastfeeding, reproduction, and the early stages of pregnancy.

Vitamins and natural supplements should not replace a balanced diet. This product is not intended to diagnose, treat or prevent any disease(s).

Vitamin B5 may be useful as a supplement for the following health benefits:

• Enhances wound healing: Data show that pantothenic acid can accelerate routine healing. This enhancement is the result of increased cellular multiplication.
• Elevated cholesterol and triglyceride levels: Pantethine, a pantothenic acid metabolite, has been shown in several clinical investigations to decrease lipid levels considerably. Additionally, pantothenic acid may have antioxidant effects that lessen the low-grade inflammation linked to early heart disease.
• Obesity and weight loss: CoA plays a vital function in the production of several lipids and steroids, as well as its significance in the metabolism of carbohydrates, fats, and proteins. Remarkable success is achieved by combining the weight-loss strategy with rigorous calorie monitoring.
• Stress: One's response to stress can be enhanced if pantothenic acid is given soon enough after a deficiency has been caused (i.e. before adrenal fatigue starts). However, no conclusive proof exists that it makes the body more resistant to stress.
• Female fertility: Regular vitamin B5 or multivitamin supplements may significantly lower the risk of ovulatory infertility. Regular use of multivitamin supplements may also decrease the risk of ovulatory infertility.
• Testicular endocrinology, sperm motility and male fertility: Supplemental vitamin B5 is crucial for improving sperm motility, plasma levels of testosterone and corticosterone, and reducing testicular weight.

Vitamin B5 supplement is commonly administered orally before or after meals for all oral solid forms.

Derivatives of vitamin B5 can be injected via IV formulations or given topically, depending on the use; some can be administered via an oral spray.

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional.

Vitamins and natural supplements should not replace a balanced diet

This product is not intended to diagnose, treat or prevent any disease(s).

Vitamin B5 is available in the form of tablets. Vitamin B5 is also frequently sold in combination with other water-soluble multivitamins.

• Limit the consumption of foods like and beverages that include caffeine, such as coffee, tea, chocolate, and alcoholic drinks, as this substance could hinder the absorption of Vitamin B5.
• Limit alcoholic beverages.
• Stay within your daily calorie needs.

The dietary restriction should be individualized as per patient requirements.

Recommended Daily Allowance (RDA)

The RDA for adults is 5 mg/day.

Upper Tolerable Intake (UTL):

No UTL is set for vitamin B5 as data concerning adverse effects is insufficient.

There are no absolute contraindications to vitamin B5 intake.

The treating healthcare professional must closely keep a watch and

monitor for signs and symptoms of adverse reactions, such as allergic

responses, diarrhoea or gastrointestinal disturbance. It is advised to discontinue the intake of vitamin B5 in case of allergies.

Vitamin B5 may affect blood sugar levels, so it should be used cautiously in diabetes.

Caution is advised when consuming alcohol with Vitamin B5.

Safe for use during breastfeeding when taken at recommended doses.

• Food may decrease the rate but not the extent of absorption. Limit foods and drinks higher in added sugars, saturated fat, and sodium.

Vitamin B5 supplement is reported to be well-tolerated and safe to use.

The adverse reactions related to Vitamin B5 can be categorized as

• Common: Nausea, headache and dizziness.
• Less Common: Doses above 10 g/day may cause mild diarrhoea or intestinal distress.
• Rare: Allergic contact dermatitis, hypersensitivity.

• Antibiotics: It has been suggested that these antibiotics may decrease gut flora's natural synthesis of vitamin B5 or its subsequent coenzymes (CoA or ACP); providing pantothenic acid reverses this enzyme inhibition.
• Oral contraceptive pill: A higher consumption of pantothenic acid may be required while taking oral contraceptive pills. Consume food that is high in vitamin B5, or consider taking supplements.
• Isotretinoin: According to a study, isotretinoin-related mucocutaneous side effects can be treated with a 5% dexpanthenol cream.
• Acetylcholinesterase inhibitor drugs: Since pantothenic acid contributes to the production of acetylcholine, it could increase the effects of acetylcholinesterase inhibitor drugs.

The common side effects associated with Vitamin B5 include

• Muscle pain

• Joint pain

• Diabetes mellitus, new-onset

• Sore throat

• Headache

• Weakness/lack of energy

• Dizziness

• Creatine phosphokinase (CPK) increased

• Nausea

• Abdominal pain

• Alanine transaminase (ALT) increased

• Constipation

• Flu-like illness

• Urinary tract infection (UTI)

• Hypersensitivity reactions, including rash, itching, hives, and swelling

• Pancreatitis

• Yellowing skin and eyes (jaundice)

• Muscle disease

• Muscle wasting (rhabdomyolysis)

• Pregnancy: The recommended daily intake of oral vitamin B5 for pregnant women is 6 mg/day

• Paediatrics: Vitamin B5 has improved growth, healing, energy production, cellular function and metabolism.

The RDA for paediatrics is 1.7- 5 mg/day

Dosage Adjustment for Paediatric Patients

There are no specific dosage adjustments provided.

• Geriatrics: Excellent for fighting free radicals that contribute to the pathophysiology of diseases like Alzheimer's and dementia, as well as general cognitive decline with ageing, vitamin B5 has been demonstrated to offer a certain level of protection.

An increasing amount of vitamin B5 is recommended with advancing age due to the lower efficiency of vitamin B5 absorption by the enterocytes.

• Lactating mothers: The recommended daily intake of oral vitamin B5 for lactating mothers is 7 mg/day

Dosage Adjustment in Kidney Impairment

Vitamin B5 deficiency is uncommon in dialysis patients.

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Adult Patients

Dietary Supplement

5-10 mg PO qDay

Neurodegeneration (Orphan)

Penatothenate phosphate

Orphan designation for pantothenate kinase-associated neurodegeneration (PKAN).

Vitamin B5 has no toxicity and is believed to cause no serious adverse effects at high intakes.

There is no specific treatment in the event of an overdose. In the event of an overdose, the patient should be treated symptomatically and supportive measures instituted as required.

The physician should be vigilant about the knowledge about the identification and treatment of overdosage of Vitamin B5.

Biochemistry profile of vitamin B5

Vitamin B5 is an amide consisting of β-alanine and pantoic acid and is frequently found in supplements such as calcium pantothenate.

Coenzyme A (CoA), a cofactor and acyl group carrier for many enzymatic activities, and the acyl carrier protein, an essential component of the fatty acid synthase complex, require pantothenic acid for their production and maintenance. CoA or phosphopantetheine makes up around 85% of the pantothenic acid in food. Nucleosidases, peptidases, and phosphorylases, which are digestive enzymes, transform these forms into pantothenic acid in the intestinal lumen and intestinal cells. Pantothenic concentrations in blood, urine, and tissue can be measured using microbiologic growth assays, animal bioassays, and radioimmunoassays; however, urinary concentrations are the most reliable methods.

Kinetic Profile:

• Absorption: With the possibility of simple diffusion at greater doses, pantothenic acid is absorbed in the intestine and delivered by active transport directly to the bloodstream. On the other hand, intestinal cells absorb phosphopantetheine's dephosphorylated form, pantetheine, and turn it into pantothenic acid before it enters the bloodstream. Although its specific effect on total absorption is unknown, the gut flora may potentially contribute to the formation of pantothenic acid. The body's pantothenic acid is distributed by red blood cells after absorption. CoA is primarily present in tissues, while it can also be found in trace amounts in free pantothenic acid or acyl carrier proteins.
• Distribution: The most significant distribution of CoA is found in the liver, adrenals, kidneys, brain, heart and testes. Much of this( 70% in the liver and 95% in the heart) is located in the mitochondria. Pantothenic acid as CoA synthesises the acetylcholine neurotransmitter in brain tissue.
• Metabolism: Pantothenate kinase, an enzyme inhibited by CoA and acyl CoA, which are end products of the route, plays a significant role in controlling the synthesis of CoA from pantothenate. Therefore, the amount of available pantothenate is not the only factor influencing CoA production. Several metabolic processes, such as the tricarboxylic acid cycle, the production of fatty acids and phospholipids, the digestion of amino acids, and the manufacture of necessary compounds like hormones, vitamins, porphyrin, and neurotransmitters, all depend on CoA. It also helps in the production of -tubulin and the acetylation and acylation of proteins.
• Excretion: Pantothenic acid is excreted intact in urine, where it can be detected using radioimmunoassay or a Lactobacillus plantarum assay.

Braun L, Cohen M. October 1, 2014.Herbs and Natural Supplements; 4th Edition Vol-2. Australia. Elsevier.

2. https://reference.medscape.com/drug /vitamin-b5-pantothenic-acid-344423

3. https://www.ncbi.nlm.nih.gov/books/NBK563233/

4. https://www.ncbi.nlm.nih.gov/books/NBK114311/

5. https://ods.od.nih.gov/factsheets/PantothenicAcid-HealthProfessional/

6. https://ods.od.nih.gov/factsheets/PantothenicAcid-Consumer/