Fish represent the group of vertebrates with the largest number of species and the largest geographic distribution; they are also used in different ways by modern civilizations. The goal of this study was to compile the current knowledge on the use of ichthyofauna in zootherapeutic practices in Brazil, including ecological and conservational commentary on the species recorded. We recorded a total of 85 species (44 fresh-water species and 41 salt-water species) used for medicinal purposes in Brazil. The three most commonly cited species were Hoplias malabaricus, Hippocampus reidi, and Electrophorus electricus. In terms of conservation status, 65% of species are in the "not evaluated" category, and 14% are in the "insufficient data" category. Three species are in the "vulnerable" category: Atlantoraja cyclophora, Balistes vetula, and Hippocampus erectus. Currently, we cannot avoid considering human pressure on the population dynamics of these species, which is an essential variable for the conservation of the species and the ecosystems in which they live and for the perpetuation of traditional medical practices.