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JAMES W. FETTERMAN JR., PHARM.D., is Associate Professor and Experiential Education Coordinator, Department of Pharmacy Practice; and MARTIN M. ZDANOWICZ, PHD.,. is Professor, Department of Pharmaceutical Sciences, School of Pharmacy, South University, Savannah, GA.

Address correspondence to Dr. Fetterman at the Department of Pharmacy Practice, School of Pharmacy, South University, 709 Mall Boulevard, Savannah, GA 31406 (jfetterman{at}southuniversity.edu).

Purpose. The potential therapeutic benefits of supplementation with n-3 polyunsaturated fatty acids (PUFAs) in various diseases are reviewed, and the antiinflammatory actions, activity, and potential drug interactions and adverse effects of n-3 PUFAs are discussed. Summary. Fish oils are an excellent source of long-chain n-3 PUFAs, such as eicosapentaenoic acid and docosahexaenoic acid. After consumption, n-3 PUFAs can be incorporated into cell membranes and reduce the amount of arachidonic acid available for the synthesis of proinflammatory eicosanoids (e.g., prostaglandins, leukotrienes). Likewise, n-3 PUFAs can also reduce the production of inflammatory cytokines, such as tumor necrosis factor , interleukin-1, and interleukin-6. Considerable research has been conducted to evaluate the potential therapeutic effects of fish oils in numerous conditions, including arthritis, coronary artery disease, inflammatory bowel disease, asthma, and sepsis, all of which have inflammation as a key component of their pathology. Additional investigations into the use of supplementation with fish oils in patients with neural injury, cancer, ocular diseases, and critical illness have recently been conducted. The most commonly reported adverse effects of fish oil supplements are a fishy aftertaste and gastrointestinal upset. When recommending an n-3 PUFA, clinicians should be aware of any possible adverse effect or drug interaction that, although not necessarily clinically significant, may occur, especially for patients who may be susceptible to increased bleeding (e.g., patients taking warfarin). Conclusion. The n-3 PUFAs have been shown to be efficacious in treating and preventing various diseases. The wide variation in dosages and formulations used in studies makes it difficult to recommend dosages for specific treatment goals. Index terms: Docosahexaenoic acid; Drug interactions; Eicosapentaenoic acid; Fish oils; Mechanism of action; Polyunsaturated fatty acids; Toxicity