Pharmaceutical contaminants in sewage represent a growing global environmental and public health concern. These bioactive substances originate from domestic discharges, hospital effluents, pharmaceutical manufacturing, and improper disposal of pharmaceuticals and are frequently detected in wastewater. Conventional wastewater treatment plants (WWTPs) are not equipped to effectively remove complex pharmaceutical residues, which results in their persistence in treated effluents and biosolids. Commonly identified contaminants include antibiotics, analgesics, hormones, and psychiatric medications, many of which exhibit high chemical stability and resistance to degradation. Once in the environment, these compounds can disrupt aquatic ecosystems, induce endocrine and behavioral changes in wildlife, and promote the proliferation of antimicrobial resistance (AMR). Moreover, chronic exposure through contaminated water and food sources raises significant human health concerns, including endocrine disruption and immune dysfunction. The chapter explores the environmental fate of pharmaceuticals, their transformation into potentially toxic byproducts, and their bioaccumulation potential. It also highlights advanced analytical techniques such as LC–MS/MS and GC–MS for detection and examines emerging treatment technologies, including membrane filtration, advanced oxidation processes (AOPs), and bioreactors that aim to enhance removal efficiency. However, these technologies often face limitations regarding cost, energy demand, and scalability. The paper concludes by emphasizing the need for integrated strategies, including green chemistry, regulatory reforms, public awareness, and multidisciplinary collaboration, to mitigate pharmaceutical pollution. Addressing this issue requires a global effort to develop sustainable pharmaceutical practices, improve wastewater treatment infrastructure, and strengthen policy frameworks to protect both environmental and human health.
