The presence of pharmaceuticals in the aquatic environment has become a significant environmental concern. Pharmaceuticals, being biologically active and persistent, pose a threat to environmental stability and public health. This review examines the sources, fate, and ecotoxicological effects of pharmaceutical contamination in aquatic ecosystems. The most common sources of environmental contamination include human excretion, metabolism post-consumption, diagnostic compounds, household disposal, and anthropogenic activities such as sewage treatment plant (STP) sludge and veterinary medicine use. Pharmaceuticals can persist in the environment due to their low volatility and high polarity, and they can be transported through water bodies and food chains. Acute and chronic toxicity studies on non-target organisms reveal that even low concentrations of pharmaceuticals can have significant impacts, including bioaccumulation and chronic toxicity. Therapeutic classes such as non-steroidal anti-inflammatory drugs (NSAIDs), blood lipid-lowering agents, antibiotics, and sex hormones are particularly concerning due to their widespread use and environmental persistence. The review highlights the need for further research to understand the full extent of pharmaceutical contamination and its ecological consequences.The presence of pharmaceuticals in the aquatic environment has become a significant environmental concern. Pharmaceuticals, being biologically active and persistent, pose a threat to environmental stability and public health. This review examines the sources, fate, and ecotoxicological effects of pharmaceutical contamination in aquatic ecosystems. The most common sources of environmental contamination include human excretion, metabolism post-consumption, diagnostic compounds, household disposal, and anthropogenic activities such as sewage treatment plant (STP) sludge and veterinary medicine use. Pharmaceuticals can persist in the environment due to their low volatility and high polarity, and they can be transported through water bodies and food chains. Acute and chronic toxicity studies on non-target organisms reveal that even low concentrations of pharmaceuticals can have significant impacts, including bioaccumulation and chronic toxicity. Therapeutic classes such as non-steroidal anti-inflammatory drugs (NSAIDs), blood lipid-lowering agents, antibiotics, and sex hormones are particularly concerning due to their widespread use and environmental persistence. The review highlights the need for further research to understand the full extent of pharmaceutical contamination and its ecological consequences.