Pharmaceuticals in Water: Fate, Health Risks, Treatment and Governance for Sustainable Management

Pharmaceuticals are increasingly recognised as emerging contaminants in aquatic environments due to their continuous input, persistence and biological activity. Despite typically occurring at trace concentrations (ng/L to µg/L), these substances can exert potential effects on ecological and human health through diverse biological mechanisms, even at low exposure levels. This review synthesises recent evidence on the occurrence, fate, transport and removal efficiency of major therapeutic classes, including antibiotics, non-steroidal anti-inflammatory drugs, antidepressants, hormones and steroids, and beta-blockers across the aquatic environment. A cradle-to-grave perspective is applied to characterise the full lifecycle of pharmaceutical residues from production and consumption to environmental persistence. Current and emerging treatment technologies are critically examined alongside regulatory and governance frameworks. To address these challenges, this paper proposes an integrated management framework that interconnects lifecycle thinking, advanced treatment technologies and adaptive regulatory governance to support sustainable protection of drinking-water resources. Collectively, this work advances a holistic understanding of pharmaceutical pollution in water and provides strategic direction for future research, policy development and environmental management.