In recent years, oral osmotic tablets have sparked a therapeutic paradigm for controlled-release dosage forms due to their intrinsic insensitivity to physiological and physicochemical factors. Despite these benefits, the design of an optimal osmotic technology is precluded by various challenges. These limitations include manufacturing complexity, the lack of understanding of the functional mechanics, and inadequate optimization for the desired bio-performance. This paper systematically reviews the development of an osmotic-driven drug delivery system and the strategy for a zero-order release profile with an emphasis on swellable core technology. We discuss the applicability of the various types of osmotic tablets, their suitability to specific needs, and factors that drive the technology selection. Finally, we review the challenges, opportunities, and future perspectives associated with osmotic tablets.