Pharmaceutical active compound (PhAC) residues are considered an emerging micropollutant that enters the aquatic environment and causes harmful ecotoxicity. The significant sources of PhACs in the environment include the pharmaceutical industry, hospital streams, and agricultural wastes (animal husbandry). Recent investigations demonstrated that wastewater treatment plants (WWTPs) are an important source of PhACs discharging ecosystems. Several commonly reported that PhACs are detected in a range level from ng L to μg L concentration in WWTP effluents. These compounds can have acute and chronic adverse impacts on natural wildlife, including flora and fauna. The approaches for PhAC removals in WWTPs include bioremediation, adsorption (e.g., biochar, chitosan, and graphene), and advanced oxidation processes (AOPs). Overall, adsorption and AOPs can effectively remove PhACs from wastewater aided by oxidizing radicals. Heterogeneous photocatalysis has also proved to be a sustainable solution. Bioremediation approaches such as membrane bioreactors (MBRs), constructed wetlands (CWs), and microalgal-based systems were applied to minimize pharmaceutical pollution. Noteworthy, applying MBRs has illustrated high removal efficiencies of up to 99%, promising prospective future. However, WWTPs should be combined with advanced solutions, e.g., AOPs/photodegradation, microalgae-bacteria consortia, etc., to treat and minimize their accumulation. More effective and novel technologies (e.g., new generation bioremediation) for PhAC degradation must be investigated and specially designed for a low-cost and full-scale. Investigating green and eco-friendly PhACs with advantages, e.g., low persistence, no bioaccumulation, less or non-toxicity, and environmentally friendly, is also necessary.