Background: Being that pharmaceuticals are expected to have a positive impact on human and animal lives, but lack of proper management and regulation leads to reproductive disorders, antibiotic resistance, and a decline of biodiversity in life and ecosystems. Their occurrence exerts downside to the environment including but not limited to the reduction of biodiversity, reproductive disorders, and resistance to antimicrobials. This review aims to identify and explore the occurrence, and source of pharmaceuticals in the environment and their ecotoxicological and regulatory aspects in Ethiopia.A narrative review of all relevant papers done in Ethiopia was conducted. Relevant papers were findings about the occurrence, source, factors, ecotoxicological aspects, and regulatory concerns of pharmaceutical residues in the environment. Literature conducted in Ethiopia was searched from Google Scholar, Scopus, PubMed, and institutional repositories.Result: Findings showed that residues of pharmaceuticals were detected in wastewater treatment facilities, liver, lake, and animal products that were commercially available to public consumers.The highest concentration of residues was detected for oxytetracycline and enrofloxacin at 607 µg/kg and 943.5 µg/kg of animal products respectively. Sulfamethoxazole and fluconazole were among the residues present at high amounts in aquatic samples of 0.15 µg/l and 0.012 µg/l respectively. It was also found antimicrobial resistance genes in wastewater and treatment plant samples, which can be linked to the presence of such residues. The ecological risk assessment was based on the risk quotient (RQ) value. Ciprofloxacin was among the antibiotics with an RQ of 8.58 which indicates a prominent ecological risk. Sulfonamide had an RQ of 0.1 to 1.The study revealed a significant presence of pharmaceutical residues in the environment and highlighted weak regulatory enforcement in addressing this public health concern. Urgent measures are required to prevent environmental contamination and mitigate public health risks including antimicrobial resistance. Regulators and relevant organizations moving to implement necessary measures to control and prevent pharmaceutical residues in the environment is an indispensable solution for the country.