Residues of pharmaceuticals used in human medical care have recently been detected as important trace contaminants of sewage, surface and groundwater. This paper compiles the recent state of knowledge on the occurrence and fate of pharmaceutical residues in the aquatic environment of urban areas. Findings in sewage effluents, surface, ground, and drinking water at concentrations up to the µg/L-level have been reported and will be discussed to demonstrate the impact of pharmaceutical residues on the aquatic environment and on public water supply. The efficiency of natural and technological processes such as bank filtration or membrane filtration for the removal of pharmaceutical residues including estrogenic steroids, analgesics, antibiotics, anti-epileptic drugs, blood lipid regulators, and several drug metabolites will be presented and discussed.