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Nowadays, hospital wastewater contains a high concentration of toxic pharmaceutical contaminants, posing a significant threat to the environment, and human and animal life. Cefixime (CFX) is one such toxic contaminant that has a detrimental impact on both aquatic and terrestrial ecosystems. Therefore, it is essential to remove this compound using non-toxic and environmentally friendly procedures to ensure healthy drinking water. In this study, a low-cost and eco-friendly nano adsorbent (nZVI/copper slag) was synthesized and characterized using FESEM, XRD, EDX, FTIR, and zeta potential to remove CFX from wastewater. The Response Surface Methodology (RSM) was used to evaluate the effects of experimental factors including adsorbent dosage (2–10 g/L), pollutant concentration (10–30 mg/L), pH (2–10), and contact time (10–50 min) for efficient CFX elimination. The optimal conditions (adsorbent dosage: 7.79 g/L, pollutant concentration: 19.42 mg/L, pH: 4.59, and reaction time: 36.17 min) resulted in 98.71% CFX removal. The adsorption isotherm and kinetics data showed that the pseudo-second-order kinetics and Langmuir isotherm models were appropriate for CFX elimination. Furthermore, the nano adsorbent demonstrated 90% CFX elimination after up to six repeated cycles in regeneration and reusability testing. Finally, the nZVI/CS nano adsorbent can be an effective and promising solution for removing CFX from wastewater.