Electrochemical detection, with its advantages of being rapid, multi-time point, compatible with cost-effective fabrication methods, and having the potential for miniaturization and portability, has great promise for point-of-care drug monitoring. However, a continuing challenge concerns the robust and sensitive electrochemical detection of pharmaceutical analytes from biological fluids. These complex matrices, such as saliva, sweat, interstitial fluid, urine, and blood/serum, contain multiple components that can contribute to an increased background or reduced analyte signal. In this mini-review, we discuss progress on electrochemical sensing in complex biofluids. We first introduce the challenge of drug titration in the management of various health conditions and provide an overview of the motivation for improved therapeutic drug monitoring, including current limitations. We then review progress on pharmaceutical drug detection from these biofluids with a focus on sample preprocessing, electrode modification for signal amplification, and/or electrode passivation to minimize fouling. Finally, we highlight promising strategies that have enabled robust drug quantification for clinical relevance and that may be useful for field-use systems.