Pharmaceuticals are detected at trace levels in waters. Their adverse effects on aquatic ecosystems and human health demand novel pharmaceutical removal technologies for treating wastewater effluents. Iron (Fe) or manganese (Mn) may play important roles in these new technologies since these metals are abundantly available at low costs and are known to contribute to organic conversions via physico-chemical, chemical, and biologically related processes. Few reviews describe and discuss Fe-or Mn-based technologies for the purpose to remove pharmaceuticals from water. Therefore, we review the current literature sorted into the three removal mechanisms, that is., through physico-chemical, chemical, and biological processes. The principals, performance, and influential parameters of these three types of technologies are described. Current and potential applications of these technologies are critically evaluated in order to identify advantages and challenges. In addition, the Fe-or Mn-based technologies which are currently not used but promising to further develop to remove pharmaceuticals cost efficiently are proposed.