It is widely accepted that purines and pyrimidines, the building blocks that gave origin to life on our planet, were created through multicomponent reactions (MCRs) on early abiotic Earth. These heterocyclic scaffolds gradually evolved into a wide range of biologically relevant molecules regulating many different physiological processes and thus becoming widely exploited as templates for the development of new drugs. Accordingly, over the years, the synthetic community has dedicated many efforts in the attempt to hypothesize and replicate the original abiotic synthesis of purines and pyrimidines, thus developing a number of multicomponent synthesis to access these scaffolds. The following evolution of synthetic chemistry towards green approaches for the production of new molecules and the recent interest in pharmaceutical sustainability underlines the importance of multicomponent synthesis of new heterocycles. This review article provides an overview of the most important multicomponent approaches for the synthesis of purine and pyrimidine derivatives for potential pharmacological applications.