The presence of pharmaceutically active compounds (PhACs) belonging to different therapeutic classes (including non‐steroidal anti‐inflammatory drugs, analgesics, antiepileptics, and lipid regulators) in hospital wastewater and surface water samples was investigated for the first time in Vietnam. Analytical results showed that 10 PhACs, including naproxen, indomethacin, ketoprofen, ibuprofen, propyphenazone, diclofenac, clofibric acid, gemfibrozil, and carbamazepine were detected at least once in the hospital wastewater samples. The detection of these PhACs in hospital wastewater demonstrates that hospital effluents are considered a significant source of pollution of the environment by pharmaceuticals. Our initial results showed that only ibuprofen was removed efficiently by the wastewater treatment plant at sampling site S2. The presence of PhACs in surface water samples may reflect the impacts of wastewater contamination in surface water bodies. The ubiquitous occurrence of carbamazepine in both wastewater and surface water may suggest that carbamazepine can potentially serve as a good molecular marker indicating wastewater contamination in surface water. A tentative assessment of environmental risk of PhACs for surface water has been discussed. Risk quotients higher than one were observed only for carbamazepine, diclofenac, ibuprofen, and naproxen, suggesting that these compounds seem to show high risk for aquatic ecosystems.