Sensitive radioactivity detection following high performance liquid chromatography (HPLC) remains a challenge in drug metabolism studies with radiolabeled compounds. The aim of this review article is to give a general overview of scintillation counting techniques and to summarize recent advances in radioactivity detection for HPLC, with a strong emphasis on the application in drug metabolism studies. State of the art and new developments with homogeneous and heterogeneous on-line radioactivity detectors, stop-flow technology, off-line microplate solid scintillation counters (SSC), and accelerator mass spectrometry (AMS) will be discussed.