The presence of pharmaceutical pollutants in wastewater poses a significant threat to aquatic ecosystems and human health. Conventional wastewater treatment plants (WWTPs) are not designed to effectively remove these emerging contaminants, leading to their persistence in treated effluent. This review paper synthesizes the current state of knowledge regarding the challenges posed by these pollutants and evaluates various advanced treatment technologies for upgrading existing WWTPs. We critically examine the efficacy of different upgrade strategies, including advanced oxidation processes (AOPs), membrane bioreactors (MBRs), and hybrid systems, in removing a wide range of pharmaceutical compounds. The review also discusses the operational limitations, cost implications, and environmental impacts of each technology. The goal is to provide a comprehensive overview for policymakers, engineers, and researchers to inform the selection and implementation of viable and sustainable upgrade solutions for tackling pharmaceutical pollution in wastewater.