The present review discusses the effects of pharmaceutical drugs on aquatic ecosystem, in particular the fish to be precise. The focus is on roles of multiple drug types like antimicrobial, antipsychotic, analgesic, and anti-inflammatory; and the toxicity induced by them towards growth and development of the fish present in the aquatic ecosystem. Few studies either in the wild or in in vivo have discussed these impacts of drugs. Interactions of drugs such as tilmicosin (TMS), tylosin (TYL), clarithromysin (CLR), azithromycin (AZM), Xanax, valium, and others, impacting fish physiology, metabolism, growth and development, have been highlighted. The toxicity of drugs on various fish models and possible modes of management in alleviating such situations are discussed.