Pharmaceutical compounds, such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, β-blocker, etc. have emerged as new classes of water pollutants due to their potential or proven adverse effects on human health and the aquatic environment. This paper aims to systematically review the current data available on the global occurrence and removal of 43 pharmaceutical compounds in municipal wastewater treatment plants (M-WWTPs) in the period from 2010 to 2020. Moreover, this work intends to assess the global daily mass load and emissions of pharmaceuticals in different regions. Nevertheless, the environmental risk of pharmaceuticals in the final effluents of M-WWTPs was also evaluated. Lastly, the guidelines and regulations concerning the occurrence of pharmaceuticals in the aquatic environment were summarized and discussed. The findings highlighted that there is significant variation in the concentrations of pharmaceuticals between different regions. Meanwhile, the concentrations of pharmaceuticals in the influents of Asian region tend to be higher than those in other monitored regions. In this respect, the highest average daily mass loads were observed for acetaminophen (473 g/1000 in./day) and atenolol (592 g/1000 in./day), while amoxicillin (944 g/day), sulfamethoxazole (688.38 g/day) recorded the highest daily emissions. The environmental risk assessment based on the risk quotient (RQ) showed that twelve of the monitored pharmaceuticals pose a high potential risk to the aquatic ecosystems. The emphasized guidelines and regulations laid focus on the measures that can be used to mitigate the occurrence of pharmaceuticals in the environment. Research needs and future recommendations are also identified and proposed.