Input of pollutants to estuaries is one of the major threats to marine biodiversity and fishery resources, and pharmaceuticals are one of the most important contaminants of emerging concern in aquatic ecosystems. To synthesize pharmaceutical pollution levels in estuaries over the past 20 years from a global perspective, this review identified 3229 individual environmental occurrence data for 239 pharmaceuticals across 91 global estuaries distributed in 26 countries. The highest cumulative weighted average concentration level (WACL) of all detected pharmaceuticals in estuarine water was observed in Africa (145,461.86 ng/L), with 30 pharmaceuticals reported. North America (24,316.39 ng/L) was ranked second in terms of WACL, followed by South America (20,784.13 ng/L), Asia (5958.38 ng/L), Europe (4691.23 ng/L), and Oceania (2916.32 ng/L). Carbamazepine, diclofenac, and paracetamol were detected in all continents. A total of 41 functional categories of pharmaceuticals were identified, and analgesics, antibiotics, and stimulants were amongst the most ubiquitous groups in estuaries worldwide. Although many pharmaceuticals were observed to present lower than or equal to moderate ecological risk, 34 pharmaceuticals were identified with high or very high ecological risks in at least one continent. Pharmaceutical pollution in estuaries was positively correlated with regional unemployment and poverty ratios, but negatively correlated with life expectancy and GDP per capita. There are some limitations that may affect this synthesis, such as comparability of the sampling and pretreatment methodology, differences in the target pharmaceuticals for monitoring, and potentially limited number and diversity of estuaries covered, which prompt us to standardize methods for monitoring these pharmaceutical contaminants in future global studies.