The dissemination of pharmaceuticals in agroecosystems originating from land application of animal manure/sewage sludge and irrigation with treated wastewater in agricultural production has raised concern about the accumulation of pharmaceuticals in food products. The pathways of pharmaceutical entries via plant roots, transport to upper fractions, and the factors influencing these processes have yet been systematically elucidated, thus impeding the development of effective measures to mitigate pharmaceutical contamination in food crops. In this study, lettuce uptake of thirteen commonly used pharmaceuticals was investigated using a hydroponic experimental setting. Pharmaceutical sorption by lettuce roots was measured in order to evaluate the influence on pharmaceutical transport from roots to shoots. Small-sized pharmaceuticals e.g., caffeine and carbamazepine with molecular weight (MW) 12.0 L g-1) and demonstrated a reduced transport to shoots. Large-sized pharmaceuticals (e.g. MW >400 g mol-1) including lincomycin, monensin sodium, and tylosin could be excluded from cell membranes, resulting in the predominant accumulation in lettuce roots. Large-sized oxytetracycline existed as zwitterionic species that could slowly enter lettuce roots; however, the relatively strong interaction with lettuce roots limits its transport to shoots. The mass balance analysis revealed that acetaminophen, β-estradiol, carbadox, estrone and triclosan were readily metabolized in lettuce with >90% loss during 144-h exposure period. A scheme was proposed to describe pharmaceutical uptake and transport in plant, which could reasonably elucidate many literature-reported results. Molecular size, reactivity and ionic speciation of pharmaceuticals, as well as plant physiology, collectively determine their uptake, transport and accumulation in plants.