Pharmaceuticals such as paracetamol and diclofenac (DCF) are among the most extensively consumed drugs worldwide and are continuously released into municipal and hospital wastewater due to incomplete human metabolism. Their persistent presence in aquatic environments, typically ranging from ng/L to µg/L, raises concerns due to endocrine disruption, chronic toxicity, and the promotion of antimicrobial resistance. Conventional wastewater treatment plants (WWTPs) remove 70–90% of ACT but less than 30% of DCF, primarily because these systems were not designed to target low-concentration, recalcitrant micropollutants. As a result, pharmaceuticals frequently pass into treated effluents, highlighting the need for advanced, sustainable, and passive treatment solutions. Permeable reactive barriers (PRBs) have emerged as a promising technology for the interception and removal of pharmaceuticals from both wastewater treatment plant effluents and groundwater. This review provides a comprehensive assessment of ACT and DCF occurrence, environmental behavior, and ecotoxicological risks, followed by a detailed evaluation of PRB performance using advanced reactive media such as geopolymers, activated carbon, carbon nanotubes, and hybrid composites. Reported removal efficiencies exceed 90% for ACT and 70–95% for DCF, depending on media composition and operating conditions. The primary removal mechanisms include adsorption, ion exchange, π–π interactions, hydrogen bonding, and redox transformation. The novelty of this review lies in systematically synthesizing recent laboratory- and pilot-scale findings on PRBs for pharmaceutical removal, identifying critical knowledge gaps—including long-term field validation, media regeneration, and performance under realistic wastewater matrices—and outlining future research directions for scaling PRBs toward full-scale implementation. The study demonstrates that PRBs represent a viable and sustainable tertiary treatment option for reducing pharmaceutical loads in aquatic environments.

Rapid industrialization, expanding urbanization, and unrestrained use of natural resources contribute to environmental issues, particularly the contamination of water bodies by a variety of chemical compounds due to inadequate wastewater treatment. These contaminants, referred to as contaminants of emerging concern (CECs), pose global challenges due to their widespread occurrence, persistence, and bioaccumulation, stemming from anthropogenic activities. Notable examples of CECs include pharmaceuticals like paracetamol and synthetic chemicals such as perfluorooctanoic acid (PFOA), underscoring the imperative for effective wastewater treatment. Furthermore, phenolic species originating from pharmaceutical and dye industries endure in wastewater, posing threats to human health and ecosystems. To address these challenges, permeable reactive barriers (PRBs) have been developed to treat polluted waters, utilizing various materials. However, concerns about their manufacturing complexity processes have prompted the exploration of simpler and eco-friendly alternatives. Promising options include geopolymers, activated carbons derived from waste, and carbon nanotubes sourced from plastic solid waste. Integrating these materials into permeable barriers and adopting the concept of PRBs, with a focus on circular economy principles, presents a sustainable approach to mitigate population exposure to contaminated water. This innovative strategy not only addresses the environmental and health risks associated with water pollution but also aligns with the broader purpose of this work, which is to produce environmentally friendly permeable barriers for application in systems post wastewater treatment plants.