Asian Journal of Research in Medicine and Medical Science

Pharmaceutical sustainability cannot be reduced to a single manufacturing metric or a recyclable pack. Environmental burdens arise across molecular and process design, active pharmaceutical ingredient synthesis, formulation, utilities, primary and secondary packaging, distribution, use, and end-of-life management. This critical narrative review integrates evidence on sustainable pharmaceutical manufacturing and packaging to examine where technological interventions genuinely prevent burdens and where they may merely shift them between life-cycle stages. Literature published mainly from 2000 to 9 June 2026 was identified through accessible scholarly indexes and verified against bibliographic and DOI landing pages, with additional evidence from authoritative regulatory and public-health sources. The strongest evidence supports prevention-oriented manufacturing strategies: route simplification, solvent substitution and recovery, catalysis and biocatalysis, process intensification, continuous manufacturing, and the systematic use of process mass intensity alongside broader life-cycle assessment. Emerging approaches such as mechanochemistry and greener-by-design active ingredients are promising but remain constrained by scale-up, quality, toxicological and regulatory evidence gaps. Packaging studies show that material choice alone does not determine sustainability; protection performance, fill efficiency, sterilisation, transport, medicine wastage, collection infrastructure and end-of-life fate can reverse apparent advantages. Multi-layer blisters and sterile formats illustrate the tension between product protection and material circularity. At disposal, take-back systems can reduce uncontrolled release and improve recovery or controlled destruction, but evidence for behavioural uptake, system coverage and environmental benefit remains geographically uneven. Antibiotic manufacturing emissions demonstrate why end-of-pipe control and environmental quality criteria must complement green process design. Overall, the evidence favours a design-to-disposal governance model in which quality, safety and access constraints are treated as boundary conditions while material, energy, toxicity, emissions and circularity outcomes are evaluated together. Priority research needs include harmonised pharmaceutical life-cycle inventories, comparative studies at commercial scale, packaging performance–environment trade-off testing, and procurement or regulatory mechanisms that reward verified life-cycle improvement without compromising medicine quality or supply resilience.