The objective of this study was to study the occurrence, fate, and seasonal variations of pharmaceuticals at two urban wastewater treatment plants (WWTPs) in India and compare the results with a similar study conducted in the United States. This is the first study of its kind in comparing occurrence and fate of pharmaceuticals in wastewater of two different countries with the same methodology and analytical techniques. Twelve most relevant pharmaceuticals were selected for seasonal monitoring at two Indian WWTPs based on the comprehensive survey and through literature review. The yearly average influent concentrations of total pharmaceuticals were found to be 537 ± 5 μg/L at WWTP-1 and 353 ± 9 μg/L at WWTP-2. WWTP-2 exhibited comparatively higher removal efficiency of total pharmaceuticals (85% versus 59%, excluding monsoon season), possibly due to the cyclic activated sludge technology followed by chlorination employed at WWTP-2. Comparison with a similar study conducted in the United States revealed that concentration of most of the pharmaceuticals detected in the U.S. WWTPs were, on an average, more than 50% lower. U.S. WWTPs also exhibited 10–30% higher removal efficiencies for total pharmaceuticals. Our study results show that preliminary treatment and biological treatment alone are not adequate for complete removal of pharmaceuticals and polishing step and tertiary treatment is a necessity if higher removal of pharmaceuticals is desired in Indian WWTPs. Information obtained from this study will not only aid the local utilities but will also benefit understanding of global trends in usage of pharmaceuticals and their distribution in the environment.@en