<p>Antibiotics and pharmaceuticals exert significant environmental risks to aquatic ecosystems and human health. Many effective remedies to this problem have been developed through research. Metal–organic frameworks (MOFs) are potential constituents, for drug and antibiotic removal. This article explores the potential of MOFs like UiO-66 (University of Oslo-66) to remove pharmaceutical and antibiotic contaminants from water. Zr-based MOF UiO-66 is used in water treatment due to its well-known chemical, thermal, and mechanical stability. The review covers several modifications, including metal doping, organic-group functionalization, and composite construction, to increase the UiO-66 selectivity and adsorption capacity for various pollutants. Recent studies have shown that UiO-66 is an effective material for pharmaceutical pollutants such as ciprofloxacin, tetracycline, and sulfamethoxazole removal. Practical application, photostability, and large-scale synthesis remain challenges in water treatment methods. Moreover, recent studies indicate the recycling potential of UiO-66 that validates its capability to retain its efficiency over multiple cycles, indicating its cost-effectiveness and sustainability. Besides, the toxicity of UiO-66 and its derivatives, which occur during water treatment, has also been highlighted, addressing the health and environmental risks. Prospective research directions include designing flaws, producing stable analogs of UiO-66, and transforming powdered UiO-66 into other forms that might be utilized, including films and membranes. This review is crucial as no comprehensive literature is currently available that thoroughly discusses the design techniques and applications of UiO-66 and its composites for drug and antibiotic removal. Our study specifically concentrates on the latest developments, emphasizing particular alterations that improve performance in water treatment.</p> Graphical Abstract <p></p>