<p><?tk 4?>Chemotherapy and antimicrobial studies now increasingly emphasize on compounds exhibiting multiple biological activities, with hydrazones growing as versatile and extremely promising candidates. Traditional antimicrobial and anticancer medications, despite their advantages, are often constrained by issues such as adverse toxicity, the emergence of resistant strains, and a decline in therapeutic efficacy. Hydrazones, an important class of Schiff base derivatives are distinguished by their wide range of biological activities, structural diversity, and ease of synthesis, The azomethine (–C=N–) group coupled with a carbonyl unit provides remarkable stability and potent donor properties to hydrazones, allowing them to work efficiently as ligands in coordination chemistry. Organotin(IV) complexes based on hydrazones are attracting a lot of attention for their stronger anticancer effects and their potential applications in various medical and industrial fields. These complexes have significant antimicrobial and anticancer effectiveness via mechanisms involving oxidative stress generation, inhibiting enzymes, and stimulation of apoptotic processes. Recent research highlights the rising interest in hydrazone-based organotin(IV) complexes, since metal ion coordination can greatly boost biological activity of these complexes by improving lipophilicity, encouraging cellular uptake, and enhancing specificity toward biological targets. In this review, recent developments since 2016 in organotin(IV) complexes containing hydrazone ligands are covered in details, emphasizing their diverse structures, noteworthy antimicrobial and anticancer profiles, mechanistic insights, and potential for their progression into effective therapeutic agents.</p> Graphical abstract <p></p>