This chapter provides some fundamental aspects on adsorption of pharmaceutically active compounds in wastewater treatment scenarios, with a strong focus on actual practicality and the most recent scientific output. It discusses the key properties of adsorbing substances and adsorbent materials impacting the associated removals. The text demonstrates how adverse competitive effects by dissolved organic matter substantially impact adsorption of targeted compounds. This chapter further highlights possibilities for efficiently exploiting the available capacities of powdered and granular adsorbents. It introduces several practical and easily applicable means for prediction of the occurring adsorptive processes. In addition, the text provides some insights into available adsorbents and new material developments, comparing their advantages, downsides, and overall potentials for successful application. The last section gives a short overview on the associated environmental impacts and costs of adsorptive stages when installed on wastewater treatment plants. The conclusion summarizes the main findings and relates them to open research questions and additional future needs beyond strictly scientific disciplines.