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Pharmaceuticals and personal care products (PPCPs) include over-the-counter and prescription drugs, veterinary drugs, fragrances, and cosmetics. PPCPs have been detected in aquatic environments at low concentrations and are emerging as contaminants of concern. PPCPs are primarily released into aquatic environments via untreated sewage, wastewater treatment plants, landfill leachate and can affect aquatic life through persistence, bioaccumulation, and toxicity. However, there are limited reviews of lethal and sublethal effects of PPCP exposures on aquatic organisms. To understand PPCP toxicity on aquatic organisms, a literature review was conducted that identified aquatic organisms known to be affected by PPCPs; concentrations of PPCPs reported as producing sublethal and lethal effects in aquatic organisms; and research gaps on PPCP aquatic toxicity. Twelve PPCPs were selected from three seminal studies for review, including bisphenol A, carbamazepine, erythromycin, fluoxetine, linear alkylbenzene sulfonate, metoprolol, naproxen, nonylphenol, ofloxacin, sertraline, sulfamethoxazole, and triclosan. Many aquatic species were affected by PPCPs at sublethal and lethal exposures, including sublethal effects at environmentally relevant concentrations. Because lethal effects were seldom observed at environmentally relevant concentrations, many studies considered PPCPs non-toxic. Few studies have compared effects of PPCPs on the same organisms for identical exposure parameters (time and concentration), resulting in wide variation in reported toxicity levels with limited consensus in the academic literature. Consensus in lethal concentrations was reported for Daphnia magna with 48 h exposure for bisphenol A and triclosan and Vibrio fischeri with 15 min exposure to carbamazepine. Environmentally relevant sublethal concentrations were higher than water quality guidelines developed for Canada and predicted no-effect concentrations derived globally. Species sensitivity distributions for some PPCPs show that aquatic species are affected lethally at environmentally relevant concentrations. More studies on indirect and long-term ecological effects along with testing chronic toxicity of PPCPs at environmentally relevant concentrations are recommended. These will help guide future research to determine extent and magnitude of PPCP concentrations in aquatic environments and help inform management decisions to reduce sources of PPCPs into the environment. Future management requires effective monitoring strategies regarding use, disposal, occurrence, and impacts at different life cycle stages of PPCPs in the environment. [ABSTRACT FROM AUTHOR]