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The pharmaceutical industry is a significant contributor to environmental pollution, yet the sustainability of pharmaceutical technologies themselves has received less sustained attention than clinical efficacy, quality assurance, manufacturability, and cost. Pharmaceutical products are commonly evaluated through therapeutic performance and regulatory compliance, while the material, energy, solvent, water, packaging, and waste implications of their production and disposal remain secondary. This imbalance is no longer defensible as medicines become embedded within wider debates on planetary health, industrial decarbonisation, chemical pollution, and responsible innovation. Current pharmaceutical technology paradigms often depend on linear manufacturing models in which raw materials, solvents, excipients, packaging components, and delivery devices move through production and use before entering waste streams. This model is particularly problematic where complex formulations, multi-material packaging, single-use components, and persistent active substances create environmental burdens that are difficult to recover or neutralise. The problem is not only the presence of pharmaceuticals in the environment, but also the technological logic that normalises excess material throughput as an acceptable cost of product performance. This critical review examines sustainable pharmaceutical technologies through three connected lenses: green manufacturing, excipient burden, and circular design principles. Green manufacturing addresses how pharmaceutical products are synthesised, processed, purified, and scaled. Excipient burden focuses on the hidden environmental and functional load created by supposedly inactive formulation ingredients. Circular design principles extend the discussion beyond production efficiency toward products, packaging, and delivery systems designed for reduction, recovery, reuse, and responsible end-of-life management. The review identifies that continuous manufacturing, flow chemistry, process intensification, biocatalysis, solvent reduction, process mass intensity, and life-cycle assessment provide important but incomplete routes toward greener pharmaceutical production. It also shows that excipients, packaging, and drug delivery systems remain under-theorised in sustainability debates despite their cumulative contribution to material intensity, environmental persistence, and disposal complexity. Five tables present green manufacturing technologies, excipient burden data, circular design principles, environmental risks, and implementation barriers. The central conclusion is that sustainable pharmaceutical technology requires a systems-level transition rather than a collection of isolated green substitutions. Genuine sustainability will depend on integrating green manufacturing with excipient stewardship, circular product design, environmental risk reduction, regulatory adaptation, and cross-sector accountability. The field must therefore move from sustainability as a supplementary efficiency concern toward sustainability as a core design principle of pharmaceutical innovation.