It is well documented that pharmaceuticals and personal care products (PPCPs) are incompletely removed during the treatment of waste water. Treated waste water and sewage sludge generated during wastewater treatment represent two sources leading to PPCPs to become persistent in both agriculture and aquatic environments. With PPCPs becoming more persistent in these environments, it is important to understand the fate and transformation of these compounds. In this review, we will focus on the pharmaceutical compound carbamazepine (CBZ) as a model for PPCPs as environmental contaminants. CBZ is commonly detected in both agriculture and aquatic environments, but a lack of understanding in fate and transformation remains. There is also a paucity of information around the risk factors involved with the fate and transformation of PPCPs, such as toxicity and endocrine disruption. Future research will be aimed towards understanding the toxicological potential of PPCPs and transformation products (TPs).