| Summary: | Waste stabilization ponds and constructed wetlands (CWs) are effective at eliminating pharmaceutical residues, but removals are not usually complete. Their combination is regarded as an efficient, robust wastewater treatment method, but their efficiency in the removal of pharmaceuticals and the effect of a mild effluent recirculation has not been sufficiently studied in full-scale systems. Effluent recirculation can help to improve performance by increasing hydraulic residence time and, eventually, dissolved oxygen concentration. In this work, the presence of pharmaceuticals in wastewater from a university campus, their removal in a macrophyte pond–CW system, and the effect of effluent recirculation on removal and ecological risk were evaluated. Stimulants (caffeine and nicotine) and non-steroidal anti-inflammatories (naproxen and ibuprofen) were the most detected compounds in the influent and showed the highest concentrations, ranging from 0.5 to 300 µg·L<sup>−1</sup>. The pond–CW combination showed notable elimination for these compounds, achieving 87% on average. The ecological risk was also reduced by between 5.5 and 12.4 times, but it was still over values that indicates high ecological risk, mainly because of the concentrations of nicotine and ibuprofen. The effect of effluent recirculation was not as high as expected since the removals of caffeine, paraxanthine and naproxen were significantly improved, but those of atenolol and ibuprofen were lower. These results suggest that a higher recirculation ratio should be tested.
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