According to the United States Environmental Protection Agency (USEPA), a number of drug entities and pharmaceutical formulations, generated in health care facilities, meet the definition of hazardous waste, including epinephrine, warfarin, nicotine, and seven chemotherapeutic agents. This study has been carried out to assess the hazardous pharmaceutical waste generation in one large multi-specialty hospital in Alexandria for the ultimate objective of recommending an environmentally sound management plan for this waste. Alexandria University Main Hospital was selected for the study. A checklist containing the names of the drugs that are considered hazardous upon disposal was developed. Data concerning the generation and the management of this waste were collected using 2 questionnaire forms. The study revealed that ten hazardous pharmaceuticals are generated from the hospital departments. They are Epinephrine, m-cresol, phenol, silver sulfadiazine, multi-mineral formulations containing Cr and Se, warfarin, cyclophosphamide, chlorambucil, melphalan, and daunomycin. These drugs, as well as the other pharmaceutical waste, are managed as infectious waste: collected in yellow bags, stored in the storage area for infectious waste, and transported by the Private Company responsible for solid waste management in Alexandria Governorate to treatment by shredding and autoclaving prior to ultimate landfill. Consequently, the study recommended a hazardous pharmaceutical waste management plan taking into consideration other equally hazardous drugs such as all chemotherapeutic agents, mutagenic or teratogenic substances, endocrine disruptors, and immunosuppressant drugs. Thermal destruction of all these drugs would provide the highest level of best management practice available at this time. The ash resulting has to be tested and eventually disposed in a lined hazardous waste landfill.