Pharmaceutical pollution, particularly the contamination of aquatic ecosystems with persistent antibiotics such as Levofloxacin (LVX), represents a significant and alarming threat to both global ecological systems and the health of the general population. These trace contaminants exhibit remarkable solubility and chemical stability, which enables them to evade removal by conventional wastewater treatment facilities that are not adequately designed to address such specific pollutants. Abstract This review provides an in-depth examination of the utilization of nanotechnology-based adsorbents, with a particular focus on Layered Double Hydroxides (LDHs), for the purpose of achieving sustainable remediation of contaminated water bodies. The capacities for LVX adsorption, the behaviours exhibited over various kinetic phases, and the underlying mechanisms that facilitate the removal of LVX—such as hydrogen bonding, electrostatic interactions, and ion exchange—are meticulously evaluated and analysed. Furthermore, the review addresses the existing techno-economic challenges that hinder the adoption of these technologies, explores various structural modification strategies, including but not limited to transition metal frameworks and organic complexation, and discusses the future prospects necessary for the effective translation of these environmentally friendly LDH nanomaterials into scalable applications for wastewater treatment.