Optimizing drug dosing in critically ill patients is complex due to dynamic changes in pharmacokinetics and pharmacodynamics driven by disease-related physiology and interventions such as extracorporeal devices. Inadequate dosing may lead to therapeutic failure, whereas excessive dosing can exceed the patient’s physiologic reserve, increasing the risk of adverse effects. As the medication experts on the interprofessional ICU team, critical care pharmacists are uniquely equipped to address the complex pharmacotherapeutic needs of critically ill patients. Key responsibilities include proactive medication management; providing education to clinicians, patients, and families; addressing drug-related questions; guideline development and implementation; and monitoring medication safety and efficacy.