Introduction: Irrational drug use remains globally common and there is a lack of country level synthesis for strategizing policy actions in Pakistan. Methodology: We conducted a scoping review of available peer reviewed and grey literature on prescribing patterns and drug dispensing in Pakistan to identify emerging concerns.

Results: There is excessive drug use in Pakistan compared to the average for LMICs with inappropriate prescribing, high use of injections and antibiotics, choice of more expensive drugs, inadequate dispensing and weak community pharmacy. Policy concerns include excessive drug registration, poor enforcement of essential drug lists and standard management protocols, open access of industry to health providers, and lack of private sector regulation.

Conclusion and Policy Recommendations: Review of evidence demonstrates deviance from rational use in the areas of medicine prescription, dispensing and self-medication, and low impact of existing policy measures. Quality of research needs to be improved focusing on standardized national surveys, consumer related formative research, and interventional research.

Rational drug use is a neglected area in Pakistan requiring policy measures at multiple levels of health system and continued and simultaneous investment in standardized research