Adverse drug reactions (ADRs) are an often overlooked but critical aspect of patient care in hospitals. In India, they pose a significant challenge, affecting patient safety, treatment outcomes, and overall healthcare resources. Hospital pharmacists are uniquely positioned to detect, monitor, and prevent ADRs, playing a crucial role in improving medication safety. This review explores how Indian hospitals are implementing ADR monitoring systems, particularly under the framework of the Pharmacovigilance Programme of India (PvPI). Studies from different parts of India highlight common trends: antimicrobials are frequently involved in ADRs, with dermatological and gastrointestinal reactions being most common. Yet, under-reporting remains a major hurdle due to lack of awareness, limited resources, and time constraints among healthcare staff. Hospital pharmacists can make a difference by leading ADR monitoring initiatives, collaborating closely with doctors and nurses, and utilizing tools such as the Naranjo algorithm and WHO-UMC causality assessment. Introducing structured protocols, regular staff training, and digital surveillance systems can further enhance detection and reporting. By combining vigilance with proactive engagement, Indian hospital pharmacies can not only reduce preventable ADRs but also contribute to safer and more effective patient care across the country.