The task of medication monitoring in the schools has increased for school psychologists, yet there is little research specific to pediatric psychoactive medication. The current article reviews issues pertinent to school-based medication monitoring. Feasibility, acceptability, and perception of effectiveness are reviewed as fundamental considerations before implementing a medication-monitoring plan in the schools. The importance of individualization, ecological implementation, and development of socially valid objectives is stressed along with the need for additional research, tools, and measures in this area. Practical considerations for school psychologists include discussion of parental consent and confidentiality, multilevel assessment and monitoring, data recording, and determining clinical significance.