Introduction. Adverse side effects (ADR) are unexpected effects resulting from the use of a medicinal product in therapeutic doses for the purpose of prevention, treatment, diagnosis or change in human physiological function. Since many drugs can potentially cause ADR, it is necessary to conduct a benefit-risk analysis when prescribing a particular medicinal product, and it is also important to exclude from circulation and production drugs that pose a threat to the health and well-being of the population. Objective. To identify the current state of the organization of activities of medical institutions of the Gorno-Badakhshan Autonomous Region (GBAO) in identifying adverse reactions to drugs and maintaining special journals, to determine factors for optimizing the pharmacovigilance system. Materials and methods. The study of pharmacovigilance activities in hospitals of GBAO was conducted with the permission of the Minister of Health and Social Protection of the Republic of Tajikistan (RT) dated 02.11.2023 No. 1-5/9632. Statistical data provided upon request by chief physicians of 27 medical institutions of GBAO were used, which were analyzed using the MS Excel 2016 program. Results and discussion. The total number of adverse reactions detected while taking medications was 225 cases for the period from 2019 to 2023. At the same time, only 2 hospitals in GBAO keep special journals in which adverse reactions are registered. In all other 25 hospitals, cases of adverse reactions while taking medications are recorded in case histories, which does not allow statistically reliable generalization of cases of adverse reactions to a particular drug, carrying out the necessary preventive and organizational work with healthcare workers, and timely notifying authorized bodies and drug manufacturers. There is no uniform requirement for the design of the adverse reactions registration journal in the region; each medical institution chooses the form of the journal at its own discretion. It should be noted that doctors, as one of the most important links in the pharmacovigilance system, play a key role in identifying adverse reactions. However, the shortage or complete absence of doctors in a number of hospitals in GBAO negatively affects the development of the pharmacovigilance system of the autonomous region. Conclusion. Shortcomings in the activities of medical institutions of GBAO in implementing the requirements for the organization of pharmacovigilance have been identified, which are associated with both violations in identifying side effects against the background of taking certain drugs, and with maintaining logs of identified adverse reactions, untimely provision of information to authorized bodies, as well as holders of registration certificates. It is necessary to approve a unified form of the registration log of adverse reactions, conduct additional training for medical workers on the system of organizing pharmacovigilance both at the stage of obtaining higher and secondary education, and at the postgraduate stage.