The production of counterfeit drugs is a broad and under reported problem particularly affecting poorer countries. It is an important cause of unnecessary mortality and morbidity, and loss of public confidence in medicines and health structures. Empirical observations show that there may be more counterfeit than genuine drugs in circulation. This article discusses the prevalence of counterfeit drugs in Nigeria. It highlights factors contributing to the preponderance of counterfeit pharmaceuticals and discusses strategies that may influence policy to combat the menace of counterfeit drugs. Major factors contributing to the prevalence of counterfeit drugs in Nigeria include ineffective enforcement of existing laws, non- professionals in drug business, loose control systems, high cost of genuine drugs, greed, ignorance, corruption, illegal drug importation, chaotic drug distribution network, demand exceeding supply amongst many others. Counterfeit drugs pose great threats to the attainment of the millennium development goals 4, 5 and 6 which hopes for a reduction in infant mortality, improved maternal health and combating human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), malaria and other diseases. Due to the complexity of the counterfeit drug problem, no single technique can eliminate the public health threat posed by counterfeit pharmaceuticals. A multi-disciplinary and cross-functional approach will help combat the prevalence of counterfeit drugs in Nigeria. Key words: Counterfeit drugs, public health, Nigeria.