The growing importance of sustainability in organizational success, particularly in the pharma-ceutical industry, underscores the need for leveraging technologies like blockchain to enhance sustainability indicators across environmental, social, and economic pillars. This study aims to identify and understand the challenges hindering the adoption of blockchain in the pharmaceuti-cal sector for improving sustainability performance, addressing two research questions: the spe-cific challenges faced by blockchain adoption in this context and the interdependencies among these challenges. Employing a two-step approach, the study compiles challenges through a litera-ture review, refines them via expert opinions, and establishes their interrelationships using methodologies like Fuzzy Interpretive Structural Modeling (FISM) and Cross-Impact Matrix Multiplication Applied to Classification (MICMAC). The research contributes to unraveling the complex relationships and dependencies within the system, providing a structured framework for improved decision-making and strategic planning. It fills a literature gap by being the first attempt to outline driving and dependent factors related to the challenges of adopting blockchain technology for sustainability enhancement in the pharmaceutical sector, offering insights that can significantly impact brand image, company perception, and consumer value.