It is pivotal for the credible utilization of surface-enhanced Raman scattering (SERS) technique in clinical drug monitoring to exploit versatile substrates with dependable quantitative detection and robust recognition abilities. Herein, a commendable electromagnetic-chemical dual-enhancement SERS substrate dependent on Ti3C2TX and Ag nanocubes (Ag NCs) was fabricated for the precise quantification of ritonavir and ibrutinib in serum. Specifically, it was revealed that numerous electromagnetic “hotspots” emerged nearby the extremely tiny nanogaps among the intimately clustered Ag NCs, which also acted as optimal channels to facilitate effective photo-induced charge transfer (PICT) between the two-dimensional Ti3C2TX matrix and target molecules. The cooperation between electromagnetic and chemical effects yielded a satisfactory enhancement factor (EF) of 4.77 × 107 for the composite substrate. Benefiting from the remarkable sensitivity of the Ti3C2TX/Ag NCs composite substrate, the low limit of detection (LOD) at 10−6 mg/mL was successfully attained, along with exceptional recoveries of exceeding 90% for ritonavir and ibrutinib in serum. Considering its reliability and simplicity, our strategy holds immense promise for its utilization in efficient monitoring and identification of clinical blood drug concentration.