Abstract: Imidacloprid, a neonicotinoid insecticide, is commonly used in agricultural and urban settings for pest control. However, its toxic effects on both target and nontarget organisms, including humans, have raised concerns. Imidacloprid poisoning can result in a wide range of symptoms, including neurological, gastrointestinal, and cardiovascular manifestations, and may even be fatal in severe cases. In recent years, plasma exchange has emerged as a potential therapeutic approach in cases of imidacloprid poisoning, with promising outcomes reported in a few published case reports. This article reviews the role of plasma exchange in imidacloprid poisoning, highlighting its mechanism of action, clinical indications, technical aspects, and potential benefits. The article also discusses the current evidence supporting the use of plasma exchange in imidacloprid poisoning, including relevant case reports and studies. While plasma exchange appears to be a promising adjunctive therapy in managing imidacloprid poisoning, further research and clinical experience are needed to establish its effectiveness and safety. This article emphasizes the importance of early recognition and management of imidacloprid poisoning, including considering plasma exchange as a potential treatment modality in severe cases.