Aim: To evaluate the impact of establishing a central aseptic intravenous (IV) drug preparation unit on pharmaceutical waste reduction and cost savings in pediatric inpatient services at a university hospital in Türkiye. Method: A retrospective analysis was conducted of 23,340 drug units ordered and 17,894 doses prepared during a three-month period. Data included quantities of medications administered, returned, and wasted, as well as cost evaluations. Descriptive statistical analyses were performed to calculate frequencies, percentages, and total costs. Results: Of the total drug units ordered, 10,464 were returned to pharmacy stock. The overall cost of drugs ordered was $34,574.74, and the value of returned drugs was $14,950.07. After accounting for the drug preparation service cost ($6,083.96), the hospital achieved a net cost savings of $8,866.11, representing a 25.64% reduction. Pharmaceutical waste by unit count decreased by 44.83%. The reduction rate was calculated by dividing the number of unused units returned to pharmacy stocks (10,464) by the total number of drug units issued (23,340). Conclusion: Centralized aseptic IV drug preparation significantly reduces pharmaceutical waste and contributes to substantial cost savings in hospital settings. The findings support broader adoption of centralized preparation units, particularly in pediatric services, to optimize resource utilization and reduce healthcare expenditures.