Chemical pleurodesis provides successful palliation for properly selected patients with both malignant and nonmalignant recurrent symptomatic pleural effusions. Talc, administered either by poudrage through a thoracoscope or slurry via a chest tube, has the highest success rates. Pleurodesis is less likely to be successful when pleural fluid pH and glucose are low (<7.20 and <60 mg/dL, respectively) and pleural space elastance is high (≥19 cm H2O). Small-bore catheters appear to be as effective for drainage as standard-sized chest tubes. Talc, when delivered as a slurry, appears to be the most cost-effective agent However, there have been reports of acute respiratory failure associated with talc pleurodesis, although talc may not have been causative in many of these cases. Unresolved issues relating to pleurodesis include the ideal agent, optimum dose and dwell time, necessity for rotating the patient, and daily drainage before chest tube removal.