Pelleted total mixed ration (PTMR) has become a widely adopted feeding strategy in modern intensive ruminant production systems. It is a compound feed that combines various feed ingredients and additives to meet the nutritional requirements of ruminants. Studies in sheep, goats, cattle, and buffaloes have shown that PTMR increases feed intake, alters rumen microbial composition, and improves growth performance compared to conventional total mixed ration (TMR). However, its effect on nutrient digestibility remains inconsistent across studies. PTMR feeding has also been associated with changes in blood metabolite levels, although most parameters stay within normal physiological ranges. Despite these advantages, the wider adoption of PTMR is limited by high processing costs and the need for stringent quality control to ensure pellet quality and long-term rumen health. Unlike earlier narrative reviews, this work identifies the main factors underlying the variability in reported outcomes, discusses methodological limitations of the available literature, and provides practical recommendations for small-scale farmers. It also highlights priorities for future research, including the long-term effects of PTMR on rumen health, economic sustainability, and the optimisation of formulations for different production stages, thereby supporting its broader application in sustainable ruminant production systems.