Objective To explore the mediating effect of family function and medication belief in the relationship between drug literacy and medication adherence in elderly patients with ischemic stroke. Methods A total of 316 elderly patients with ischemic stroke were conveniently selected to fill out the Medication Literacy Questionnaire, the Medication Belief Specific Questionnaire, the Family APGAR and the Morisky Medication Adherence Scale. Mediation analysis was carried out by running stratified regression, and the Bootstrap method was used for further validation. Results The elderly ischemic stroke patients scored (5.03±1.60) points in medication literacy, 7.00（4.00,10.00） points in family function, 9.00（3.00,14.00） points in medication belief, and (6.18±1.65) points in medication adherence. There were positive correlations between medication literacy, medication belief, family function and medication adherence in elderly patients with ischemic stroke (all P<0.05); family function and medication belief had chain mediating effect between medication literacy and medication adherence in elderly patients with ischemic stroke. Conclusion Medication literacy can directly or indirectly affect patients′ medication adherence through medication of belief and family function. Medical staff should take measures to improve patients′ medication belief and encourage family members to support patients, in an effort to improve patients′ medication adherence behavior.