In the 2018 general election

 

Khan participated in the electoral campaign across multiple constituencies, including NA-35 (Bannu), NA-53 (Islamabad-II), NA-95 (Mianwali-I), NA-131 (Lahore-IX), and NA-243 (Karachi East-II). Initial results showed Khan leading the polls, but allegations of vote rigging and administrative malpractices were raised by opposition parties, particularly the PML-N. Despite this, election officials declared Khan's party, PTI, as having won a plurality in the National Assembly with 110 seats, later revised to 116 out of 270 contested seats. Khan's victory was notable as he won in all five constituencies, a feat unprecedented in Pakistan's electoral history.

Following the election, Khan's party announced a 100-day agenda focusing on government reforms, including proposals for the creation of a new province in Southern Punjab, the merger of Federally Administered Tribal Areas into Khyber Pakhtunkhwa, improvements in Karachi's law and order situation, and efforts to strengthen relations with Baloch political leaders.

However, allegations of widespread rigging persisted, with opposition parties accusing Khan's victory of being influenced by military interference. Despite these claims, the Election Commission dismissed the allegations, and PTI's victory was acknowledged even by its opponents, although with reservations.

In his victory speech, Khan outlined his policy priorities, emphasizing a commitment to building a welfare state inspired by the principles of the first Islamic state of Medina. He pledged to prioritize the welfare of the poor and marginalized, ensure equal treatment under the law, and pursue a foreign policy aimed at improving relations with neighboring countries and global powers.

Following his nomination as PTI's candidate for prime minister, Khan promised to be publicly accountable, pledging to hold weekly sessions to answer questions from the public. He proceeded to make nominations and appointments for key government positions, including Asad Umar as finance minister, Imran Ismail as Governor of Sindh, and Mahmood Khan as Chief Minister of Khyber Pakhtunkhwa.

Khan's party also nominated individuals for various other positions at both national and provincial levels, including Chaudhry Muhammad Sarwar as Governor of Punjab, Asad Qaiser as Speaker of the National Assembly, and Sardar Usman Buzdar as Chief Minister of Punjab. These nominations reflected a mix of party insiders and alliances with other political factions.

Khan holding a media press with Arif Alvi during the 2018 electoral campaign