Document Type

Article

Publication Date

9-2026

Identifier

DOI: 10.3389/fped.2026.1911224; PMCID: PMC13635174

Abstract

Children with congenital and acquired heart disease frequently require complex and prolonged pharmacotherapy, often involving off-label cardiovascular medications with narrow therapeutic ranges. Consequently, variability in drug response and medication-related adverse events remains a significant clinical challenge in pediatric cardiology. Pharmacogenetics provides a framework to individualize drug selection and dosing by incorporating genetic variability alongside established clinical and developmental factors. This review outlines the current clinical utility and emerging role of pharmacogenetics in pediatric cardiology, emphasizing applications most relevant to day-to-day patient care. Established pharmacogenetic associations with direct implications for pediatric cardiac practice include gene-drug pairs involving tacrolimus (CYP3A5), warfarin (CYP2C9, VKORC1, CYP4F2, rs12777823 within the CYP2C), clopidogrel (CYP2C19), flecainide (CYP2D6), metoprolol (CYP2D6), and statins (SLCO1B1, ABCG2, CYP2C9), many of which are supported by guideline-based recommendations from the Clinical Pharmacogenetics Implementation Consortium. This review also highlights pharmacogenetic considerations for commonly prescribed non-cardiac medications that may influence cardiovascular outcomes in children with heart disease, identifies emerging areas for research, and emphasizes that as pharmacogenetic testing becomes increasingly accessible, its thoughtful integration into pediatric cardiology practice may improve therapeutic precision, enhance safety, and reduce preventable adverse drug events.

Journal Title

Front Pediatr

Volume

14

First Page

1911224

Last Page

1911224

PubMed ID

42835306

Keywords

adverse drug events; guidelines; pediatric cardiology; pharmacogenetics; precision medicine

Comments

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Publisher's Link: https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2026.1911224/full

Download

Share

COinS