{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:01:55Z","timestamp":1789970515810,"version":"4.0.1"},"reference-count":79,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>\n                    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\u2013drug pairs involving tacrolimus (\n                    <jats:italic>CYP3A5<\/jats:italic>\n                    ), warfarin (\n                    <jats:italic>CYP2C9<\/jats:italic>\n                    ,\n                    <jats:italic>VKORC1, CYP4F2,<\/jats:italic>\n                    rs12777823 within the\n                    <jats:italic>CYP2C)<\/jats:italic>\n                    , clopidogrel (\n                    <jats:italic>CYP2C19)<\/jats:italic>\n                    , flecainide (\n                    <jats:italic>CYP2D6)<\/jats:italic>\n                    , metoprolol (\n                    <jats:italic>CYP2D6)<\/jats:italic>\n                    , and statins (\n                    <jats:italic>SLCO1B1, ABCG2, CYP2C9<\/jats:italic>\n                    ), 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.\n                  <\/jats:p>","DOI":"10.3389\/fped.2026.1911224","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:35:37Z","timestamp":1789968937000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmacogenetics in pediatric cardiology"],"prefix":"10.3389","volume":"14","author":[{"given":"Adenike T.","family":"Adenikinju","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine","place":["Kansas, MO, United States"]},{"name":"Ward Family Heart Center, Children\u2019s Mercy Kansas City","place":["Kansas, MO, United States"]},{"name":"Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children\u2019s Mercy","place":["Kansas, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan B.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine","place":["Kansas, MO, United States"]},{"name":"Ward Family Heart Center, Children\u2019s Mercy Kansas City","place":["Kansas, MO, United States"]},{"name":"Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children\u2019s Mercy","place":["Kansas, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mollie M.","family":"Walton","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine","place":["Kansas, MO, United States"]},{"name":"Ward Family Heart Center, Children\u2019s Mercy Kansas City","place":["Kansas, MO, United States"]},{"name":"Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children\u2019s Mercy","place":["Kansas, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e512","DOI":"10.1542\/peds.2013-2987","article-title":"Impact of pediatric exclusivity on drug labeling and demonstrations of efficacy","volume":"134","author":"Wharton","year":"2014","journal-title":"Pediatrics"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e390","DOI":"10.3928\/19382359-20220803-05","article-title":"Precision medicine in pediatric cardiology","volume":"51","author":"Kikano","year":"2022","journal-title":"Pediatr 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