Year: 2026
Type: article
Abstract: Nearly 20% of emergency department (ED) encounters involve medications with actionable pharmacogenomic (PGx) guidance available, and population-based studies suggest over 90% of patients carry at least one PGx variant potentially affecting drug response. Despite this, PGx testing in emergency medicine remains rare. This perspective summarizes current evidence supporting PGx implementation in the ED, key barriers to integration, and future directions for PGx testing in acute care. Feasibility studies demonstrate that PGx testing can be incorporated into ED workflows. Observational data suggest clinically important associations between CYP2C19 variability and clopidogrel-related bleeding, CYP2D6 metabolism and opioid-related ED visits, and a high prevalence of actionable gene–drug interactions in older adults presenting with falls. In pediatric psychiatric populations, combinatorial PGx testing has been associated with differences in drug exposure and clinical outcomes. However, no randomized controlled trials testing the clinical utility of PGx testing have been conducted in ED populations. Key barriers to implementation include prolonged PGx testing turnaround times, lack of standardized ordering workflows, limited clinician familiarity with PGx interpretation, inconsistent reimbursement, and challenges integrating results into clinical decision support systems. Future priorities should include prospective interventional trials assessing clinical outcomes, targeted implementation focused on high-risk gene-drug pairs, and incorporation of PGx education into emergency medicine training. Although current evidence is largely feasibility-based, the ED represents a potentially high-yield setting for PGx integration given frequent exposure to actionable medications and the high burden of potentially preventable adverse drug events.
Source: Frontiers in Pharmacology
Language: English
Subfield: Pharmacology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223148530