Pharmacogenomics, applied as an aspect of molecular autopsy, might become an integral part of forensic medicine in the near future. Pharmacogenomics is the study of the relationship between an individuals genetic/genomic information and the disposition/response to medications. As a result, pharmacogenomics may provide a deeper mechanistic insight necessary for forensic pathologists to fully understand/interpret postmortem toxicology results and correctly determine the cause and manner of death. In this paper, the use of pharmacogenomics as a molecular autopsy tool to raise the standards in forensic medicine is discussed, and illustrated with selected cases. In addition, the current limitations and hurdles for using pharmacogenomics in the postmortem forensic setting are also reviewed.