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Clinical Rx combines calculators, reference material, and protocol workflows. Check the references and limitations within the specific module you use. A source publication date, a software release date, and a documented clinical review date are different things.

• FDA labeling: use the specific product’s current US prescribing information for labeled dosing, indications, contraindications, and warnings.
• US guidelines: society or agency recommendations can include guideline-supported off-label practice; that does not make the recommendation FDA-labeled.
• Original validation studies: score performance and eligibility depend on the population and setting studied.
• Institutional protocols: local choices, such as workflow or weight-selection conventions, should be identified as such.
• Non-US sources: identify the jurisdiction and limitations; do not present these as US labeling or US society recommendations.

A full dated clinical review is not recorded for every tool. The new tool-information panels deliberately do not certify a calculator as “verified.” An individual source correction does not certify the rest of a module.

Documented changes

This is a selected change history, not a complete clinical audit log. Follow each change for its exact scope and code.

• September 24, 2026 — InfectionRx label alignment: cefepime hemodialysis/CAPD dosing and CrCl 11–29 tier, oseltamivir hemodialysis treatment regimen, CAPD timing, strict CrCl bands and prophylaxis renal adjustment, and valacyclovir initial genital herpes dosing (1 g BID, not halved at CrCl 10–49) now follow the current FDA labels on DailyMed.
• Interface release site-2026-09-24: Copy result (patient identifiers excluded) and Reset inputs on calculator results, page-last-changed dates (not clinical review dates), offline access to recently loaded pages with an out-of-date warning, and a dark theme for the home page, a blue/pink patient-sex colour cue on calculators with a sex selector, and a concise Renal Function Calculator result layout (KDIGO notes reworded to match the 2024 guideline text). This release does not revise drug doses or clinical equations.
• October 1, 2026 — ElectrolyteRx sodium-correction safety: a fall in sodium since the start of the 24-hour window no longer adds extra "room" under the ceiling; the window-start sodium is range-checked; a sodium of 105 mEq/L or less now lowers the ceiling automatically (the US expert panel's wording is "or less", not "below"); 3% saline is no longer calculated at a sodium of 130 or above (the tool's own stop point); the infusion card flags very short durations and high rates; the bolus card refuses a further bolus when less than one bolus of room remains; and the high-risk, ECG, acidosis and urine-output questions can no longer be left blank and read as a default answer. Hyperkalemia now names a low or high-normal potassium instead of calling it "not hyperkalemic". Calcium gluconate and magnesium sulfate administration text, the potassium chloride label description, the potassium phosphate replacement table and the tolvaptan cautions now match their FDA labels, and the 100 mL bolus is attributed to the US expert panel rather than the Korean SALSA trial. Calcium or glucose entered in mmol/L now triggers a unit warning.
• October 1, 2026 — SepsisRx: the Phoenix respiratory input now counts low-flow oxygen as respiratory support (a child on nasal cannula previously scored 0); the vasopressor reference table shows the FDA label ranges for epinephrine and phenylephrine (the old phenylephrine range was about three times the label ceiling) and flags phenylephrine in septic shock as off-label; SOFA and pSOFA totals now carry a Sepsis-3 interpretation; the vasopressin converter rejects impossible inputs and flags doses outside the label range; the Early Management tab is marked adults-only and no longer leaves a stale "start vasopressors" instruction on screen.
• October 3, 2026 — Home page: the home page now counts seven specialty groups (critical care and pharmacy were missing from the intro), the ElectrolyteRx and SepsisRx cards describe the hyperkalemia, hyponatremia/hypernatremia workup, SEP-1 checklist and vasopressor-dose tools, the ShortageRx card has its own icon, the footer links Terms, Privacy and this page, and the “Evidence-Based” card no longer says the workflows are “validated”. InfectionRx no longer points to the unlisted VancoRx page; it says to use an AUC-guided method such as institutional Bayesian software.
• October 3, 2026 — InfectionRx (allergy): with a severe penicillin allergy, carbapenems now show a warning instead of being blocked, following the AAAAI/ACAAI 2022 drug allergy practice parameter (a carbapenem may be given without testing, even after anaphylaxis, about 1% cross-reactivity). The warning says to avoid carbapenems after a severe delayed reaction such as SJS/TEN or DRESS, and that the meropenem, meropenem-vaborbactam and ertapenem labels still list beta-lactam anaphylaxis as a contraindication. Tebipenem and sulopenem stay blocked per their labels. A new PCN — SJS/TEN/DRESS allergy chip blocks all beta-lactams (the practice parameter generally recommends avoiding them after a severe cutaneous reaction), and the penicillin risk screen now gives separate advice for anaphylaxis and for severe cutaneous reactions. Blocked drugs now always show the reason.
• October 3, 2026 — InfectionRx (new infections): added PD-Associated Peritonitis (ISPD 2022, including its intraperitoneal dosing table, organism-specific durations, catheter-removal criteria and antifungal prophylaxis); Cardiac Device (Pacemaker/ICD) Infection (AHA 2024 statement as summarized by ACC and a 2024 review: complete device removal, empiric vancomycin, durations by infection type, reimplantation timing); and Orbital (Postseptal) Cellulitis, split from the periorbital entry and labelled review-based because no US society guideline exists. Intraperitoneal doses show the IP route, IP administration notes and an explanatory panel instead of the IV renal table and IV preparation text; the PD fluconazole prophylaxis dose is not reduced again by the CrCl tiers; a vancomycin + aztreonam IP option (ISPD 2022 Table 5) covers cephalosporin allergy. The periorbital entry no longer gives orbital-cellulitis regimens, and the daptomycin pediatric note now lists the labelled S. aureus bacteremia indication (ages 1–17).
• October 3, 2026 — InfectionRx: added Acute Pancreatitis / Infected Necrosis (ACG 2024 acute pancreatitis guideline and AGA 2020 pancreatic necrosis update): no prophylactic antibiotics in severe or necrotizing pancreatitis, antibiotics only for infected necrosis or an extrapancreatic infection, agents that penetrate necrosis (meropenem; cefepime or ciprofloxacin plus metronidazole), no routine antifungals. Added tebipenem pivoxil (UTEBZI), the first US oral carbapenem, from its current label (June 2026; posted on DailyMed October 1, 2026): a reserve option for complicated UTI/pyelonephritis with limited or no other oral options, 600 mg every 6 hours for 7–10 days, with the label's eGFR-based renal tiers, carnitine contraindication and valproate interaction. Meropenem and imipenem-cilastatin renal tiers now follow their current US labels (meropenem: above 50, 26–50, 10–25, below 10 mL/min; PRIMAXIN Table 3: 90 or more, 60–89, 30–59, 15–29, and no use below 15 unless dialysis starts within 48 hours). A drug-class allergy now blocks every drug in that class: cefixime, amikacin, streptomycin, minocycline, omadacycline, eravacycline, tigecycline, delafloxacin, sulfadiazine, tinidazole (metronidazole allergy), bismuth quadruple therapy (tetracycline or metronidazole allergy), meropenem-vaborbactam and imipenem-relebactam (carbapenem allergy) were previously missed. Tigecycline is flagged, not blocked, with a tetracycline allergy, matching its label's "should be avoided".
• October 2, 2026 — SepsisRx: added a CMS SEP-1 element checklist to the Early Management tab, labeled as a US reporting measure rather than clinical guidance and checked against the SEP-1 specification (version 5.18/5.18a, 2026 discharges). The 30 mL/kg fluid element is listed under its own triggers (initial hypotension, initial lactate 4 or higher, or septic shock).
• October 2, 2026 — ScoreRx: the Wells PE "unlikely" result now states the ACP 2015 age-adjusted D-dimer cutoff (age × 10 ng/mL for patients older than 50; ADJUST-PE), with a reminder to check the assay's units and cutoff.
• October 2, 2026 — Renal function, ElectrolyteRx, Sotalol IV and VancoRx: BMI categories now use the CDC names (Healthy weight; Class 1–3 obesity), are assigned from the displayed value, and are marked not applicable under age 20. The drug-dosing details now cite the FDA renal-impairment pharmacokinetics guidance for industry (March 2024) next to KDIGO 2024. Sex no longer defaults to Male on Sotalol IV, VancoRx, and the ElectrolyteRx free water deficit and 3% saline tools; it must be selected for adults. The free water deficit result explains the age-18 change in the water fraction for female patients aged 15–19.
• October 2, 2026 — InfectionRx: changing an allergy, pregnancy or liver toggle now clears the recommendations and any Stewardship result on screen (previously only age, weight, creatinine and similar did, so ampicillin-sulbactam could stay "Second-line" after a severe penicillin allergy was added); "Vanco — True allergy" now blocks vancomycin (it had no rule); the stop-date calculator pre-fills days only from a number that carries a time unit and converts weeks and months ("6 weeks" was pre-filled as 6 days; "ANC ≥500" as 500 days).
• October 2, 2026 — AnticoagRx: "New Patient" now clears hemoglobin, platelets, baseline anti-Xa and the bleeding, pregnancy, APS, valve, liver, neuraxial and recent-Xa answers (they previously carried into the next patient's safety flags); an adults-only warning appears on every module when age is under 18 (the apixaban pediatric VTE entry excepted); a new Heparin/Enoxaparin reversal path gives protamine dosing from the protamine sulfate and Lovenox labels with its boxed warning; the patient panel has a HIT history question, the UFH and enoxaparin safety tabs list their label contraindications (heparin: any history of HIT/HITTS; Lovenox: HIT within 100 days or circulating antibodies), and an intermediate or high 4Ts result states that warfarin should not be used as initial therapy in HIT (warfarin label 5.6).
• October 2, 2026 — ChemoRx: label renal-dose rules now fire for lenalidomide (REVLIMID Table 3, multiple myeloma combinations: CrCl 30–60 → 10 mg daily; below 30 not on dialysis → 15 mg every other day; on dialysis → 5 mg daily after dialysis — the 25 mg shown is for CrCl above 60), oxaliplatin (65 mg/m² below CrCl 30), fludarabine (not established below 30; reduced dosage 30–79), etoposide (reduced dose 15–50; not established below 15), olaparib (200 mg twice daily at CrCl 31–50; no data at 30 or below) and bendamustine (do not use below CrCl 30); these regimens now require a serum creatinine. Regimens that name rasburicase carry a G6PD-deficiency caution (ELITEK label). The cumulative-anthracycline check now includes idarubicin and mitoxantrone.
• October 2, 2026 — TPN and ElectrolyteRx: the TPN calculator now requires an age (a blank age could previously be bypassed with the labs-pending box, letting a 3.5 kg neonate receive an adult-derived order), and the refeeding-risk assessment reads the BMI and usual weight that were already entered (BMI below 16 or weight loss over 15% is NICE Group A; BMI below 18.5 or loss over 10% is Group B) instead of scoring a BMI of 14.7 as standard risk. ElectrolyteRx now shows the potassium phosphates label contraindications (hyperkalemia, eGFR below 30 or end-stage renal disease, hyperphosphatemia, hypercalcemia or significant hypocalcemia), states that the replacement tab is adult-only, and refuses the 3% saline bolus and infusion calculators for patients under 18.
• October 2, 2026 — Renal function, Opioid MME, Sotalol IV and VancoRx: the Renal Function Calculator no longer defaults to male — sex must be chosen (it changes Cockcroft-Gault by 15%). The MME calculator now states on the main screen that it takes oral doses (and the transdermal fentanyl patch) only, and the fentanyl patch caution quotes the label's drug-by-drug opioid-tolerance definition (not an MME threshold). The sotalol IV calculator asks about other heart-rate-slowing or AV-conduction-slowing drugs (beta-blocker, digoxin, any calcium channel blocker, clonidine, ivabradine) and lists hemodynamic and ECG monitoring from the label (sections 5.2, 5.4, 7.2–7.4, 7.7). VancoRx asks about other nephrotoxic or AKI-risk drugs and adds renal-monitoring advice from the vancomycin label; the 2020 guideline's frequency statement is shown as applying to vancomycin level monitoring, not creatinine checks.
• October 1, 2026 — ElectrolyteRx hyperkalemia tab: added an adults-only banner, a digoxin question (calcium gluconate label sections 5.1/7.1 and DIGIFAB label cautions shown when yes), a renal-impairment hypoglycemia line for the insulin step (regular insulin label section 8.6), a "shifting is temporary — recheck and repeat" step, and a hemolyzed-sample repeat prompt that does not delay treatment. New questions for digoxin (label and KDIGO conference sources differ, shown side by side), kidney failure and an ongoing potassium load (rhabdomyolysis, tumor lysis, hemolysis, GI bleeding, burns); a potassium of 5.5–5.9 with an ongoing load or suspected digoxin toxicity is raised to the urgent tier (clinical-judgment rule, disclosed), a contributing-drugs line from current US labels, and the KDIGO conference calcium-dose equivalence (10 mL of 10% calcium chloride ≈ 30 mL of 10% calcium gluconate) shown beside the 1 g gluconate dose. The calcium step now states 1 g per dose repeated every 5–10 minutes up to about 3 g in total (KDIGO conference summary; hyperkalemia is off-label for calcium gluconate in the US), the recheck step gives the KDIGO timing (about 60 minutes; rebound possible at 2–3 hours), a suspected-digoxin-toxicity box always shows with a DIGIFAB step, the potassium is rounded once so the displayed value and the tier agree, and amiloride, triamterene-hydrochlorothiazide and spironolactone are described as contraindicated in hyperkalemia. Pediatric dosing and condition-specific protocols are still not provided.
• October 1, 2026 — ElectrolyteRx, SepsisRx and ScoreRx (second review): ElectrolyteRx's hypernatremia rate tab now judges the current sodium (no "remaining margin" once sodium is back in range or below it), maintenance fluids refuse weights outside 2–400 kg, and free water deficit uses 0.6 for patients under 18. SepsisRx no longer defaults respiratory support to "No" in SOFA and pSOFA, says when Phoenix septic shock could not be assessed, flags a Sepsis-3 entry that conflicts with a vasopressor requirement, refuses implausible norepinephrine-equivalent doses and clears per-organ point badges when inputs change. ScoreRx now states a decisive verdict when confirmed CURB-65, Wells DVT, Wells PE or Glasgow-Blatchford points already settle the category, HEART troponin bands follow Backus 2013 (≥3× scores 2) with risk figures taken from the two cited cohorts, and typing in the score-search box no longer clears results.
• October 1, 2026 — ScoreRx: the non-intubated Glasgow Coma Scale now states mild, moderate or severe impairment (GCS 9–12 was shown green with no verdict); the anion gap no longer shows a green "Normal" on the uncorrected value when albumin is low; FENa cites Espinel's actual finding (acute tubular necrosis above 3%); CURB-65 quotes the derivation-cohort figures from the paper's abstract and adds the 2019 ATS/IDSA guidance (the Pneumonia Severity Index is preferred for the hospitalization decision; CURB-65 does not set ICU level); displayed values can no longer sit on the wrong side of a cutoff in FENa, HEART and Glasgow-Blatchford; the Glasgow-Blatchford systolic blood pressure bands handle decimals correctly.
• September 30, 2026 — TPN Calculator targets: non-obese ICU energy is now 12–25 kcal/kg/day (ASPEN 2022, lowered from 25–30); critical-illness and trauma protein 1.2–2.0 g/kg actual body weight (SCCM/ASPEN 2016); burns are now separate from trauma, with protein 1.5–2.0 g/kg and an entered, measured energy target (the guideline gives no weight-based figure; the previous 30–35 kcal/kg had no source); AKI without dialysis is split into ICU (1.2–2.0 g/kg, US) and non-ICU (0.8–1.0 g/kg, KDIGO 2012 — international, labelled as such); hepatic failure uses the general ICU range with a dry-weight note. Obese patients in every critically-ill condition get the SCCM/ASPEN 2016 obese protein rates; CRRT energy follows the ICU range; an entered measured energy target now replaces the weight-based estimate for any condition (65–70% of it for obese ICU patients, Q5); refeeding advancement steps no longer exceed the goal; and phosphate in renal impairment no longer rises with a higher phosphorus.
• September 30, 2026 — ChemoRx topotecan and HP maintenance safety checks: topotecan's renal reduction now uses Cockcroft-Gault with ideal body weight as its label specifies and holds the order until a reduction of at least 50% is entered; the 4 mg maximum single dose is enforced after any reduction; from Cycle 2 the label's retreatment counts apply (neutrophils >1,000, platelets >100,000, hemoglobin ≥9). HP maintenance asks for early vs metastatic disease and applies the matching PERJETA LVEF rule. The Labs tab no longer reads as clear beside a banner hold. Lurbinectedin interaction, preparation and filter text follow the ZEPZELCA label.
• September 30, 2026 — ShortageRx wording: the sterile-injectable factor now cites the FDA's 2019 root-causes report (63% of drugs in shortage); an unsourced prediction about long-running shortages was removed.
• September 30, 2026 — ChemoRx HP maintenance, topotecan, lurbinectedin and tarlatamab: new “HP Maintenance” entry for trastuzumab + pertuzumab after the taxane in THP/TCHP (maintenance or re-load chosen by time since the last dose, per the PERJETA label; metastatic until progression, early breast cancer to 1 year). Topotecan no longer lists cervical cancer, which uses a different labeled dose with cisplatin, and adds the label's extravasation warning and IBW-based renal check. Lurbinectedin is flagged for extravasation necrosis (central line preferred). Tarlatamab Cycle 1 monitoring follows the September 2026 label (6–8 hours in a healthcare setting, then 48 hours nearby).
• September 25, 2026 — AnticoagRx label alignment: edoxaban for AFib at CrCl exactly 50 now gives 30 mg; rivaroxaban AFib at CrCl <15 and the CAD/PAD vascular dose follow the XARELTO label; apixaban on dialysis uses the usual 2-of-3 rule; the DOAC eligibility comparison now rules out drugs the labels say not to use on dialysis; idarucizumab administration and warnings follow the PRAXBIND label.
• September 25, 2026 — InfectionRx renal tiers re-sourced: ceftolozane/tazobactam (including a corrected hemodialysis dose), cefixime, cephalexin, cefpodoxime and Truvada follow their FDA labels (Truvada PrEP is not recommended below CrCl 60); quinine and flucytosine follow the label and NIH OI Table 6; tobramycin extended-interval bands follow the Hartford program. Nitrofurantoin pregnancy timing follows the label (term, 38–42 weeks).
• September 25, 2026 — ChemoRx daraxonrasib (Rasonque): new fixed-dose oral entry for previously treated metastatic pancreatic adenocarcinoma, checked against the current DailyMed label, including its CYP3A/P-gp dose changes.
• September 25, 2026 — InfectionRx valganciclovir, dalbavancin, cryptococcal meningitis and VVC: a duplicate valganciclovir renal entry was overriding the correct one; tiers now follow the current VALCYTE label (not recommended on hemodialysis; use IV ganciclovir). Dalbavancin on regularly scheduled hemodialysis now shows the full dose with no adjustment, per the DALVANCE label. Cryptococcal meningitis in HIV follows the NIH adult/adolescent OI guideline in both the infection and organism views. Vulvovaginal candidiasis follows CDC 2021, including topical-only treatment in pregnancy.
• September 25, 2026 — ChemoRx sevabertinib (Hyrnuo) and camizestrant (Etcamah): two new fixed-dose oral entries checked against their current DailyMed labels, with QTc gating for camizestrant and LVEF gating for sevabertinib. The print summary now lists every warning, and states that a percentage reduction entered for fixed-dose agents was not applied.
• September 25, 2026 — new Corticosteroid Equivalence Calculator: equivalent milligram doses from the FDA label comparison table (identical in current dexamethasone, triamcinolone and betamethasone labels), limited to oral or IV use as the labels specify, with the labels' sodium-retention and gradual-withdrawal statements.
• September 25, 2026 — new Opioid MME Calculator: total daily MME from the CDC 2022 conversion-factor table (read directly from the CDC MMWR), with the guideline's ≥50 MME/day reassessment, follow-up and naloxone guidance and its cautions (not a conversion tool; methadone, fentanyl, tramadol and tapentadol cautions; buprenorphine, opioid use disorder and parenteral doses excluded).
• September 25, 2026 — InfectionRx nitrofurantoin and daptomycin renal text: nitrofurantoin now follows the current FDA label throughout (avoid at CrCl <60 mL/min, anuria or oliguria; AGS Beers 2023 for adults ≥65 is shown for comparison only), including the Stewardship check and all indication rows that previously used CrCl 30. Daptomycin renal dosing and CPK monitoring text now match the label (4 or 6 mg/kg q48h below CrCl 30 and on dialysis; CPK more often than weekly in any renal impairment).
• Serum creatinine unit check (September 24, 2026): the Renal Function Calculator, ChemoRx, InfectionRx, AnticoagRx and the Vancomycin calculator treat a serum creatinine above 20 mg/dL as a likely µmol/L entry and show the conversion (µmol/L ÷ 88.4 = mg/dL) instead of a result.
• September 2026 — source corrections: PR #169 corrected InfectionRx rickettsial treatment durations and pediatric dose limits, Candida auris age-specific pathways, and infective-endocarditis dental prophylaxis eligibility and allergy pathways. Sources were accessed September 2, 2026. This targeted update is not a whole-site review.
• ChemoRx safety: PR #167 records safety corrections, including preservation of hold information in print output.
• InfectionRx input and result safety: PR #165 records the patient-input and stale-result safeguards.
• Renal calculator: PR #156 removed the optional AI assistant and verification checklist. Its renal calculation function was unchanged.
• Interface release site-2026-09-06: local tool search, favorites/recent tools, result section navigation, source-information panels, accessibility improvements, and report context. This release does not revise drug doses or clinical equations.

Source review needs to be repeated when a relevant label or guideline changes. If you find a discrepancy, report a clinical problem using a fictional example without patient information.