How Long Does Opdivo Stay In Your System? Plus, 6 More Opdivo FAQs

Opdivo (nivolumab) promises to give people “a choice and a chance against their cancer.” And when it comes to a potentially life-threatening health condition, we all want that for ourselves and our loved ones. But does the tagline hold up?

Opdivo and many other immune checkpoint inhibitors (ICIs) have revolutionized the way we treat cancer. These immunotherapy medications allow your immune system to identify and destroy cancer cells better. This is different from chemotherapy, which is “nonspecific” and targets both rapidly dividing cancer cells and healthy cells. ICIs, such as Opdivo, have increased the amount of time before cancer gets worse and allowed people to live longer.

If you’ve never received immunotherapy before, it’s normal to have questions. We’ll discuss seven frequently asked questions about Opdivo so you feel well equipped for your next infusion.

1. How long does Opdivo stay in your system?

Opdivo can stick around in your body for at least 3 to 4 months after your last dose. But certain medication-related risks can extend beyond this time frame.

Opdivo has the potential to cause harm to unborn babies. If you’re planning to get pregnant, you should use effective birth control for at least 5 months after your last Opdivo dose, just to be safe. You also shouldn’t breastfeed during this time.

What’s more, your chance of having side effects from Opdivo lingers for a while — even after you stop treatment. Be on the lookout for side effects for at least 1 year after finishing treatment.

2. What are Opdivo’s common uses?

Opdivo is FDA approved to treat a variety of cancers. It’s often used by itself (monotherapy) and in combination with other treatments. This chart shows Opdivo’s approved uses as of February 2024.

3. How is Opdivo different from Keytruda?

Opdivo and Keytruda (pembrolizumab) are both ICIs, so they work in the same way. They also have similar side effects. But a few key differences set them apart.

FDA-approved uses

One difference is their approved uses. Keytruda has a few more indications than Opdivo. In addition to most of the above uses, Keytruda is also approved to treat:

• B-cell lymphoma

• Breast cancer (triple negative)

• Cervical cancer

• Biliary tract cancer

• Merkel cell carcinoma

• Endometrial carcinoma

• Cutaneous squamous cell carcinoma (skin cancer)

• Cancers with specific genetic mutations such as microsatellite instability-high (MSI-H), deficient DNA mismatch repair (dMMR), and high tumor mutational burden (TMB-high)

Opdivo is also technically approved for people with colorectal cancer that have MSI-H/dMMR genetic mutations. But Keytruda is approved for more types of cancers with these genetic changes. 

However, Opdivo does have one approved indication that Keytruda doesn’t. It can treat malignant pleural mesothelioma.

Medication combinations

Another key difference between Opdivo and Keytruda is the types of medications they’re combined with.

Keytruda is approved for use in combination with tyrosine kinase inhibitors (TKIs) such as Lenvima (lenvatinib) and Inlyta (axitinib). TKIs interfere with specific signals that drive cancer cell growth. Meanwhile, Opdivo is approved for use in combination with a TKI called Cabometyx (cabozantinib). 

What’s more, Keytruda isn’t typically combined with other ICIs. Only Opdivo is approved for use with other ICIs — specifically Yervoy (ipilimumab).

These differences aside, both medications are often combined with chemotherapy.

Dosage and frequency

Opdivo and Keytruda differ in their dosages and how often they’re given. 

In most cases, Opdivo is given at a dose of 240 mg every 2 weeks, 360 mg every 3 weeks, or 480 mg every 4 weeks. Keytruda is often given at a dose of 200 mg every 3 weeks or 400 mg every 6 weeks. Like Opdivo, it’s given as an infusion in your vein. Both medications also have weight-based dosing options for specific situations.

4. Is Opdivo always combined with Yervoy?

No. Advertisements may make it seem as though Opdivo and Yervoy are always given together, but this isn’t the case. Receiving combination treatment with Opdivo and Yervoy is most often recommended when treating melanoma, liver, and kidney cancers, among others. 

Like Opdivo, Yervoy allows your body to better see cancer cells and destroy them. Combining Opdivo and Yervoy increases treatment effectiveness in certain situations, but the combination can increase your chance of having side effects in turn. Your healthcare team may decide not to treat you with combination therapy if they’re worried you might have trouble handling the side effects.

5. Can you administer Opdivo yourself?

No. You can’t administer Opdivo to yourself. Opdivo is an infusion you receive through your vein. Opdivo can only be given by a trained healthcare professional.

Where can you receive Opdivo?

Opdivo is typically given in a doctor’s office, infusion center, or hospital. This is because Opdivo can cause infusion-related reactions, though it’s rare. This means that your body may recognize Opdivo as a foreign invader and try to fight it off. Symptoms are typically mild to moderate and include itching, raised bumps on the skin (hives), and feeling sweaty or flushed. But, sometimes, the reactions can be severe and include trouble breathing, facial swelling, and low blood pressure. 

The locations above have trained staff who know how to treat infusion reactions so that you can receive the medication safely.

6. How do you know if Opdivo is working?

Monitoring Opdivo’s progress is hard to do on your own. Your cancer specialist will monitor you regularly while you’re receiving Opdivo to see how well it’s working. Specific types of monitoring include blood tests, physical exams, and regular scans. The scans are currently the best way to tell if your cancer is improving, staying the same, or getting worse.

Scientists are also studying whether the appearance of side effects caused by immunotherapy is connected with a better response. Some studies suggest a connection, but we need more information to confirm if this is true.

7. What are the most common side effects of Opdivo?

Opdivo allows your immune system to attack cancer cells more efficiently. But it can sometimes miss the mark and attack healthy cells, too. Immune-related adverse events (irAEs) are inflammation-related side effects caused by immunotherapy. 

IrAEs are specific to certain parts of the body, with the most common being:

• Skin inflammation (dermatitis)

• Lung inflammation (pneumonitis)

• Low thyroid function (hypothyroidism)

• Adrenal insufficiency (decreased ability to make important hormones, such as cortisol)

• Liver inflammation (hepatitis)

• Gut inflammation (colitis)

IrAEs range in severity, but most can be managed with early treatment. Corticosteroids such as prednisone are one notable treatment option. If an irAE is more severe, a medication such as Remicade (infliximab) can be used.

Other Opdivo side effects

IrAEs aside, about 1 in 5 people who receive Opdivo as a stand-alone treatment may experience the following side effects:

• Fatigue or weakness

• Rash

• Itching

• Muscle and bone pain

• Joint aches

• Diarrhea

• Nausea or vomiting

• Decreased appetite

• Stomach pain

• Cough

• Shortness of breath

• Constipation

• Back pain

• Upper respiratory tract infection

• Urinary tract infection

• Fever

• Headache

It’s important to know that side effects can vary based on your cancer type and whether Opdivo is combined with other cancer treatments. Stay in touch with your cancer specialist and let them know about any side effects that are bothersome or don’t seem to be getting better.

How to save on Opdivo infusions

Opdivo is only available as a reference (“brand-name”) medication. But GoodRx can help you navigate ways to save on your infusion.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Opdivo’s price is as little as $0 per infusion if you use the manufacturer’s savings card.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Opdivo’s patient assistance program, which offers the medications at no charge.

Why trust our experts?

Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Vanessa Carranza, PharmD

Vanessa Carranza, PharmD, is a pharmacist who has dedicated her career to the advancement of medical education for healthcare providers, patients, and caregivers, most notably in the oncology space.

Our editorial standards

Meet our experts