8 Opdivo (and Opdivo Qvantig) Side Effects, and How to Manage Them

Cancer treatments have evolved quite a bit over the last few decades. Today, some of the most advanced cancer therapies recruit the assistance of your immune system to fight cancer. Two examples of these immune-harnessing medications are Opdivo (nivolumab) and Opdivo Qvantig (nivolumab / hyaluronidase-nvhy).

Opdivo is an immunotherapy medication that helps your immune system recognize and attack cancer cells. It treats cancers of the lungs, kidneys, and other organs. There’s no doubt that it’s a powerful, potentially life-saving treatment. 

Opdivo does have side effects, though — as many cancer treatments do. Some Opdivo side effects are common and may resolve at home. Other side effects are more serious and require an oncologist to address them.

Good to know: Opdivo is injected into a vein, while Opdivo Qvantig is injected under the skin. For simplicity, we’ll refer to both versions simply as “Opdivo,” unless stated otherwise.

Opdivo side effects at a glance

Common Opdivo side effects include:

• Fatigue

• Muscle, joint, or bone pain

• Weakness

• Decreased appetite

• Headache

• Fever

• Itchiness and rashes

• Upset stomach

• Upper respiratory tract infections

• Low thyroid levels

• Injection site reactions (Opdivo Qvantig)

EXPERT PICKS: WHAT TO READ NEXT

• The dynamic duo: Learn how Opdivo works together with Yervoy to fight cancer.

• Opdivo’s final stop: Understand how long it takes for Opdivo to leave your system after you receive your last dose.

• Immunotherapy differences: Read about how Opdivo stacks up to Keytruda, a similar cancer medication.

Less common, but potentially serious, Opdivo side effects include:

• Infusion reactions (Opdivo)

• Inflammation of the liver (hepatitis), kidneys (nephritis), or lungs (pneumonitis)

• Inflammation of other organs

Here, we’ll dive deeper into eight notable Opdivo side effects and how to manage them. 

1. Fatigue

Feeling unusually tired is one of the most common side effects of Opdivo. This symptom may be related to the cancer your body is trying to fight, or it may be related to how Opdivo works. 

Light exercise, such as walking and stretching, can improve your energy levels throughout the day. But you don’t want to push yourself too hard; make sure to listen to your body. Speak with your oncology care team to formulate a movement plan that’s right for you.

Prioritizing rest — and allowing yourself the time to take it — is another important step in maintaining your energy. Plan for naps throughout the day when you’re feeling fatigued. And consider completing your most difficult tasks at the beginning of the day, when you have the most energy. 

2. Muscle, joint, or bone pain

You may experience pain in your muscles, joints, or bones while receiving Opdivo. There are many ways this pain can manifest, including in your neck, back, and jaw. 

The good news is that most pain-related side effects aren’t too severe. They’re often somewhat mild and manageable with over-the-counter (OTC) pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Applying heat or cold packs to painful areas may also provide relief. 

That being said, make sure to loop in a healthcare professional if your symptoms become more severe. Joint pain can become inflammatory arthritis, and your muscle pain can turn into severe muscle inflammation in rare cases. Your prescriber may recommend prescription medications or other treatments that are more effective for intense pain.

3. Itchiness and rashes

Itchiness and skin rashes are possible with Opdivo. The vast majority of Opdivo rashes are mild and require minimal treatment. However, severe rashes, including Stevens-Johnson syndrome, can occur in rare cases.

It’s a good idea to monitor your skin closely while receiving Opdivo. Pay close attention to rashes that cover a large area, spread, or become painful.

Moisturizing creams are one accessible resource to preemptively fight rashes. Eucerin, Cetaphil, and Aquaphor are popular moisturizer brands that you can find in your local pharmacy. Ask your pharmacist to recommend the one that is best for you. Topical steroids, such as hydrocortisone, can also reduce rash symptoms. Oral antihistamines, such as diphenhydramine (Benadryl), can also help.

Speak to your oncologist for advice if your rash doesn’t get better or worsens over time. They may be able to recommend a prescription-strength cream, ointment, or gel.

4. Upset stomach

You may experience nausea, vomiting, and diarrhea while receiving Opdivo. While these gut-related Opdivo side effects can be bothersome, they’re generally manageable with some precautionary measures.

For example, consider eating smaller, frequent meals instead of fewer, large ones to lessen nausea. Drinking ginger and peppermint teas can also soothe your symptoms. Stay hydrated by sipping water or electrolyte drinks, and avoid foods that are greasy, spicy, or high in fiber if you have diarrhea.

5. Infusion reactions and injection site reactions

Some cancer treatments must be administered directly into a vein, or intravenously (IV). But you have options with Opdivo. You can receive Opdivo IV as an injection under the skin (as Opdivo Qvantig).

Some people experience infusion reactions when they receive Opdivo IV. Symptoms include fever, chills, and dizziness. You may also notice pain, swelling, or redness at the injection site with Opdivo Qvantig — also known as injection site reactions. 

If you’re receiving the IV formulation, your oncologist may anticipate these symptoms and give you supportive medications in advance, namely diphenhydramine, a corticosteroid such as prednisone, and/or acetaminophen. They may need to slow your infusion or possibly discontinue Opdivo if you have a severe reaction.

If you’ve left the treatment clinic and start to develop intense injection- or infusion-related side effects, contact your oncologist without delay.

6. Upper respiratory tract infections

Some people develop upper respiratory tract infections (URTIs), such as the flu or common cold, while being treated with Opdivo. You may be all too familiar with URTI symptoms, which can include a runny nose, cough, and sore throat. 

Mild URTI symptoms should gradually go away on their own. Rest and hydration are key to helping you recover along the way. OTC medications can also help with symptom relief.

7. Low thyroid levels

Opdivo can affect your thyroid gland, which is responsible for producing thyroid hormone. Thyroid hormone helps control how quickly your body breaks down food and turns it into energy, among other functions. Opdivo can cause thyroid inflammation, low levels of thyroid hormone (hypothyroidism), and high levels of thyroid hormone (hyperthyroidism). 

Hypothyroidism is more likely when Opdivo is combined with Yervoy (ipilimumab) or Cabometyx (cabozantinib). Signs and symptoms include:

• Fatigue

• Weight gain

• A feeling of being cold 

• Dry skin

• Brittle nails

• Hair loss

• Constipation

Hyperthyroidism warning signs include:

• Tremors

• Weight loss

• Nervousness

• Fast heart rate

• Trouble sleeping

• Brittle skin

Your healthcare professional may prescribe thyroid hormone, such as levothyroxine (Synthroid) if you develop low thyroid levels. Or they may prescribe a medication such as methimazole if your thyroid levels are too high. They may put a pause on your treatment or stop it entirely if you develop severe thyroid issues.

8. Immune-mediated side effects

Opdivo works by harnessing your immune system to fight cancer. However, sometimes this can cause your immune system to mistakenly attack healthy parts of your body. This can include one or more body parts, including your lungs (pneumonitis), liver (hepatitis), or kidneys (nephritis). It may also involve your digestive system (colitis), skin, and more.

Symptoms of lung problems include a feeling that you can’t catch your breath, cough, and chest pain. Yellowing of your skin and eyes (jaundice), dark urine, and pain on the right side of your stomach are symptoms of liver-related issues. Severe stomach pain; dark, tarry stools; and diarrhea are symptoms associated with your digestive system. 

These problems can become severe. Your oncologist will likely temporarily or permanently stop giving you Opdivo if you develop any worrisome immune-mediated side effects. Your oncologist will also likely want to collect your lab work routinely to proactively monitor for these issues.

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Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

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.

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