Opdivo
Opdivo (nivolumab) is used for treating many different types of cancer, such as melanoma, lung cancer, and Hodgkin lymphoma. Depending on the cancer, this medication is given by itself or with other therapies. Opdivo (nivolumab) is an intravenous (IV) infusion that’s administered at a medical office or infusion center. The medication turns on your immune system to fight cancer so it’s considered immunotherapy. It can sometimes cause side effects, like rash, diarrhea, and breathing problems, that might need treatment with corticosteroids.
What is Opdivo (nivolumab)?
What is Opdivo (nivolumab) used for?
Certain types of the following cancers:
Non-small cell lung cancer (NSCLC)
Pleural mesothelioma (cancer of the lining of the lungs)
Renal cell carcinoma (kidney cancer)
How Opdivo (nivolumab) works
Your immune system plays an important role to protect you from harm in many different ways. For example, it can attack and kill cancer cells that it recognizes as abnormal. But some cancer cells can hide from your immune system through the programmed death-1 (PD-1) pathway. When this happens, it prevents your immune system from finding and attacking the cancer cells well. This allows the cancer to grow.
Opdivo (nivolumab) is an immunotherapy medication that blocks the PD-1 pathway. It’s also called a PD-1 inhibitor or checkpoint inhibitor.
By blocking the PD-1 pathway, Opdivo (nivolumab) helps your immune system find and recognize cancer cells better. As a result, your immune system can attack and kill the cancer cells and stop the cancer from growing.
Drug Facts
More on Opdivo (nivolumab) essentials
What are the side effects of Opdivo (nivolumab)?
Common Side Effects
- Tiredness (59%)
- Higher blood sugar levels (46%)
- Muscle or bone pain (42%)
- Anemia (low red blood cell count; 41%)
- Low white blood cell count (41%)
- Rash (40%)
- Diarrhea (36%)
- Nausea (30%)
- Higher liver enzyme levels in blood (up to 29%)
- Cough (28%)
- Lower appetite (22%)
- Upper respiratory tract infection (22%)
- Vomiting (20%)
Other Side Effects
- Trouble breathing
- Fever
- Weight loss
- High blood pressure
- Thyroid hormone changes
- Electrolyte changes in blood
Serious Side Effects
- Serious immune-related side effects: rash, diarrhea, trouble breathing, chest pain, severe stomach pain, mucus or blood in stool
- Serious reaction during infusion: chills, fever, itching, fast heartbeat, trouble breathing
Source: DailyMed
More on Opdivo (nivolumab) side effects
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dry cough, shortness of breath or trouble breathing
- Eye pain, redness, irritation, or discharge with blurry or decreased vision
- Heart muscle inflammation—unusual weakness or fatigue, shortness of breath, chest pain, fast or irregular heartbeat, dizziness, swelling of the ankles, feet, or hands
- Hormone gland problems—headache, sensitivity to light, unusual weakness or fatigue, dizziness, fast or irregular heartbeat, increased sensitivity to cold or heat, excessive sweating, constipation, hair loss, increased thirst or amount of urine, tremors or shaking, irritability
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- Kidney injury (glomerulonephritis)—decrease in the amount of urine, red or dark brown urine, foamy or bubbly urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Bone, joint, or muscle pain
- Diarrhea
- Fatigue
- Loss of appetite
- Nausea
- Skin rash
Pros and cons of Opdivo (nivolumab)
Pros
Less likely to cause nausea, vomiting, and hair loss, which are common side effects of traditional chemotherapy
Recommended first-choice treatment option for certain people with melanoma and esophageal cancer
Each infusion lasts about 30 minutes
Cons
Given as an injection through the veins
Might cause immune-related side effects like diarrhea, rash, and lung problems
Might require treatment breaks and additional corticosteroids to manage side effects
Pharmacist tips for Opdivo (nivolumab)
Notify your oncology care team right away if you have any immune-related side effects, such as diarrhea, rash, or trouble breathing, at any time during your treatment with Opdivo (nivolumab). These side effects could be signs that treatment made your immune system become too active. You might need additional medical attention for these side effects.
Don’t take over-the-counter (OTC) medications to treat any side effects you have while you’re taking Opdivo (nivolumab) without talking with your oncology care team first. OTC medications that you might typically use might not be enough to help. Instead, you might need a corticosteroid like prednisone to manage side effects from Opdivo (nivolumab).
If you’re prescribed to take a steroid for a few weeks to manage side effects, don’t suddenly stop taking the steroid medication. Otherwise, this can cause uncomfortable symptoms like nausea and body aches. Your prescriber will provide specific directions to slowly lower the dose over time before you stop the steroid.
Be sure you get your lab work done on time while you’re taking Opdivo (nivolumab). The lab results help your oncology care team check for possible immune-related side effects that might not have noticeable symptoms, such as kidney problems or hormone changes.
It’s rare but possible to have reactions during your Opdivo (nivolumab) infusion. Call for a nurse right away if you have chills, itchiness, fever, or trouble breathing during your infusion. Your care team is trained to help manage infusion reactions.
Don’t breastfeed while you’re taking Opdivo (nivolumab) and for 5 months after your last dose. We don’t know whether the medication passes into human breast milk. But because of the risk of harm to a nursing infant, it might be safer to consider other feeding options.
More on Opdivo (nivolumab) tips
Frequently asked questions about Opdivo (nivolumab)
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What are the risks and warnings for Opdivo (nivolumab)?
Opdivo (nivolumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Immune-related side effects
Side effects from immunotherapy medications like Opdivo (nivolumab) are called immune-related adverse events (irAEs). These side effects happen when your immune system becomes too active and doesn’t just attack cancer cells; it attacks healthy cells, too. Immune-related side effects can happen anywhere in your body and at any time during treatment. They can range from mild to very serious and life-threatening in severity.
Some of these side events, such as liver or kidney problems, are found on your lab test results. For this reason, it’s important to get your lab work done when your oncologist recommends you to so your care team can check for side effects that might not have noticeable symptoms.
Other side effects can cause recognizable symptoms, such as diarrhea, rash, and trouble breathing. Call your care team right away if you have these symptoms or if you notice anything unusual happening to your body. Depending on how severe your symptoms are, you might need to pause or stop taking Opdivo (nivolumab) and take a corticosteroid to help manage them.
Infusion-related reactions
Although uncommon, some people who take Opdivo (nivolumab) can have reactions during their infusion. Your care team will watch for these reactions while you’re getting your infusion. But be sure to tell a nurse right away if you notice symptoms like feeling itchy or warm, nausea, fever, fast heartbeat, or trouble breathing during your infusion.
Most of the time, pausing or slowing down the infusion can help manage these infusion reactions enough so that you can keep taking Opdivo (nivolumab). But you might need to stop taking the medication altogether if the reaction is severe.
Complications from stem cell transplants
Risk factors: People who’ve had a stem cell (bone marrow) transplant
Some people who’ve taken immunotherapy like Opdivo (nivolumab) and who’ve also had a stem cell transplant have experienced serious complications from the transplant. These problems can include graft-versus-host disease (GVHD) and veno-occlusive disease (VOD).
Before you start Opdivo (nivolumab), let your oncology care team know if you’ve had a stem cell transplant in the past. Also tell them if you have a stem cell transplant planned even after you’ve completed treatment with Opdivo (nivolumab). Your care team will follow up with you to check for signs and symptoms of these complications.
Harm to unborn baby
Risk factors: Pregnancy
Treatment with Opdivo (nivolumab) hasn’t been studied in humans during pregnancy. But based on animal studies and the way this medication works, it might harm an unborn baby when it’s given during pregnancy.
Your oncologist might ask that you take a pregnancy test before you start Opdivo (nivolumab) to make sure you’re not pregnant. If you’re able to become pregnant, you should use effective birth control while you’re taking this medication and for 5 months after your last dose. Let your care team know right away if you become pregnant at any time during treatment with Opdivo (nivolumab).
Opdivo (nivolumab) dosage forms
Typical dosing for Opdivo (nivolumab)
Opdivo (nivolumab) is given as an intravenous (IV) infusion at a medical office or infusion center.
Your dose depends on the type of cancer you have and sometimes your weight. Your oncologist will determine your dose for you.
When Opdivo (nivolumab) is taken by itself
Most times: The typical dose is 240 mg IV every 2 weeks or 480 mg IV every 4 weeks.
For people 12 years of age and older who weigh less than 88 lbs (melanoma or colorectal cancer only): The dose is based on your weight. The typical dose is 3 mg/kg IV every 2 for 3 weeks or 6 mg/kg IV every 4 weeks.
When Opdivo (nivolumab) is taken with other cancer therapies
Your Opdivo (nivolumab) dose will depend on your specific treatment plan and the other cancer medications you’re taking. For example, depending on the type of cancer you’re treating, the Opdivo (nivolumab) dose is either 360 mg, 1 mg/kg, or 3 mg/kg IV every 3 weeks if you’re taking it with Yervoy (ipilimumab).
What are alternatives to Opdivo (nivolumab)?
Certain types of the following cancers:
Non-small cell lung cancer (NSCLC)
Pleural mesothelioma (cancer of the lining of the lungs)
Renal cell carcinoma (kidney cancer)
Non-small cell lung cancer (NSCLC)
Renal cell carcinoma (kidney cancer)
Endometrial carcinoma (uterine cancer)
Cancers with high tumor mutation burden (TMB-H), high microsatellite instability (MSI-H), or deficient mismatch repair (dMMR)
Advanced renal cell carcinoma; with Opdivo (nivolumab)
Metastatic colorectal cancer after previous treatment with chemotherapy; with Opdivo (nivolumab)
Advanced liver cancer that was previously treated with Nexavar (sorafenib); with Opdivo (nivolumab)
Metastatic non-small cell lung cancer (NSCLC) in people with PD-L1 expression; with Opdivo (nivolumab) and with or without additional chemotherapy
Advanced malignant pleural mesothelioma; with Opdivo (nivolumab)
Advanced or metastatic esophageal cancer; with Opdivo (nivolumab)
What is the latest news about Opdivo (nivolumab)?
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References
Best studies we foundAmerican Cancer Society. (n.d.). Stem cell or bone marrow transplant.
American Cancer Society. (2020). Chemotherapy side effects.
American Cancer Society. (2024). Infusion or immune reactions.
Centers for Disease Control and Prevention. (2023). Mesothelioma basics.
E.R. Squibb & Sons, L.L.C. (2024). Opdivo- nivolumab injection [package insert]. DailyMed.
Han, Y., et al. (2020). PD-1/PD-L1 pathway: Current researches in cancer. American Journal of Cancer Research.
Hodgens, A., et al. (2023). Corticosteroids. StatPearls.
InformedHealth.org. (2023). In brief: How does the immune system work? Institute for Quality and Efficiency in Health Care.
National Cancer Institute. (2020). Hair loss (alopecia) and cancer treatment.
National Cancer Institute. (2021). Head and neck cancers.
National Cancer Institute. (2022). Immune checkpoint inhibitors.
National Cancer Institute. (2023). Hodgkin lymphoma treatment (PDQ®)–Patient version.
National Cancer Institute. (2023). What is bladder cancer?
National Cancer Institute. (2024). What is liver cancer?
National Comprehensive Cancer Network. (2023). Stomach cancer.
National Comprehensive Cancer Network. (2024). Esophageal cancer.
National Comprehensive Cancer Network. (2024). Immunotherapy side effects: Immune checkpoint inhibitors.
National Comprehensive Cancer Network. (2024). Melanoma.
National Comprehensive Cancer Network. (2024). Understanding immunotherapy side effects.
National Marrow Donor Program. (n.d.). What is graft-versus-host disease (BVHD)?
Senzolo, M., et al (2007). Veno occlusive disease: Update on clinical management. World Journal of Gastroenterology.
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