Opdivo (Nivolumab)- Intravenous

What Is Opdivo?

Opdivo (nivolumab) is an intravenous (IV) medication used to treat many different types of cancer. It is in a class of medications called programmed death-1 (PD-1) inhibitors, also known as immune checkpoint inhibitors or immunotherapy.

Although used for cancer, Opdivo is not chemotherapy. As a PD-1 inhibitor, it works with your immune system to target cancer cells, allowing the immune system to find and destroy them.

Opdivo is administered intravenously (into the vein) in a healthcare provider's office or infusion center.

Drug Facts

Generic Name: Nivolumab

Brand Name(s): Opdivo

Drug Availability: Prescription

Administration Route: Intravenous

Therapeutic Classification: PD-1 inhibitor

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Nivolumab

Dosage Form(s): Solution 

What Is Opdivo Used For?

Opdivo is used to treat many types and stages of cancer, such as to treat metastatic cancer (cancer that has spread to other areas of the body) for the following:

Opdivo can also be used as a treatment for some cancers that have not spread. In these cases, the cancer may have been removed with surgery already. This is called adjuvant treatment. Opdivo can be used for adjuvant treatment of:

  • Melanoma
  • Urothelial (urinary tract) cancer
  • Esophageal cancer

It may also be given to treat NSCLC when combined with chemotherapy, in a scenario where surgery will happen after chemotherapy and the Opdivo regimen. This is referred to as neoadjuvant therapy.

In addition to the cancers listed above, Opdivo can also be used to treat Hodgkin’s lymphoma that has come back after treatment or gotten worse after previous treatments.

How to Take Opdivo

Since Opdivo is an infusion, it is not something that is taken at home. Opdivo is given in an infusion center, through an IV that has been placed into a vein.

How Long Does Opdivo Take to Work?

Opdivo may be able to start working to help the immune system fight cancer as soon as it’s infused. However, it may take multiple doses of Opdivo over a few months before any improvement is seen in the cancer cells. Your oncologist will order imaging tests to help determine how the cancer is responding.

What Are the Side Effects of Opdivo?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Because of the way Opdivo works, it can cause certain side effects related to the immune system. These side effects can occur at any point during treatment.

The most common side effects of Opdivo include:

  • Feeling tired
  • Itchy skin
  • Diarrhea
  • Cough
  • Fever (pyrexia)
  • Joint pain
  • Muscle pain
  • Nausea
  • Decreased appetite
  • Headache

Tell your healthcare team as soon as you feel any new or worsening symptoms. If your symptoms are mild, your healthcare provider may continue to keep you on Opdivo while monitoring you closely. However, you may need to stop taking the drug if these side effects become severe.

Severe Side Effects

Because of how Opdivo works, treatment may cause the immune system to interact differently with healthy cells. If the immune system begins to attack healthy cells and not just cancer cells, this causes inflammation and related symptoms. Some of these symptoms can be severe if they are not treated promptly. These side effects are called immune-mediated reactions.

Any area of the body could potentially have an immune-mediated reaction. Some of the possible effects and their symptoms can include:

  • Pneumonitis (lung inflammation): Cough, chest pain, and shortness of breath
  • Colitis (colon inflammation): Diarrhea and abdominal pain
  • Hepatitis (liver inflammation): Abdominal pain and yellowing of the skin (jaundice)
  • Endocrinopathies (abnormal hormone production): Fatigue and confusion
  • Nephritis (kidney inflammation): Back or abdominal pain and decreased urination
  • Skin reactions: Severe rash and itching

Long-Term Side Effects

Severe side effects can potentially turn into long-term health problems, such as immune-mediated hypothyroidism (underactive thyroid gland). This can be treated, but you may need to go on lifelong thyroid replacement medication.

Symptoms of hypothyroidism can include:

  • Cold intolerance
  • Dry skin
  • Constipation
  • Weight gain
  • Fatigue

Report Side Effects

Opdivo may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program online or by phone (800-332-1088).

Dosage: How Much Opdivo Should I Take?

You receive this medication in a healthcare setting through an IV infusion.

Opdivo can be given in multiple doses and schedules depending upon the type of cancer being treated. Your healthcare provider will determine your dosage.

  • Metastatic or adjuvant melanoma: 240 milligrams (mg) every two weeks or 480 milligrams every four weeks
  • Neoadjuvant treatment for lung cancer (combined with chemotherapy): 360 milligrams every three weeks for three cycles
  • Metastatic NSCLC: 240 milligrams every two weeks or 480 milligrams every four weeks
  • Malignant pleural mesothelioma: 360 milligrams every three weeks used in combination with another immunotherapy called Yervoy (ipilimumab)
  • Advanced renal cell carcinoma: 240 milligrams every two weeks or 480 milligrams every four weeks in combination with a medication called cabozantinib (brand names: Cabometyx, Cometriq), or 3 milligrams per kilogram (kg) every three weeks when used in combination with Yervoy (ipilimumab)
  • Classical Hodgkin's lymphoma: 240 milligrams every two weeks or 480 milligrams every four weeks
  • Metastatic or recurrent head and neck cancer: 240 milligrams every two weeks or 480 milligrams every four weeks
  • Adjuvant urothelial carcinoma/metastatic urothelial carcinoma: 240 milligrams every two weeks or 480 milligrams every four weeks
  • Metastatic colorectal cancer: 3 milligrams per kilogram when used in combination with ipilimumab, then 240 milligrams every two weeks or 480 milligrams every four weeks when used alone
  • Hepatocellular (liver) carcinoma: 1 milligram per kilogram when used with ipilimumab, then 240 milligrams every two weeks or 480 milligrams every four weeks when used alone
  • Adjuvant esophageal and gastroesophageal junction cancer: 240 milligrams every two weeks or 480 milligrams every four weeks, then 480 milligrams every four weeks for a total of one year of treatment
  • Esophageal/gastric cancers: 240 milligrams every two weeks or 480 milligrams every four weeks when used in combination with chemotherapy

Overdose: What Happens If I Take Too Much Opdivo?

Opdivo is not taken at home; it is given in an infusion room by specially trained pharmacists and nurses. Therefore, there should be a low risk of overdose.

Precautions

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It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Receiving this medicine while you are pregnant can harm your unborn baby. If you are a woman who can bear children, your doctor may give you a pregnancy test before you start using this medicine to make sure you are not pregnant. Use an effective form of birth control to keep from getting pregnant during treatment with this medicine and for at least 5 months after the last dose. If you think you have become pregnant while receiving the medicine, tell your doctor right away.

Tell your doctor right away if you have a cough, chest tightness, or any type of breathing problem with this medicine. These could be symptoms of a serious lung problem (eg, pneumonitis).

Colitis (inflammation of the colon) may occur with this medicine. Tell your doctor right away if you have stomach pain or tenderness, watery or bloody diarrhea, or a fever after receiving the medicine.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, a loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Serious problems with adrenal, pituitary, or thyroid gland may occur while you are receiving this medicine. Tell your doctor if you have changes in mood or behavior (eg, being irritable or forgetful), constipation, dry skin or hair, feeling cold, sensitivity to heat, sweating, trouble sleeping, unusual or continuing headaches, or weight changes.

This medicine may affect blood sugar levels. If you notice a change in the results of your blood or urine sugar tests or if you have any questions, check with your doctor.

Tell your doctor right away if you have bloody or cloudy urine, decrease in the amount of urine, nausea, vomiting, trouble breathing, swelling of the face, feet, or lower legs, unusual tiredness or weakness, or unusual weight gain. These may be symptoms of a serious kidney problem.

Check with your doctor if you have a headache, confusion, seizures, stiff neck, or vomiting while receiving this medicine. These may be symptoms of encephalitis.

Serious skin reactions, including Stevens-Johnson syndrome, drug rash with eosinophilia and systemic syndrome (DRESS), and toxic epidermal necrolysis can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, red skin lesions, often with a purple center, severe acne or skin rash, sores or ulcers on the skin, mouth or lips, or swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness with this medicine.

Check with your doctor right away if blurred vision, difficulty with reading, eye pain, or any other change in vision occurs while you are receiving this medicine. Your doctor may want your eyes be checked by an ophthalmologist (eye doctor).

This medicine may cause infusion-related reactions, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you start to have fever, chills or shaking, dizziness, trouble breathing, itching or rash, lightheadedness, or fainting after receiving this medicine.

This medicine may increase your risk for transplant complications (eg, graft-versus-host-disease [GVHD]) in patients who have received a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic), which can be severe and life-threatening. Check with your doctor right away if you have skin rash, stomach pain, diarrhea, yellow skin or eyes, swelling in the legs or ankles, dark urine, pale stools, nausea, or vomiting.

What Are Reasons I Shouldn’t Take Opdivo?

Opdivo should not be given to anyone who is pregnant or planning to become pregnant during treatment. Use effective contraception during treatment and for at least five months following the last dose. Also, do not breastfeed while receiving Opdivo.

What Other Medications Interact With Opdivo?

The medications that can interact with Opdivo are steroids, such as Rayos (prednisone) and dexamethasone (brand names such as Decadron). Because steroids reduce inflammation, it’s possible that high doses of steroids could keep Opdivo from working the way it should.

Before starting treatment, tell your oncologist what medications you take, including prescription or over-the-counter (OTC) drugs, vitamins, or herbal supplements. Ask for a complete list of possible drug interactions and whether there are any other substances you should avoid while undergoing treatment.

What Medications Are Similar?

Other medications fall into the class of PD-1 inhibitors, including Keytruda (pembrolizumab) and Libtayo (cemiplimab).

These drugs work in the same way as Opdivo, by targeting the PD-1 receptor to allow the immune system to see and attack cancer cells. These medications are not given in combination with each other.

Frequently Asked Questions

  • What is Opdivo used for?

    Opdivo is used to treat many types of cancer, including metastatic non-small cell lung cancer, hepatocellular cancer, and head and neck cancers, among others.

  • How does Opdivo work?

    Opdivo works by helping the immune system target and destroy cancer cells in the body.

  • What drugs should not be taken with Opdivo?

    High doses of steroids should not be taken along with Opdivo, as they can prevent Opdivo from working the way it needs to.

How Can I Stay Healthy While Taking Opdivo?

Opdivo is a medication proven to help treat many types of cancer. Because of how Opdivo affects your immune system, you may experience side effects while undergoing treatment. Side effects can appear at any time during therapy.

Talk to your cancer care team about what you should expect and let them know of any new or worsening side effects. Prompt treatment of adverse reactions is key to getting you feeling your best during treatment. In some cases, you may need to stop taking Opdivo if your side effects become severe.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Schneider BJ, Naidoo J, Santomasso BD, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. J Clin Oncol. 2021;39(36):4073-4126. doi: 10.1200/JCO.21.01440

  3. Guo L, Zhang H, Chen B. Nivolumab as programmed death-1 (PD-1) inhibitor for targeted immunotherapy in tumor. J Cancer. 2017;8(3):410-416. doi:10.7150/jca.17144

  4. Petrelli F, Signorelli D, Ghidini M, et al. Association of steroids use with survival in patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis. Cancers (Basel). 2020;12(3):546. doi: 10.3390/cancers12030546

  5. American Cancer Society. Immune checkpoint inhibitors and their side effects.

By Julie Scott, MSN, ANP-BC, AOCNP
Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.