Nivolumab (Opdivo)

Nivolumab at a glance

Nivolumab (Opdivo) is an immune checkpoint inhibitor given as an intravenous infusion or a specific under-the-skin formulation. Opdivo is an immune checkpoint inhibitor. Intravenous and subcutaneous products have different doses and instructions. Opdivo Qvantig is a US name for nivolumab with hyaluronidase; it is not the same product as nivolumab with relatlimab.

This page explains preparation, everyday care and symptoms that need attention. Use it alongside your own hospital’s treatment plan. Do not change medicines or appointment intervals without the treating team.

What is nivolumab, and how does it work?

Nivolumab blocks an immune checkpoint called PD-1. Checkpoints help prevent immune cells from attacking healthy tissue. Some cancer cells exploit these signals to avoid attack; blocking the signal can help immune cells recognise and act against cancer. This is a form of immunotherapy, with a different mechanism from conventional chemotherapy.

Immune activation can also affect normal organs. A new symptom may therefore need assessment even when it seems unrelated to the cancer. Neither strong side effects nor their absence proves whether treatment is working.

How your team decides whether it is suitable

Nivolumab is used to treat certain cancers. Your oncologist will advise whether it is suitable for you, taking account of your cancer type, relevant test results, previous treatment, overall health and the applicable prescribing information and regulatory guidance in your country.

When considering checkpoint immunotherapy, your doctor may check markers such as PD-L1 (programmed death-ligand 1), MMR (DNA mismatch repair), MSI (microsatellite instability) or TMB (tumour mutational burden). These tests look at different features of the cancer: an immune-related protein, how well DNA errors are repaired, changes in short repeated DNA sequences, or the number of genetic changes in the tumour.

Not everyone needs all these tests, and they are not interchangeable. Their relevance depends on the cancer type, stage and exact medicine or combination being considered. Some treatment plans require a particular test result; others do not. Discuss with your doctor which tests are relevant to you and how the results affect your options. A result alone does not guarantee that treatment will work.

Your team also checks whether the selected formulation is appropriate for your combination and treatment phase. Nivolumab with a thalidomide-type medicine and dexamethasone is not recommended for multiple myeloma outside a controlled clinical trial because that combination increased deaths in trials.

Before treatment starts

Your team will ask about autoimmune conditions, previous organ or donor stem-cell transplantation, lung or heart disease, infections and earlier cancer treatment. Mention previous severe reactions to any immunotherapy, even if you are now well. Tell them about pregnancy, breastfeeding, any possibility of pregnancy and whether you want to discuss fertility preservation before starting.

Bring a complete medicines list, including inhalers, eye drops, steroid creams, tablets, injections, vitamins and traditional or herbal remedies. A medicine taken only occasionally can still matter. Do not stop prescribed steroids or immune-suppressing treatment yourself; the team must weigh why you need them and how they fit with treatment.

Baseline tests usually include blood counts, kidney and liver function, blood sugar and thyroid function. Other hormone tests, heart tests or infection screening depend on your history and treatment plan. Record your usual bowel pattern, breathing, energy level and any existing rash. This makes it easier to identify a change rather than attributing everything to cancer.

Before leaving the first appointment, know how to reach your own hospital’s urgent oncology service, including outside clinic hours. Keep the treatment alert card or an up-to-date medicine record with you. A family member can help remember instructions and recognise changes you may not notice yourself.

How treatment is given

Common adult intravenous schedules include 240 mg every two weeks or 480 mg every four weeks, infused over 30 minutes. Other weight-based or three-weekly schedules are used in particular plans. Combination treatment may change the schedule and the number of visits.

A separate subcutaneous formulation contains nivolumab and hyaluronidase. Current US Opdivo Qvantig schedules include 600 mg every two weeks, 900 mg every three weeks or 1,200 mg every four weeks, with the appropriate hyaluronidase amount, over approximately three to five minutes. EU product information also describes a subcutaneous Opdivo formulation. These doses are not milligram-for-milligram substitutes for intravenous Opdivo. A trained professional administers the injection. Eligibility and switching depend on the exact prescribed product and treatment setting.

Do not assume a subcutaneous product can replace intravenous nivolumab while you are receiving ipilimumab. Current US Qvantig information distinguishes certain maintenance uses after nivolumab-ipilimumab from concurrent combination use. Opdualag is a different fixed combination containing nivolumab plus relatlimab.

A nurse checks your identity, prescription and recent symptoms before administration. Tell staff immediately about flushing, itching, chills, back pain, wheezing or dizziness. Staff can stop or slow an infusion and provide treatment. Do not leave the unit with unexplained new symptoms. If a line remains in place between visits, follow the dressing and flushing instructions and report redness, pain, leakage or fever.

Monitoring and checking whether treatment is working

Before treatment, staff review symptoms and blood results to check that another dose is appropriate. Some immune problems first appear on a blood test, before you feel unwell. Thyroid, liver, kidney or glucose abnormalities may need repeat tests, additional investigations or another specialist’s advice.

Scans and, where appropriate, other disease measurements assess whether treatment is helping. Feeling well or having side effects cannot reliably tell you whether it is working. Occasionally immune inflammation complicates the interpretation of a scan; your oncologist decides whether a repeat scan or other assessment is appropriate. Worsening symptoms should still be reported promptly.

A dose may be delayed while a new symptom is investigated. Checkpoint antibodies are commonly withheld or stopped for significant toxicity rather than simply reduced to a smaller dose. This is a safety decision, not evidence that you have done anything wrong. The team balances cancer control with recovery and the risk of the same reaction happening again.

Common side effects and how to manage them

Side effects vary with the medicine, your health and any accompanying treatment. You may have several, a few or none. The following effects are commonly encountered across checkpoint treatment; their frequency is not identical in every regimen.

Tiredness and reduced energy

Plan demanding tasks for the time of day when you feel best, accept practical help and include gentle activity if you can. Rest is useful, but spending the entire day in bed can make weakness worse. A sudden increase in tiredness, dizziness or inability to manage normal activities needs assessment for anaemia, infection or hormone problems rather than being accepted as inevitable.

Skin rash and itching

Use a plain moisturiser, lukewarm water and comfortable clothing. Protect your skin from strong sunlight. Let the team know about a new rash; photographs can help show how it changes. Do not use a new medicated cream without checking. Blisters, peeling skin, mouth sores or a painful widespread rash need urgent help.

Loose stools or diarrhoea

Note how many times you pass stool compared with your normal pattern, whether it wakes you at night and whether there is pain, mucus or blood. Keep drinking unless you have a fluid restriction. Contact your team promptly for new or increasing diarrhoea. Do not repeatedly suppress it with over-the-counter medicines before the team has considered immune bowel inflammation.

Nausea, appetite changes and constipation

Small, regular meals and prescribed anti-sickness medicines may help. Ask for dietetic support if weight is falling or eating is difficult. Constipation can be related to other medicines or reduced activity; discuss an appropriate laxative rather than straining. Persistent vomiting, a swollen abdomen, severe pain or inability to keep fluids down requires urgent advice.

Muscle and joint discomfort

Gentle movement, pacing and the team’s recommended pain relief can help. Check before taking ibuprofen or similar anti-inflammatory medicines, especially with kidney problems or other treatment. New marked weakness, drooping eyelids, difficulty swallowing or dark urine is different from ordinary aching and needs urgent assessment.

Less common but important side effects

Checkpoint treatment can make the immune system inflame healthy organs. Several organs can be affected together. Problems may appear during treatment or after it stops, and a symptom does not have to be dramatic to deserve attention.

Lung inflammation

New cough, breathlessness or chest discomfort can reflect inflammation called pneumonitis, infection or another problem. Contact the team promptly. Severe breathlessness, blue lips, collapse or difficulty speaking because of breathing requires emergency care.

Bowel and liver inflammation

Immune colitis can cause diarrhoea, cramps, blood or mucus, and occasionally serious bowel damage. Liver inflammation may initially show only on blood tests. Yellow eyes or skin, dark urine, right-sided upper abdominal pain or unusual bruising needs prompt assessment. Do not assume an existing digestive or liver condition explains a new change.

Hormone gland problems and diabetes

Thyroid, pituitary or adrenal inflammation can cause unusual tiredness, headache, feeling cold, weight changes, dizziness or altered mood. New excessive thirst and frequent urination can signal diabetes. Vomiting with marked thirst, deep or rapid breathing, confusion or severe weakness is an emergency. Some hormone deficiencies require long-term replacement even after the immune inflammation settles.

Kidney, heart, muscle and nerve problems

Reduced urine, blood in the urine or swelling may indicate kidney injury. Chest pain, palpitations, faintness, rapid weakness, swallowing difficulty, confusion or a seizure can signal serious heart or nervous-system effects. Heart, muscle and nerve inflammation can overlap. Do not wait for all the symptoms in a list to appear.

Eye problems, severe skin reactions and transplant complications

Eye pain, light sensitivity or new blurred vision needs urgent advice. Severe rash with blistering, peeling or mouth involvement needs immediate assessment. Checkpoint activation can also cause transplant rejection or complications around a donor stem-cell transplant. Tell every treating specialist that you have received this medicine.

How immune side effects are treated

Treatment may involve temporarily withholding immunotherapy, corticosteroids, hormone replacement or other specialist medicines. Severe reactions sometimes require hospital care and permanent discontinuation. Take the steroid taper exactly as prescribed; stopping abruptly can be dangerous. Early reporting often makes management more straightforward, but no one can promise that every effect will completely reverse.

Additional points for this treatment

For an under-the-skin injection, report pain, swelling, redness or itching around the site and tell staff about previous hyaluronidase reactions. Widespread hives, throat swelling, wheeze or faintness requires immediate attention. The injection route does not remove the risk of delayed immune inflammation elsewhere in the body.

Other medicines, supplements and vaccinations

Check new prescriptions, non-prescription medicines, supplements and herbal products with the cancer team or pharmacist. Avoid products marketed as “immune boosters”: they are not proven substitutes for treatment and can complicate safety assessment. Do not assume a natural product is harmless.

Steroids may be essential to treat immune side effects, despite the medicine’s aim of activating immunity. Never withhold necessary steroids because you are worried they will cancel the treatment. Equally, do not start leftover steroid tablets yourself. If you require hormone replacement or long-term steroids, carry the relevant alert information.

Discuss influenza, COVID-19 and other vaccines with the team. Non-live vaccines are often appropriate, but timing and response depend on the full treatment, particularly chemotherapy or immune-suppressing medicines. Live vaccines need specific specialist approval. There is no single post-treatment vaccine waiting period that is correct for every checkpoint-treated patient.

Everyday life during treatment

Eating does not alter the dose of a medicine given by infusion or injection. Aim for adequate fluids and regular food, adjusting for nausea or diarrhoea, and follow any kidney, heart or diabetes advice already in place. Avoid restrictive diets or supplements promising to improve immune treatment response.

Work and exercise can continue if you feel able, with flexibility around appointments and fatigue. Start activity gently and reduce it when unwell. Do not drive if you are dizzy, sleepy, weak, visually affected or unable to concentrate. Premedicines and pain medicines can also impair driving. Sudden neurological symptoms require assessment, not simply a rest before driving again.

Discuss travel before booking, especially long journeys or places far from emergency care. Keep your treatment record, medicines list and enough prescribed medicines with you. Tell dentists and other clinicians about immunotherapy before procedures. Wash hands, avoid close contact with people who are clearly infectious and use food safety precautions; complete isolation is not usually necessary solely because you are receiving a checkpoint inhibitor.

Sex is generally possible if comfortable, with the contraception precautions below. Symptoms, dryness or fatigue may affect intimacy and can be discussed without embarrassment. Emotional support can help with uncertainty between scans; report persistent anxiety, poor sleep or low mood rather than carrying it alone.

Fertility, contraception, pregnancy and breastfeeding

If you could become pregnant, use effective contraception throughout treatment and for at least 5 months after the final dose. Pregnancy status should be checked before treatment when relevant. Contact the team immediately if you become pregnant, suspect pregnancy or have a contraceptive failure; do not wait for the next appointment.

The US prescribing information advises against breastfeeding during treatment and for 5 months after the last dose. EU wording may express the breastfeeding decision differently, so agree a feeding and restart plan using the product you receive. Other anticancer medicines can require longer precautions.

Effects on future fertility are not fully established. Discuss sperm, egg or embryo preservation before treatment if this matters to you, especially when chemotherapy is also planned. The pregnancy-prevention interval above applies to a person who can become pregnant; do not assume it is an evidence-based universal rule for male partners. Your team should give partner advice for the complete regimen.

After treatment finishes

Keep attending the follow-up appointments and tests recommended by your team. Immune side effects can start after the final dose, so continue to mention previous immunotherapy when seeking medical care. Keep your alert card or treatment summary accessible and tell emergency staff about the medicine even months later.

Continue prescribed hormone replacement, steroid tapering and other supportive treatment. Do not stop these because the anticancer infusion has finished. Follow the specified contraception and breastfeeding restrictions from the date of the final relevant dose. Recovery is individual; ask for rehabilitation, nutritional support or help returning to work if symptoms persist.

Frequently asked questions