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Side effects of nivolumab (Opdivo)

Find out about the side effects of the cancer treatment drug nivolumab.

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection, including a temperature above 38C.

The side effects may be different if you are having nivolumab with other cancer treatments.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.

This can affect about 3 out of 10 people (about 30%). 

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

This happens in 2 out of 10 people (20%). 

You might develop a skin rash on your face and body. It may appear like blisters on the skin. It may be itchy but not always.  

If you notice a rash on your skin let your doctor know straight away. They may need to stop your treatment.

Feeling or being sick can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Contact your doctor or nurse straight away if you’ve been sick more than once in a day.

Tips

  • Avoid eating or preparing food when you feel sick.
  • Avoid foods that are fried, fatty, or have a strong smell.
  • Drink plenty of liquid to stop you from getting dehydrated.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Fizzy drinks help some people when they’re feeling sick.

This can happen in around 2 out of 10 people (around 20%). It is usually well controlled with anti sickness medications.

You may have changes in levels of minerals and salts in your blood, such as low potassium, magnesium, calcium and phosphate. You have regular blood tests during treatment to check this.

You might have liver changes that are very mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. 

You have regular blood tests to check for any changes in levels of chemicals produced by the liver.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.

Your thyroid might produce too much of the thyroid hormones (overactive thyroid). Or it might not produce enough hormones (underactive thyroid). 

Overactive thyroid 

You may feel hot, sweaty, agitated, lose weight, and have problems concentrating and sleeping.

Underactive thyroid 

You may feel tired and gain weight. 

Let your doctor or nurse know if you have any of these symptoms.

Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.

Tips

  • Keep your hands and feet warm.
  • Wear well fitting, protective shoes.
  • Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
  • Use oven gloves when cooking and protective gloves when gardening.
  • Moisturise your skin at least a couple of times a day.
  • Take care when cutting your nails.

You might develop a chest infection. Talk to your doctor if this happens to you.

You have regular blood and urine tests to check this. Let your doctor or nurse know if you feel thirsty or need to pass urine a lot.

If you have diabetes you may need to check your blood sugar levels more often than usual. 

Let your doctor or nurse know if you have headaches. They can give you painkillers. 

Don’t drive or operate heavy machinery if you feel dizzy.

Tell your doctor or nurse if you’re breathless or have a cough. This could be due to an infection, such as pneumonia. Or it could be caused by changes to the lung tissue, making it less flexible.

Tell your nurse straight away if you have a reaction. This usually happens with the first or second treatment.

Symptoms include a skin rash, itching, feeling hot and shivering. Other symptoms include redness of the face, dizziness, a headache, shortness of breath and anxiety.

Your nurse will stop or slow your drip if you have a reaction. 

Your mouth and throat might get sore. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.

You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.

Tell your doctor or nurse if your throat is sore.

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.

Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

You might have patchy changes in your skin colour (vitiligo). 

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse checks your blood pressure regularly. 

Let your doctor or nurse know if you have pain anywhere during or after having treatment. There are lots of ways to treat pain, including relaxation and painkillers.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

Some drugs can affect the way your kidneys work. You'll have regular blood tests to check how well your kidneys are working.

You are unlikely to notice any symptoms from this and any changes will almost certainly go back to normal after treatment. 

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 38C. Severe infections can be life threatening.

Cancer drugs can reduce the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

Your white blood cell level begins to fall after each treatment. Then it gradually goes up again.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You'll have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

This treatment makes the level of red blood cells fall (anaemia). You may feel breathless and look pale.

Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

Tell your doctor or nurse if you feel breathless.

These problems include eye pain, redness, blurred vision and other eyesight changes. Tell your doctor or nurse if you have these.

Your nurse will check your heart rate (pulse) regularly.

Tell your doctor or nurse if you have a faster heart rate. 

This drug can cause inflammation of the pancreas (pancreatitis).

Tell your doctor straight away if you have sudden and severe pain in your tummy (abdomen).

Or if you have diarrhoea, blood in your poo. 

You might have changes in the amount of hormones your adrenal and pituitary glands produce. 

You might have inflammation of nerves causing pain, weakness and paralysis (Guillain-Barre syndrome) and loss of the protective outer lining of the nerves.

You might have muscle weakness and find that your muscles are tiring easily (myasthenic syndrome).

The skin changes can be severe. This may be an itchy, red rash that can cover the whole of your body. Or you may have red patches of skin that are thickened and scaly. Or you may have very red cheeks and nose (rosacea).

You have blood tests before your treatments, to check your kidneys.

Drink plenty of water. You also have fluids into your vein before and after your treatment for several hours.

Your nurse might ask you to keep a record of how much you drink. And you may need to measure the amount of urine that you pass and keep a record of that.

Tell your nurse or doctor if you are not able to drink as much as you should – for example, if you feel sick. And tell them if you are passing less amount of urine than normal. Or no urine.

You might have pain in your back, chest, bones, arms or legs. Tell your doctor or nurse if you have any pain. They can give you painkillers to help.

Contact your doctor or nurse immediately if you have any chest pain.

Fluid around the lungs is called a pleural effusion. 

This can be a serious problem so if you are breathless or have a cough, contact your doctor or nurse straight away.

You may be dehydrated if you are very thirsty and have dark coloured urine. 

Other symptoms include:

  • dizziness or light headedness
  • headache
  • tiredness
  • dry mouth, lips and eyes
  • passing small amounts of urine infrequently (less than three or four times a day)

Increase the amount of fluids you drink. Contact your doctor or nurse if the symptoms continue despite drinking more fluids.

About nivolumab

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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