This page tells you about the cancer drug nivolumab (pronounced nee-vol-u-mab). There are sections on
Nivolumab (pronounced nee-vol-u-mab) is also called by its brand name, Opdivo. It is a treatment for
- Advanced melanoma
- Squamous non small cell lung cancer
Nivolumab is also used in clinical trials for other types of cancer.
Nivolumab is a type of immunotherapy. This type of treatment stimulates the body’s immune system to fight cancer cells.
Nivolumab targets and blocks a protein called PD-1 on the surface of certain immune cells called T-cells. Blocking PD-1 activates the T-cells to find and kill cancer cells.
You have nivolumab into a vein as a drip. You can have the drug through a thin, short tube (a cannula) put into a vein in your arm or hand each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. The tube stays in place as long as you need it.
You can read our information about having cancer drugs into a vein.
You have the treatment over 1 hour, every 2 weeks.
You usually carry on having nivolumab for as long as it works, unless it causes bad side effects.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with nivolumab. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having nivolumab with other drugs.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in 100 people have one or more of these side effects.
- Tiredness and weakness affects 3 in 10 people (30%) during and after treatment
- Diarrhoea happens in 2 out of 10 people (20%). Drink plenty of fluids. Contact your treatment centre straight away if you have signs of diarrhoea. Your doctor or nurse will give you anti diarrhoea medicines to take
- Feeling or being sick occurs in around 2 out of 10 people (20%). This is usually well controlled with anti sickness medicines
- Skin reactions happen in 2 out of 10 people (20%). You may have a rash similar to acne on your face, neck and trunk or your skin may be dry and itchy
- Liver changes that are very mild and unlikely to cause symptoms
- Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
- Kidney changes that are mild and unlikely to cause symptoms
Between 1 and 10 in every 100 people have one or more of these side effects
- Change to your thyroid gland – your thyroid may become overactive so you may feel hot, sweaty, agitated, lose weight, and have problems concentrating and sleeping. Or it may be underactive and cause tiredness and weight gain. Let your doctor or nurse know if you have any of these symptoms
- Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons
- Chest infections
- High blood sugar levels – If you are diabetic, you will have to take extra care in checking your blood sugar. High blood sugar may cause thirst, hunger and passing more urine than normal
- Dizziness and headaches
- High blood pressure
- A cough and shortness of breath caused by inflammation of your lungs
- A sore mouth – you may have mouth ulcers and cold sores
- Constipation – your doctor or nurse may give you medicines to help prevent this. Tell them if you are constipated for more than 3 days
- Patchy changes in your skin colour
- Painful joints or muscles
- An allergic reaction while you have the treatment, causing a skin rash, a high temperature (fever), chills, shivering (rigors), a headache and feeling sick. Rarely, people have a more severe reaction with wheezing, an itchy rash and a drop in blood pressure. Your nurse will stop or slow your drip if you have a reaction
Fewer than 1 in 100 people have these side effects.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and breathlessness from a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily from a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Changes in the amount of hormones your adrenal glands and pituitary gland produce
- Eye problems, including eye pain, redness, blurred vision and other eyesight changes – tell your doctor or nurse if you have these
- Change to your heart beat (heart rhythm) – you may have a faster heart rate
- Inflammation of your pancreas causing abdominal pain
- Inflammation of nerves causing pain, weakness and paralysis (Guillain-Barre syndrome) and loss of the protective outer lining of the nerves
- Muscle weakness and muscles tiring easily (myasthenic syndrome)
- Severe skin changes – 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)
- Kidney failure – let your nurse know straight away if you are passing less urine than normal or no urine
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don’t breastfeed during this treatment because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
We don’t list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk/emc.
If you have a side effect we don’t mention here and you think may be due to this treatment, you can report it to the Medicines Health and Regulatory Authority (MHRA) at yellowcard.mhra.gov.uk mhra.gov.uk
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