Nivolumab (Opdivo®)

Nivolumab (Opdivo®) is used to treat:

• melanoma
• non-small cell lung cancer
• kidney cancer
• classical Hodgkin lymphoma
• oesophageal cancer
• some head and neck cancers
• mesothelioma.

It may sometimes be used to treat other cancers. It is best to read this information with our general information about the type of cancer you have.

Nivolumab is an immunotherapy drug. It may also be called a checkpoint inhibitor. Your doctor will talk to you about this treatment and the possible side effects before you agree (consent) to have treatment.

We explain the main side effects of this treatment here. We also include some other possible side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

This treatment may cause delayed side effects. These can start weeks, months or sometimes more than a year, after you finish treatment.

If you have symptoms or side effects that start during treatment or after treatment finishes, contact your doctor or hospital straight away. Side effects can become serious if they are not treated.

Your doctor, nurse or pharmacist will give you a card with information about your treatment. It is important to keep the card with you during treatment and after treatment finishes. You should show it to any doctor or healthcare professional who looks after you.

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Sometimes side effects can become serious very quickly. If you have new symptoms or side effects, it is important to contact the hospital straight away.

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Some of these side effects are rare. But it is important to know about them. They can become serious if they are not treated or if you try to treat them yourself. Always contact your doctor or the hospital straight away if you have these side effects during treatment or after it finishes.

This treatment can cause changes to the lungs. Contact the hospital straight away if you notice any of these changes during treatment or after it finishes:

• breathlessness
• a cough
• wheezing
• a fever, with a temperature over 37.5°C (99.5°F).

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs. You may need steroids or other treatments.

This treatment can affect how your liver works. You will have regular blood tests to check this. If the blood tests show liver changes, your doctor may give you steroids.

Sometimes liver changes can be serious. Contact the hospital straight away if you have any of these symptoms during treatment or after it finishes:

• yellow skin or eyes
• feeling very sleepy
• dark urine (pee)
• unexplained bleeding or bruising
• pain in the right side of your tummy (abdomen)
• loss of appetite.

You may need steroids or other treatments, and may be monitored until your liver recovers.

You may have diarrhoea or tummy (abdominal) pain.

Contact the hospital straight away if you have any of these symptoms during treatment or after it finishes:

• needing to empty your bowels (poo) more than 4 times a day
• waking up at night to empty your bowels 
• pain in your tummy 
• being sick
• blood or mucus in your stools (poo)
• a fever, with a temperature over 37.5°C (99.5°F).

You may need to go into hospital to have fluids through a drip (infusion) or other treatments, such as steroids.

This treatment can make your pancreas swell (pancreatitis). Tell your doctor straight away if you get a sharp pain in your upper tummy area (abdomen) with sickness and vomiting.

This treatment can affect how your kidneys work. This is not common, but if it is not treated it can become serious. You will have regular blood tests to check how your kidneys are working. If tests show kidney changes, your doctor may give you steroids or other treatments.

Contact the hospital straight away if either of these things happen during treatment, or after it finishes:

• you are not passing urine (peeing) at all
• you are only passing very small amounts of urine.

This treatment may raise your blood sugar levels. You will have regular blood tests to check this. Symptoms of raised blood sugar include:

• feeling thirsty
• needing to pass urine (pee) more often
• feeling tired.

Tell your doctor or nurse if you have these symptoms during treatment or after it finishes.

If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this.

This treatment may affect how your body makes hormones. Hormones control many different processes in the body. You will have regular blood tests to check some of your hormone levels. Your doctor may give you drugs to control your hormone levels, and to reduce the risk of side effects such as:

• increased sweating
• weight gain or weight loss
• dizziness or fainting
• feeling more hungry or thirsty than usual
• loss of sex drive
• passing urine (peeing) more often than usual
• headaches that do not go away
• feeling tired (fatigue)
• mood changes.

If you have any of these symptoms during treatment or after it finishes, tell your doctor.

This treatment may cause skin changes, including:

• a rash
• itching
• dry skin
• patches of white or paler skin.

If you are out in the sun, use a suncream with a high sun protection factor (at least SPF 30) to protect your skin. If you notice any skin changes during treatment or after it finishes, always tell your doctor or nurse straight away. You may need creams, steroids or other medicines. Your doctor may stop your treatment until the skin changes improve.

Rarely, a much more serious skin condition can develop. You may have:

• a skin rash which then blisters
• peeling skin
• flu-like symptoms, such as a high temperature and joint pain.

If you have any of these symptoms, contact your doctor or hospital straight away.

This treatment can cause sore or weak muscles. Your joints may also be stiff, sore or swollen. Contact your doctor if you have any of these symptoms during treatment or after it finishes:

• new aches or pains
• new stiffness in a joint
• swollen or red joints.

You may need steroids or other treatments such as painkillers.

This treatment can affect how the heart works. This is not common, but it can be serious. You may have tests to see how well your heart is working. These may be done before, during and after treatment.

Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:

• pain or tightness in your chest
• breathlessness
• dizziness
• changes to your heartbeat.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot contact your doctor, call the NHS urgent advice number on 111.

If your symptoms are caused by this treatment, you may need steroids. You may be monitored in hospital for a time.

This treatment can affect the brain, the lining of the brain and the spinal cord. This is not common but can be serious. During treatment or after treatment finishes, contact a doctor straight away if:

• you have a stiff neck
• you have a headache
• you have a fever or chills
• you vomit
• your eyes are sensitive to light
• you feel confused or sleepy.

If your symptoms are caused by this treatment, you may need steroids and may be monitored in hospital for a time. Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

Feeling tired is a common side effect of this treatment. But sometimes tiredness is a sign that treatment is affecting your hormone levels or nerves. You may need treatment for this.

Contact your doctor straight away if you have either of these symptoms during treatment or after it finishes:

• tiredness that gets worse
• feeling weak or shaky.

If you feel sleepy, do not drive or use machinery.

This treatment can affect the brain and nerves. These effects are not common but if they are not treated quickly, they can become serious. These side effects may be mild to start with. Contact your doctor straight away if you have any of these symptoms during treatment or after it finishes:

• problems fastening buttons or doing other fiddly tasks
• any weakness, numbness or tingling in your arms, legs or face
• headaches
• feeling drowsy or confused
• problems with moving or speaking
• any unexplained pain in other parts of your body.

You may need steroids and other treatments.

This treatment can affect your eyes and eyesight. Contact your doctor straight away if you have any of these symptoms during treatment or after it finishes:

• sore, painful, or swollen eyes
• eyes that are sensitive to light
• changes to your eyesight.

You may need steroids or other treatments. A specialist eye doctor (ophthalmologist) may also need to check your eyes.

You may feel sick during treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

This treatment can affect your appetite. Don't worry if you do not eat much for a day or 2. But if your appetite does not come back after a few days, or if you are losing weight, tell your nurse or dietitian. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.

This treatment can reduce the number of white cells in your blood. These cells fight infection. Tell your doctor or nurse if you have any signs of an infection. These include:

• a cough
• a sore throat
• diarrhoea
• needing to pass urine (pee) often.

Contact your doctor or the hospital straight away if:

• your temperature goes over 37.5°C (99.5°F)
• you suddenly feel unwell, even with a normal temperature

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the includes blood to clot. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

• nosebleeds
• bleeding gums
• tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.