If you have cancer and your doctor recommends Opdivo to treat it, you may be wondering what side effects this drug might cause.

Opdivo (nivolumab) is a brand-name prescription medication used in adults to treat certain types of cancer. These include specific forms of bladder, colorectal, and esophageal cancer, as well as several other cancer types. It’s also used in some children to treat colorectal cancer.

Opdivo is a biologic drug (a type of drug made from living cells). Specifically, it’s an immunotherapy treatment, which means it can cause side effects involving your immune system. It’s given as an intravenous infusion (an injection into a vein that’s given over a period of time). For more information about Opdivo, see this in-depth article.

Opdivo may be a long-term cancer treatment. Your doctor will decide the length of your treatment based on various factors, including what side effects you experience.

Read on to learn more about the possible mild and serious side effects of Opdivo.

Like all drugs, Opdivo may cause side effects in some people.

The more common side effects of Opdivo include:

For more information about rash as well as muscle, bone, and joint pain, see the “Side effects explained” section below.

Certain side effects may be more common if other cancer drugs, such as ipilimumab (Yervoy), are part of your treatment plan. You may have a higher risk for certain side effects depending on the type of cancer you have.

Talk with your doctor about your risk for side effects, given your specific treatment plan. Also tell them about any side effect symptoms you may have.

Learn more about Opdivo’s side effects in the next sections.

You may experience mild side effects with Opdivo, such as:

For more information about muscle, bone, and joint pain, see the “Side effects explained” section below.

Opdivo may cause mild side effects other than the ones listed above. See the Opdivo Medication Guide for details.

Opdivo’s mild side effects should be manageable, and they’ll likely go away during your treatment. But some could also be signs of more serious side effects.

If any side effects bother you, get worse, or don’t go away, talk with your doctor or pharmacist. Try to keep all of your appointments to get Opdivo unless your doctor stops your treatment.

Opdivo may cause serious side effects. While these are generally rare, some people may be at higher risk for certain serious side effects. For example, your risk for some side effects may increase if you’re receiving both Opdivo and other drugs for your cancer.

Call your doctor right away if you’re having any new or worsening symptoms. If your symptoms feel life threatening, call 911 or get emergency medical care right away.

Serious side effects can include:

For more information on hepatitis, type 1 diabetes, and allergic reaction, see the “Side effects explained” section below.

Talk with your doctor about your risk for serious side effects. Also let them know about any concerns you may have.

Get answers to some frequently asked questions about Opdivo’s side effects.

Does Opdivo cause confusion?

No, Opdivo shouldn’t cause confusion. In clinical studies of Opdivo, confusion wasn’t a reported side effect.

However, confusion may be a symptom of rare, serious side effects of Opdivo, such as:

Also, Opdivo can cause hyponatremia (low blood sodium levels). Confusion is a symptom of this condition, which was a common side effect in certain clinical studies of Opdivo.

If you’re feeling disoriented or having trouble thinking clearly during Opdivo treatment, contact your doctor right away.

When Opdivo is used to treat melanoma, what kind of side effects does it cause?

In clinical studies of Opdivo as a melanoma treatment, reported side effects were similar to those researchers found when looking at the drug to treat other cancers.

However, Opdivo isn’t always used alone to treat melanoma. The risk of side effects may differ depending on your treatment plan. For more information, see the Opdivo Medication Guide.

If you’re receiving Opdivo infusions to treat melanoma, ask your doctor about your side effect risks.

When do side effects from Opdivo typically start?

Side effects with Opdivo can happen at any time, including after stopping treatment.

For example, severe reactions have happened during Opdivo infusions. However, these are rare compared with mild or moderate infusion-related reactions. Some people have had reactions within 2 days after their infusion, although these are rare as well.

Opdivo may cause your immune system to attack healthy tissues or organs. This can happen anytime during or after stopping Opdivo treatment.

What are some of the symptoms of severe infusion-related reactions?

Symptoms of a severe reaction that may happen during an Opdivo infusion can include:

If you have these or other symptoms during an Opdivo infusion, immediately tell the healthcare provider who is giving you the infusion.

Though rare, people have had reactions up to 2 days after their infusion. You should watch for any new or bothersome symptoms on the days between your infusions, too.

If you have a severe reaction, your healthcare provider may stop your Opdivo infusion. If you have a mild or moderate reaction during your infusion, they may slow the rate of infusion or pause it to help manage your symptoms.

Can Opdivo increase the risk of serious infections?

Yes, it can. For example, Opdivo treatment could increase your risk for pneumonia. Pneumonia is a serious infection of the air sacs in one or both of your lungs.

In clinical studies for certain cancers, pneumonia was one of the more common serious reactions when Opdivo was used alone or with the cancer drug ipilimumab (Yervoy).

In clinical studies for certain cancers, rare but fatal infections have also occurred when Opdivo was used alone or with other cancer drugs.

Upper respiratory tract infection, such as a cold, is a common side effect of Opdivo. Though upper respiratory tract infections aren’t usually serious, they can lead to secondary infections such as pneumonia.

See your doctor if you have any infection symptoms such as a cough, shortness of breath, or fever.

Learn more about some of the side effects Opdivo may cause.

Pain in the joints and other areas

You may have painful joints from treatment with Opdivo. Joint pain is a common side effect of the drug.

Muscle, back, and bone pain are also common side effects of Opdivo.

Opdivo can cause your immune system to attack healthy tissues, even after you’ve stopped the drug. This can happen to any part of your body, including your joints. Rarely, arthritis (swelling in your joints) has occurred with Opdivo treatment.

What might help

If you’re experiencing pain in your joints or other areas of your body during or after Opdivo treatment, talk with your doctor. They can check your symptoms and suggest ways you can manage them.

For mild joint pain, they may recommend you take an over-the-counter pain reliever, such as ibuprofen (Advil or Motrin). They may also suggest applying ice packs or warm compresses to your joints.

Rash

Rash is a common side effect of Opdivo.

In rare cases, Opdivo may cause a severe skin reaction, such as Stevens-Johnson syndrome. It may also result in allergic reactions, which may be mild or serious. Rash can be a symptom of both of these reactions.

What might help

During and after Opdivo treatment, contact your doctor if you have a rash that bothers you, gets worse, or doesn’t go away. Get emergency medical care right away if you have blisters, peeling skin, or rash accompanied by fever, swelling, or trouble breathing. These could be signs of a severe, life threatening reaction.

If your symptoms are mild to moderate, your doctor may suggest that you manage them with a topical cream or ointment, such as hydrocortisone cream.

If you’re having a severe skin reaction, your healthcare provider will pause or permanently stop your Opdivo infusions. They’ll manage the reaction with corticosteroids, such as prednisone, or other immune-suppressing drugs.

Hepatitis

Though rare, Opdivo treatment may cause your immune system to attack healthy tissues, including your liver. When this happens, it can cause inflammation (swelling and damage) of your liver known as hepatitis.

This side effect may be more likely to happen if your treatment plan includes both Opdivo and the cancer drug ipilimumab (Yervoy).

What might help

If you have hepatitis from Opdivo treatment, your healthcare provider will pause or permanently stop your infusions. They’ll manage the condition with a corticosteroid drug, such as prednisone. In some cases, you may need to take another immune-suppressing drug.

During and after stopping Opdivo treatment, tell your doctor if you have any symptoms of hepatitis, such as:

Type 1 diabetes

Rarely, Opdivo may cause type 1 diabetes. With type 1 diabetes, your blood glucose (sugar) level becomes too high because your pancreas isn’t releasing insulin. If untreated, this can lead to serious complications. An example is diabetic ketoacidosis (high levels of blood acids called ketones), which can be fatal.

What might help

Your doctor may check your blood glucose level while you’re getting Opdivo. During and after your treatment, watch for any diabetes or ketoacidosis symptoms, such as:

Remember, high blood glucose can cause severe complications. If you have any of the symptoms listed above, see your doctor or get medical care right away.

Allergic reaction

Like most drugs, Opdivo can cause an allergic reaction in some people. Symptoms can be mild or serious and can include:

  • rash
  • itchiness
  • flushing (warmth, swelling, or redness in your skin)
  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

For mild symptoms of an allergic reaction, such as a mild skin rash or itching, call your doctor right away. They may suggest an over-the-counter oral antihistamine, such as diphenhydramine (Benadryl), or a topical product, like hydrocortisone cream, to manage your allergic reaction.

If your doctor confirms you had a mild allergic reaction to Opdivo, they’ll decide if you should continue receiving this drug.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you had a serious allergic reaction to Opdivo, they’ll stop your Opdivo treatment and decide if another cancer treatment is right for you.

Keeping track of any side effects

During your Opdivo treatment, consider keeping notes on any side effects you’re having. Then, you can share this information with your doctor. This is especially helpful to do when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things like:

  • what dose of drug you were getting when you had the side effect
  • how soon after starting that dose you had the side effect
  • what your symptoms were from the side effect
  • how it affected your daily activities
  • what other medications you were also taking
  • any other information you feel is important

Sharing such notes with your doctor will help your doctor learn more about how Opdivo affects you. Your doctor can also use this information to adjust your treatment plan if needed.

Opdivo may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before starting Opdivo. Factors to consider include those mentioned below.

Stem cell or organ transplant. Opdivo treatment before or after an allogenic hematopoietic stem cell transplant (transplant of blood-forming cells from a genetic match) could cause serious or fatal problems.

If you’re planning a stem cell transplant or have had one, talk with your doctor about the safety of Opdivo treatment. Also tell your doctor if you’ve received an organ transplant.

Allergic reaction. If you’ve had an allergic reaction to Opdivo or any of its ingredients, Opdivo shouldn’t be part of your cancer treatment. Ask your doctor what other medications are better options for you.

Immune system problems. With Opdivo treatment, your immune system may attack healthy tissues.

Before starting Opdivo, tell your doctor if you have an autoimmune or inflammatory condition, such as Crohn’s disease, ulcerative colitis, or lupus. Tell them even if your condition is in remission (times when you’re symptom-free).

History of chest radiation. Opdivo may cause a serious side effect of the lungs called pneumonitis. Your risk for pneumonitis may be higher if you’ve had radiation treatment to your chest.

Before starting Opdivo, tell your doctor about any past chest radiation treatments you’ve had and if you’ve received other drugs similar to Opdivo.

Nervous system problems. In rare cases, Opdivo treatment may cause your immune system to attack your nervous system, including your brain, spinal cord, or nerves.

Before starting Opdivo, tell your doctor if you’ve had a condition that affects your nervous system, such as myasthenia gravis or Guillain-Barré syndrome.

Alcohol use and Opdivo

Opdivo doesn’t interact with alcohol.

However, alcohol can harm your liver. In rare cases, Opdivo can cause inflammation (swelling and damage) of your liver known as hepatitis. Opdivo can be used to treat some liver cancers.

Ask your doctor if it’s safe to consume alcohol while being treated with Opdivo.

Pregnancy and breastfeeding while taking Opdivo

It’s unsafe to be treated with Opdivo during pregnancy. If you’re able to become pregnant, you’ll need to get a pregnancy test before starting Opdivo to make sure you’re not pregnant.

You’ll also need to use effective birth control during treatment and for at least 5 months after your last infusion.

Opdivo’s manufacturer hasn’t given recommendations about contraception for people taking Opdivo who have a partner who can become pregnant. If you have questions or concerns about this, talk with your doctor.

It’s unknown if Opdivo is safe to use while breastfeeding. You shouldn’t breastfeed during Opdivo treatment or for at least 5 months after your last infusion.

Before starting Opdivo, talk with your doctor about safe ways to feed your child.

Opdivo may help treat your type of cancer. At the same time, it can put you at risk for rare but serious side effects. However, most common symptoms of Opdivo are mild or manageable.

If you’re wondering about Opdivo’s side effects, talk with your doctor or pharmacist. Ask questions to get the answers you need to feel confident about your cancer treatment. Here are a few to get you started:

  • Are there other ways to help me manage side effects from Opdivo?
  • I have rheumatoid arthritis. Am I at higher risk for side effects from Opdivo?
  • What could happen if I become pregnant during Opdivo treatment?

Q:

My doctor said thyroid problems are possible serious side effects of Opdivo. What symptoms should I watch for?

Anonymous patient

A:

Opdivo may cause your immune system to attack your thyroid gland, resulting in thyroiditis (inflammation of the thyroid gland). Though thyroiditis isn’t usually serious, it can lead to hypothyroidism (low thyroid levels) or hyperthyroidism (high thyroid levels).

Hypothyroidism may happen more often, especially when Opdivo is used with ipilimumab (Yervoy).

Symptoms of hypothyroidism include increased weight, fatigue (lack of energy), and feeling cold. They also include a slow heart rate, depression, and a puffy face.

Symptoms of hyperthyroidism include a fast heart rate, high blood pressure, shaking hands, and trouble sleeping.

Call your doctor if you have any of the above symptoms. They may pause or stop your Opdivo treatment depending on how severe the side effect is. Your doctor may also recommend that you take other medication to treat your hypothyroidism or hyperthyroidism.

Melissa Badowski, PharmD, MPH, FCCPAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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