Nivolumab (Opdivo®)

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

The medication helps your body's immune system attack cancer cells. However, as your immune system attacks cancer cells, it can also affect normal organs and tissues. This can cause serious or life-threatening problems.  Tell your provider right away if you have any of the following symptoms:

• Autoimmune Complications: Tell your provider about all of your health conditions. They need to know if you have an autoimmune condition like Crohn’s disease, lupus, or rheumatoid arthritis. These conditions can get worse with immunotherapy.
• Gastrointestinal Problems: Gastrointestinal (GI) problems can include colitis (inflammation of the bowel) and diarrhea. Symptoms are abdominal (belly) pain, cramping, mucus or blood in the stool, dark or tar-like stools, and fever.  Diarrhea can be stools that are looser or more frequent than what you are used to.
• Bowel Obstruction or Perforation: Bowel obstruction is a blockage in your intestines. A perforation is a tear in your intestines. Symptoms of an obstruction or a tear are abdominal (belly) pain, fever, constipation, bloating, and cramping. Call your provider if you are not moving your bowels as often as you normally do.
• Skin Reactions: Skin reactions can include rash, with or without itching (pruritis), sores in your mouth, and blistering or peeling skin. Your provider will suggest ways to manage these issues.  
• Hormone Changes: Your pituitary, thyroid, pancreas, and adrenal glands can be affected by this medication. When these glands are inflamed or irritated, they can make too much or too little of a certain hormone. Some hormone levels can be monitored with blood work. Symptoms of hormonal changes may be: headaches, nausea, vomiting, constipation, rapid heart rate, increased sweating, extreme fatigue, weakness, changes in your voice, changes in memory and concentration, increased hunger or thirst, increased urination, weight gain, hair loss, dizziness, feeling cold all the time, and changes in mood or behavior (including irritability, forgetfulness and decreased sex drive).
• Brain and/or Nerve Problems: Symptoms include headaches, drooping of eyelids, double vision, trouble swallowing, weakness in the arms, legs, or face, or numbness or tingling in the hands or feet.
• Eye Problems: Changes in vision (eyesight), blurry or double vision, and eye pain or redness are symptoms of eye problems. 
• Kidney Problems: Kidney problems, like inflammation or not working as well as they should, can cause decreased urine output, blood in the urine, swelling in the ankles, or loss of appetite (not feeling as hungry). 
• Liver Problems: Hepatitis, or inflammation of the liver, can cause yellowing of the skin or eyes,  dark or brown urine, pain in your abdomen (belly), bleeding or bruising more easily than normal, or severe nausea and vomiting.
• Lung Problems: This medication can cause pneumonitis, which is inflammation of the lungs. Symptoms are a new or worsening cough, shortness of breath, trouble breathing, or chest pain.
• Pancreas Problems: Signs can be bloating, indigestion, fatty stools, loss of appetite, sweating, abdominal (belly) pain, and weight loss.

Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

Some people may have an allergic reaction to this medication. Signs of an allergic reaction are:

• Shortness of breath or trouble breathing.
• Chest pain.
• Rash.
• Itching.
• Flushing (reddening of the skin, often on the face, neck, or chest).
• A drop in blood pressure (you may feel lightheaded, dizzy, or weak).

If you have any of these signs while you are getting an infusion, tell your provider right away. The infusion will be slowed down or stopped. Depending on your reaction, you may still be able to get the medication if you are given medicine to prevent a reaction or if the medication is given at a slower rate.