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 make the immune system more active so it can better attack cancer cells.  However, as the immune system attacks cancer cells, it can also affect normal organs and tissues in the body. This can cause serious or life-threatening problems.  Tell your provider right away if you have any of the following symptoms:

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.

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.  

This medication can cause pneumonitis, which is inflammation of the lungs. Symptoms may be a new or worsening cough, shortness of breath, trouble breathing, or chest pain.

Hepatitis, or inflammation of the liver, can cause yellowing of the skin or eyes, your urine appears dark or brown, pain in your abdomen (belly), bleeding or bruising more easily than normal, or severe nausea and vomiting.

Symptoms can be headaches, drooping of eyelids, double vision, trouble swallowing, weakness of arms, legs, or face, or numbness or tingling in the hands or feet.

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).

Changes in vision (eyesight), blurry or double vision, and eye pain or redness are symptoms of eye problems. 

Kidney problems, like inflammation and not working as well as they should, can cause less urine output, blood in your urine, swelling in your ankles, or loss of appetite (not feeling as hungry). 

This medication can cause inflammation of the heart muscle. Call your provider if you have:

• Chest pain.
• Shortness of breath.
• Trouble breathing when lying down.
• Feeling like you can’t catch your breath when you wake up.
• Feeling like your heart is racing.
• Swelling in your feet or legs.
• Feeling lightheaded or faint.

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.