Nivolumab

Other Names: Opdivo®

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About this Drug

Nivolumab is used to treat cancer. It is given in the vein (IV).

Possible Side Effects (More Common)

  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding.
  • Tiredness and weakness
  • Joint, muscle and bone pain
  • Back pain
  • Loose bowel movements (diarrhea)
  • Nausea
  • Decreased appetite (decreased hunger)
  • Constipation (not able to move bowels)
  • Cough and trouble breathing
  • Upper respiratory infection
  • Fever
  • Rash and itching
  • Electrolyte changes. Your blood will be checked for electrolyte changes as needed.

Note: Each of the side effects above was reported in 20% or greater of patients treated with nivolumab. Not all possible side effects are included above. Your side effects may be different or more severe if you receive nivolumab in combination with other chemotherapy agents.

Warnings and Precautions

This drug works with your immune system and can cause inflammation in any of your organs and tissues and can change how they work. This may put you at risk for developing serious medical problems which can very rarely be fatal.

Colitis. This is swelling (inflammation) in the colon - symptoms are loose bowel movements (diarrhea), stomach cramping, and sometimes blood in the bowel movements

Changes in liver function. Your liver function will be checked as needed.

Changes in kidney function. Your kidney function will be checked as needed.

Inflammation (swelling) of the lungs which can very rarely be fatal - you may have a dry cough or trouble breathing.

This drug may affect some of your hormone glands (especially the thyroid, adrenals, pituitary and pancreas). Your hormone levels will be checked as needed.

Blood sugar levels may change and you may develop diabetes. If you already have diabetes, changes may need to be made to your diabetes medication.

Severe allergic skin reaction which can very rarely be fatal. You may develop blisters on your skin that are filled with fluid or a severe red rash all over your body that may be painful.

Changes in your central nervous system can happen. The central nervous system is made up of your brain and spinal cord. You could feel:

  • Extreme tiredness
  • Agitation
  • Confusion
  • Hallucinations (see or hear things that are not there)
  • Trouble understanding or speaking
  • Loss of control of your bowels or bladder
  • Eyesight changes
  • Numbness or lack of strength to your arms, legs, face, or body, and coma

If you start to have any of these symptoms let your doctor know right away.

While you are getting this drug in your vein (IV), you may have a reaction to the drug. Sometimes you may be given medication to stop or lessen these side effects. Your nurse will check you closely for these signs:

  • Fever or shaking chills
  • Flushing
  • Facial swelling
  • Feeling dizzy
  • Headache
  • Trouble breathing
  • Rash
  • Itching
  • Chest tightness
  • Chest pain

These reactions may happen after your infusion. If this happens, call 911 for emergency care.

Increased risk of complications, which may very rarely be fatal, in patients who will undergo a stem cell transplant after receiving nivolumab.

Important Information

This drug may be present in the saliva, tears, sweat, urine, stool, vomit, semen, and vaginal secretions. Talk to your doctor and/or your nurse about the necessary precautions to take during this time.

Treating Side Effects

  • To decrease infection, wash your hands regularly.
  • Avoid close contact with people who have a cold, the flu, or other infections.
  • Take your temperature as your doctor or nurse tells you, and whenever you feel like you may have a fever.
  • To help decrease bleeding, use a soft toothbrush. Check with your nurse before using dental floss.
  • Be very careful when using knives or tools.
  • Use an electric shaver instead of a razor.
  • Ask your doctor or nurse about medicines that are available to help stop or lessen constipation, diarrhea and/or nausea.
  • Drink plenty of fluids (a minimum of eight glasses per day is recommended).
  • If you are not able to move your bowels, check with your doctor or nurse before you use any enemas, laxatives, or suppositories.
  • To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help or stop lessen these symptoms.
  • If you get diarrhea, eat low-fiber foods that are high in protein and calories and avoid foods that can irritate your digestive tracts or lead to cramping. Ask your nurse or doctor about medicine that can lessen or stop your diarrhea.
  • To help with decreased appetite, eat small, frequent meals.
  • Eat high caloric food such as pudding, ice cream, yogurt and milkshakes.
  • Manage tiredness by pacing your activities for the day. Be sure to include periods of rest between energy-draining activities.
  • Keeping your pain under control is important to your wellbeing. Please tell your doctor or nurse if you are experiencing pain. • If you have diabetes, keep good control of your blood sugar level. Tell your nurse or your doctor if your glucose levels are higher or lower than normal.
  • If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.
  • Infusion reactions may occur after your infusion. If this happens, call 911 for emergency care.

Food and Drug Interactions

There are no known interactions of nivolumab with food or other medications.

Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

When to Call the Doctor

Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Easy bleeding or bruising
  • Wheezing or trouble breathing
  • Dry cough, or cough with yellow, green or bloody mucus
  • Confusion and/or agitation
  • Hallucinations
  • Trouble understanding or speaking
  • Blurry vision or changes in your eyesight
  • Numbness or lack of strength to your arms, legs, face, or body
  • Feeling dizzy or lightheaded
  • Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or lightheadedness
  • Nausea that stops you from eating or drinking, and/or that is not relieved by prescribed medicines
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • No bowel movement for 3 days or you feel uncomfortable
  • Bad abdominal pain, especially in upper right area
  • Fatigue or extreme weakness that interferes with normal activities
  • Decreased urine
  • Unusual thirst or passing urine often
  • Rash that is not relieved by prescribed medicines
  • Rash or itching
  • Flu-like symptoms: fever, headache, muscle and joint aches, and fatigue (low energy, feeling weak)
  • Signs of liver problems:
    • Dark urine
    • Pale bowel movements
    • Bad stomach pain
    • Feeling very tired and weak
    • Unusual itching
    • Yellowing of the eyes or skin
  • Signs of infusion reaction:
    • Fever or shaking chills
    • Flushing
    • Facial swelling
    • Feeling dizzy
    • Headache
    • Trouble breathing
    • Rash
    • Itching
    • Chest tightness
    • Chest pain
  • If you think you may be pregnant

Reproduction Warnings

  • Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of child bearing potential should use effective methods of birth control during your cancer treatment and for at least 5 months after treatment. Let your doctor know right away if you think you may be pregnant.
  • Breastfeeding warning: It is not known if this drug passes into breast milk. For this reason, women should not breast feed during treatment because this drug could enter the breast milk and cause harm to a breast feeding baby.
  • Fertility warning: Human fertility studies have not been done with this drug. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking.

Revised September 2017