Key Takeaways

  • Opdivo’s side effects can range from mild, such as fatigue and rash, to serious, such as severe infections and immune system reactions.
  • Abdominal pain, diarrhea, shortness of breath, and headache were among Opdivo’s more common side effects in studies.
  • Be sure to tell your doctor if you have any symptoms of an infusion-related reaction, such as dizziness, fever or chills, shaking, or itchy skin. A reaction can occur during or after an Opdivo infusion.

Opdivo is used to treat various forms of cancer, including certain forms of lung, colorectal, and skin cancer. It can be prescribed for use in adults or children, depending on the type of cancer. You can refer to the drug’s prescribing information for an overview of all the cancers Opdivo is approved to treat.

The active ingredient in Opdivo is nivolumab. (An active ingredient is what makes a drug work.) The drug is given as an intravenous (IV) infusion (an injection into a vein that’s given over a period of time).

Keep reading to learn about the common, mild, and serious side effects that Opdivo can cause.

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

The more common side effects of Opdivo include:

For more information about some of these side effects, see the “Side effects explained” section.

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

Talk with your doctor about your risk of 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 some of these side effects, see the “Side effects explained” section.

Opdivo may cause mild side effects other than the ones listed here. See the Opdivo prescribing information 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 last long term, talk with your doctor or pharmacist. Try to keep all your appointments to get Opdivo unless your doctor stops your treatment.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medication safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect during Opdivo treatment and want to tell the FDA about it, visit MedWatch or call 800-332-1088.

Opdivo may cause serious side effects. While these are generally rare, some people may be at higher risk of certain serious side effects. For example, your risk of 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 some of these serious side effects, see the “Side effects explained” section.

Talk with your doctor about your risk of 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 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:

  • encephalitis (swelling of your brain caused by an infection)
  • meningitis (swelling of the lining around your brain and spinal cord caused by an infection)
  • diabetic ketoacidosis (dangerously high levels of blood acids called ketones)

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

If you’re feeling disoriented or having difficulty 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 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 prescribing information.

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

When do side effects from Opdivo typically start? And how long do they usually last?

Side effects with Opdivo can happen at any time, including after stopping treatment. And some side effects can go away quickly, while others may be long term.

For example, severe reactions have happened during Opdivo IV infusions. However, these are rare compared with mild or moderate infusion-related reactions. Some people have had reactions within 2 days of their infusion, although this was also rare.

Opdivo may cause your immune system to attack healthy tissues or organs, which can cause inflammation (swelling and damage) of your liver, known as hepatitis. This can happen anytime during treatment with Opdivo or after stopping treatment.

How long a side effect lasts can also vary. For example, hepatitis can be short or long term, depending on the type of hepatitis you develop.

Talk with your doctor to learn more about when possible side effects of Opdivo may start. They can also tell you how long certain side effects may last.

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

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

  • feeling faint or dizzy
  • fever
  • flushing (swelling, warmth, redness, or discoloration in your skin)
  • neck or back pain
  • shaking or chills
  • shortness of breath or wheezing
  • itchy skin or rash

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

Although 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, the healthcare professional giving you your Opdivo infusion may stop the 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.

For more information about infusion-related reactions from Opdivo, talk with your doctor or the healthcare professional who is giving your infusion.

Can Opdivo increase the risk of serious infections?

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

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

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

An 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.

Talk with 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. In rare cases, arthritis 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 Advil (ibuprofen). 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 difficulty 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 develop a severe skin reaction, your doctor may pause or permanently stop your Opdivo treatment. 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 Yervoy (ipilimumab).

What might help

If you develop hepatitis from using Opdivo, your doctor may pause or permanently stop your Opdivo treatment. They’ll manage the condition with a corticosteroid drug, such as prednisone. In some cases, you may need to receive another immune-suppressing drug.

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

  • jaundice (yellowing of the whites of your eyes or skin)
  • pain on the right side of your abdomen
  • dark urine or light stools
  • unusual bleeding or bruising
  • severe nausea or vomiting
  • decreased appetite
  • lethargy (feeling sleepy or sluggish)

Type 1 diabetes

In rare cases, 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:

  • increased thirst or hunger
  • increased urination
  • breath that has a fruity odor
  • weight loss
  • blurry vision
  • fatigue (low energy) or weakness
  • mood changes or irritability

Remember, high blood glucose can cause severe complications. If you have any of the listed symptoms, 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, redness, or discoloration 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 Benadryl (diphenhydramine), 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 whether you should continue receiving this drug.

If you have symptoms of a severe allergic reaction, such as swelling or difficulty 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 whether another cancer treatment is right for you.

Before starting Opdivo treatment, discuss your health history with your doctor. Opdivo may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:

Alcohol 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.

If you drink alcohol, ask your doctor whether it’s safe to consume while being treated with Opdivo.

Pregnancy and breastfeeding while receiving Opdivo

It is not safe to receive Opdivo during pregnancy. If you can 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 IV infusion.

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

It’s not known whether Opdivo is safe to receive while breastfeeding. You should not breastfeed during Opdivo treatment or for at least 5 months after your last infusion.

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

Q:

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

Anonymous

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 Yervoy (ipilimumab).

Symptoms of hypothyroidism include increased weight, fatigue (low 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 difficulty 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.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.