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Chemotherapy and other systemic treatment regimens may change due to COVID-19. Find out more at Systemic Treatment Regimens During COVID-19.

nivolumab

( nye-VOL-ue-mab )
Funding:
New Drug Funding Program
  • Nivolumab - Advanced Melanoma (Unresectable or Metastatic Melanoma)
  • Nivolumab - Advanced or Metastatic Non-Small Cell Lung Cancer
  • Nivolumab - Advanced or Metastatic Renal Cell Carcinoma and No Prior mTOR Inhibitor
  • Nivolumab - Advanced or Metastatic Renal Cell Carcinoma and Prior mTOR Inhibitor
  • Nivolumab - Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck which is Platinum Resistant or Refractory
  • Nivolumab plus Ipilimumab - Advanced Melanoma (Unresectable or Metastatic Melanoma)
  • Nivolumab plus Ipilimumab – Metastatic Renal Cell Carcinoma
  • Nivolumab - Adjuvant Treatment for Completely Resected Stage III or IV Melanoma
  • Nivolumab - Relapsed Classical Hodgkin Lymphoma (cHL) Post-Autologous Stem Cell Transplant (ASCT) or ASCT Ineligible
Other Name(s): Opdivo
Appearance: solution , mixed into larger bags of fluids

Medication Information Sheet
nivolumab (nye-VOL-ue-mab)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Opdivo

 

Appearance:
solution

, mixed into larger bags of fluids

 

What is this medication for?
  • For treating a type of:

    • skin cancer (melanoma) 

    • lung cancer (non-small cell)

    • kidney cancer

    • liver cancer

    • head and neck cancer

    • a type of blood/lymphatic cancer called Hodgkin Lymphoma

  • Nivolumab is an immune therapy drug. For more information on immune therapy, click here.

What should I do before I have this medication?
  • Tell your doctor and pharmacist if you have or had any major medical conditions (such as diabetes) and especially if you have or had:

    • an organ transplant

    • immune conditions (such as ulcerative colitis or Crohn's, rheumatoid arthritis or lupus)

    • problems with your hormone producing glands (such as thyroid, pituitary, adrenal glands, and pancreas)

    • liver, kidney or lung problems

    • active infections

    • if you are taking corticosteroids (such as prednisone) or

    • any allergies

  • Tell your doctor or pharmacist if you are on a low salt diet.

  • People with cancer have a higher risk of getting other cancers or developing blood clots. Some cancer medications may increase these risks, especially if used for a long period of time. Discuss any concerns about this medication with your health care team.

How will this medication affect sex, pregnancy and breastfeeding?
  • The use of this medication in men or women may cause harm to the unborn baby if pregnancy occurs. Let your health care team know if you or your partner is pregnant, becomes pregnant during treatment, or if you are breastfeeding

  • If there is any chance that you or your partner may become pregnant, you and your partner together must: 
    • ► Use 2 effective forms of birth control at the same time while taking this drug. Keep using birth control for at least 5 months after your last dose unless your health care team told you differently. Talk to your health care team to figure out the best method(s) for you and/or your partner.

  • Nivolumab may pass into your breast milk.  Do not breastfeed while using this drug.
  • This medication is unlikely to affect fertility (ability to get pregnant).

How is this medication given?
  • This drug is given by injection into a vein.

  • If you miss an appointment to receive nivolumab, contact your healthcare team to ask when to schedule your next dose.

 

What else do I need to know while on this medication?
  • Although it is unlikely that other medications can affect your treatment, make sure your health care team knows about all of your medicines (prescription or over-the-counter medications, herbals and supplements). Check with your health care team before starting or stopping any of them.

  • For mild aches and pain or fever:

    • If you feel unwell, take your temperature before taking any medications for pain or fever. They may hide a fever. 
       
    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
       
    • Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), including low dose aspirin for heart conditions, may increase your chance of bleeding. Talk to your health care team before you start or stop these medications.
       
    • Talk to your health care team or go to the closest emergency room right away if you have a fever.  See the Fever pamphlet for more information.
  • Drinking alcohol and smoking during your treatment may increase some side effects and make your medication less effective. Speak to your health care team about smoking and drinking alcohol while on treatment.

What are the side effects of this medication?
  • Nivolumab makes your immune system work harder. Your immune system is what fights infections and your cancer.
     
  • When your immune system is working harder, you may have side effects in your bowels, liver, lungs, skin, kidneys, hormones and other organs.
     
  • These side effects may be mild or may become serious or life-threatening in rare cases.
     
  • They may happen during your treatment or weeks to months after your treatment ends.
     
  • You may need urgent treatment (such as a corticosteroid for up to 4 weeks) to treat these side effects

 

 

 

 

 

 

Side effects and what to doWhen to contact doctor?
Common Side Effects (25-49 out of 100 people)

Fatigue (tiredness)

  • Be active and aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise.
  • Pace yourself, do not rush. Put off less important activities. Rest when you need to.
  • Eat well and stay hydrated by drinking at least 6 to 8 glasses of water or other liquids every day (unless your doctor told you to drink more or less).
  • Avoid driving or using machinery if you are feeling tired

See our Fatigue pamphlet for more information. 

Contact your health care team if fatigue is new or worse than normal

Abnormal liver lab tests (maybe severe)

  • You may have yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. Talk to your health care team right away if this happens.
  • Your doctor may monitor your liver regularly with a blood test.
Contact your health care team if no improvement or if severe

 

Side effects and what to doWhen to contact doctor?
Less Common Side Effects (10-24 out of 100 people)

Rash

You may experience itching with a mild rash.

To prevent and treat dry skin,

  • Use skin moisturizer.
  • Protect your skin from the sun and the cold.
  • Use sunscreen with UVA and UVB protection and a SPF of at least 30.

In rare cases, rash may be severe

  • If the rash covers more than a third of your skin (for example your whole trunk or an arm AND a leg) or your skin blisters

Talk to your health care team for advice.

 

 

 

Talk to your health care team or go to the emergency room right away.

Salt imbalances (including potassium, calcium, magnesium and sodium)

It may cause muscle twitching, severe weakness or cramping, confusion and irregular heartbeat.

Get emergency medical help right away

Nausea and vomiting (generally mild)

May occur in hours to days after your treatment. 

If you have nausea or vomiting:

  • Take anti-nausea medication(s) as prescribed to you by your doctor. 
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (e.g. coffee, tea) and alcohol.
  • Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

 Also see Nausea & Vomiting pamphlet for more information.

Contact your health care team if no improvement or if severe

Diarrhea

May happen days to weeks after you get your treatment.

If you have diarrhea :

  • Take anti-diarrhea medication if your health care team prescribed it.
  • Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “diet” drinks), coffee and alcohol as they may make your diarrhea worse.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day. Talk to your health care team if you can’t drink 6-8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy.

​See the Diarrhea pamphlet for more information.

In rare cases, may be severe due to inflammation of the intestines:

  • If you have blood in your stool or 4 to 6 bowel movements a day (if that is not normal for you)

Talk to your health care team for advice.

 

 

 

 

 

 

 

Talk to your health care team or go to the emergency room right away.

Skin pigment changes or lightening of skin colourContact your health care team if no improvement or if severe

 

 

Constipation

To help prevent constipation :

  • Drink more liquids and eat well. Drink at least 6 to 8 cups of liquids each day unless you have been told otherwise.
  • Be Active. Exercise can help to keep you regular.
  • Try to eat more fiber (e.g. fruits with skin, leafy greens and whole grains). If you take opioid pain medication, ask your health care team if eating more fibre is right for you.

To help treat constipation :

  • If you have not had a bowel movement in 2 to 3 days you may need to take a laxative. Ask your health care team what to do.

See the Constipation Pamphlet for more information.

 

 

Contact your health care team if no improvement or if severe

Abnormal kidney lab tests

  • Signs of a kidney problem include swelling, passing very little or no pee, or new unusual weight gain. If you have these signs, call your health care team or go to your closest emergency department.
  • To prevent bladder or kidney problems, drink lots of water or other liquids. Your doctor may ask you to drink at least 6 to 8 cups (2 L) per day on treatment days, unless you have been told otherwise.
  • Your doctor may check your kidney function regularly.
Contact your health care team if no improvement or if severe

 

Other rare, but serious side effects are possible.

If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

  • Problems with your hormone glands which may present as:

    • headaches that will not go away or are unusual
    • unusual tiredness or sleepiness
    • changes in behaviour such as less sex drive
    • feeling irritable, anxious or forgetful
    • dizziness or fainting
    • unexpected changes in your weight
       
  • Itchiness, rash, swollen lips, face or tongue, chest and throat tightness
  • Severe pain in the muscles, dark pee or not peeing as much
  • Muscle weakness, difficulty moving your arms or legs or numbness or tingling in your arms or legs
  • Tingling and or weakness that started in your feet or toes and that is spreading to your upper body
  • Peeing more than normal and feeling very thirsty
  • Chest pain, irregular heart beat, fainting spells or palpitations
  • Pain, swelling and hardening of a vein
  • Swelling in your legs or ankles
  • Pain at the center of your belly that may extend to you back
  • Bloody or coffee-ground coloured stools (poo), red or pink coloured urine (pee)
  • Shortness of breath, cough or coughing up blood that is new
  • Severe headache/confusion or memory problems
  • Unexplained bleeding or bruising or bleeding that will not stop
  • Changes in your vision
  • Rare immune problems after a stem cell transplant or if one is planned (if this applies to you). Your doctor may discuss these with you

 

For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.