Common Side Effects During Infusion
Opdivo (nivolumab) infusions can trigger immediate reactions like fatigue, chills, fever, itching, rash, nausea, diarrhea, and low blood pressure. These often occur within hours of administration and affect over 10% of patients in clinical trials.[1][2]
Immune-Related Side Effects
As a PD-1 inhibitor, Opdivo boosts immune activity, which can attack healthy tissues. Frequent issues include:
- Skin: Rash, pruritus (up to 40% of patients).
- Gastrointestinal: Colitis, diarrhea (15-20%).
- Endocrine: Thyroid dysfunction, adrenal insufficiency (10-15%).
- Pulmonary: Pneumonitis (3-5%, potentially severe).
- Liver: Hepatitis (1-5%).
These may appear weeks to months after starting and require steroids or treatment pauses.[1][3]
Severe or Life-Threatening Reactions
Rare but serious effects hit 1-5% of users:
- Severe infusion reactions (anaphylaxis-like).
- Myocarditis or neurological issues like encephalitis.
- Toxic epidermal necrolysis or Stevens-Johnson syndrome.
Fatal outcomes occur in under 1% from organ inflammation.[2][4]
Side Effects by Cancer Type or Combination Therapy
Reactions intensify with combos like Opdivo + Yervoy (ipilimumab):
- Higher colitis (40%) and hepatitis (20%) rates.
Lung cancer patients see more pneumonitis; melanoma users report more skin issues. Long-term use (over 1 year) raises endocrine risks.[1][3]
What Happens if Side Effects Occur
Mild cases need monitoring; severe ones stop infusions and use immunosuppressants. Patients on blood thinners face bleeding risks from colitis. Regular blood tests track thyroid/liver function.[2]
Patient-Reported Experiences
Forum discussions highlight persistent fatigue (lasting months post-treatment), joint pain, and hypothyroidism requiring lifelong meds. Some recover fully after discontinuation.[4]
[1]: Opdivo Prescribing Information (Bristol Myers Squibb)
[2]: FDA Label for Nivolumab
[3]: NCCN Guidelines for Immunotherapy Toxicity
[4]: Cancer.gov - PD-1/PD-L1 Inhibitors Side Effects