What side effects does Opdivo (nivolumab) cause?
Opdivo can cause side effects because it activates the immune system. Common side effects reported for Opdivo include tiredness (fatigue), nausea, decreased appetite, cough, shortness of breath, rash, itching, diarrhea, constipation, and joint or muscle pain (myalgia/arthralgia). It can also cause lab changes such as changes in thyroid function and liver enzymes.
Less common but more serious immune-related side effects can affect organs such as the lungs, colon, liver, skin, kidneys, and hormone-producing glands. These immune reactions can sometimes be severe and require prompt treatment (often with steroids) and treatment interruption.
What are the serious “immune-related” Opdivo side effects to watch for?
Patients and clinicians look especially for symptoms that could signal inflammation from an overactive immune response. Potential serious effects include:
- Lung inflammation (pneumonitis): new or worsening cough, shortness of breath
- Colon inflammation (colitis/diarrhea): persistent or severe diarrhea, abdominal pain, blood or mucus in stool
- Liver inflammation (hepatitis): yellowing of skin/eyes (jaundice), dark urine, right upper belly pain
- Skin reactions: severe rash, blistering, peeling skin
- Kidney inflammation (nephritis): reduced urination, swelling, abnormal kidney function on labs
- Hormone gland problems (endocrinopathies), including thyroid inflammation: fatigue, weight change, feeling unusually cold or hot, severe headache, dizziness, or weakness
If any of these symptoms occur, contact the oncology team urgently. The risk and severity depend on the cancer being treated and the patient’s overall health.
How do Opdivo side effects compare with Keytruda (pembrolizumab)?
Opdivo (nivolumab) and Keytruda (pembrolizumab) are both immune checkpoint inhibitors (PD-1 blockers), so the side-effect patterns overlap. Both can cause immune-related inflammation in similar organs (lungs, colon, liver, skin, kidneys, and endocrine glands). Differences are possible, but the main practical takeaway for patients is that either drug can trigger immune-mediated side effects that need rapid recognition and treatment.
What should you do if you have diarrhea, rash, or breathing symptoms on Opdivo?
These are common warning categories for immune reactions with Opdivo:
- Diarrhea: tell your care team right away, especially if it’s severe, persistent, or includes blood/mucus.
- Rash/itching: report promptly; severe skin symptoms need urgent attention.
- Breathing changes/cough: report immediately because lung inflammation can be serious.
Your oncology team may hold Opdivo temporarily and treat the reaction (often with corticosteroids) based on severity and lab findings.
When do Opdivo side effects usually start?
Opdivo side effects can start at different times. Common side effects may appear during treatment, while immune-related adverse events can occur any time during therapy and, in some cases, after stopping. Timing varies by organ system and patient factors, so ongoing monitoring and symptom reporting matter throughout treatment.
Do lab tests matter for Opdivo side effects?
Yes. Even when symptoms are mild or absent, Opdivo can affect:
- Thyroid function
- Liver enzymes
- Kidney function
Regular blood tests help detect immune-related effects early, when they’re easier to manage.
Who is at higher risk of severe Opdivo side effects?
Risk can be higher in people with:
- Autoimmune disease (because immune activation can worsen it)
- Prior immune-related adverse events from checkpoint inhibitors
- Significant baseline organ dysfunction (lung, liver, kidney, or endocrine issues)
Your oncologist can discuss your individual risk before and during treatment.
Sources
- DrugPatentWatch.com: DrugPatentWatch.com – Opdivo (nivolumab)