Opdivo (nivolumab)

Opdivo generic or biosimilar

Opdivo is available only as a brand-name medication. It’s not currently available in biosimilar form.

A biosimilar is a drug that’s similar to a brand-name biologic drug, referred to as the parent drug. Opdivo is a biologic medication, which is also called a biologic.

Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication. Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

Opdivo side effects

Opdivo can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while using Opdivo. These lists do not include all possible side effects.

For more information on the possible side effects of Opdivo, see this article. You can also talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

More common side effects

The more common side effects of Opdivo can include:

• headache
• abdominal pain
• nausea
• vomiting
• diarrhea
• constipation
• loss of appetite
• skin rash
• fatigue
• muscle pain
• bone pain
• back pain
• joint pain
• itchiness
• weakness
• cough
• shortness of breath
• upper respiratory infections, such as the common cold
• fever
• weight loss

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Opdivo can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

• Hepatitis (inflammation in your liver). Symptoms can include:
  • nausea
  • vomiting
  • loss of appetite
  • itchiness
  • jaundice (yellowing of your skin and the whites of your eyes)
• Hormonal problems, including changes in thyroid hormone and cortisol levels. Symptoms can include:
  • fatigue
  • loss of appetite
  • weight loss
  • weakness
  • trouble sleeping
• Type 1 diabetes. Symptoms can include:
  • feeling very hungry or thirsty
  • fatigue
  • urinating more often than usual
  • weight loss
• Kidney damage. Symptoms can include:
  • decreased urine output
  • nausea
  • vomiting
  • swelling in your legs and feet
  • blood in your urine
• Severe skin reactions, including Stevens-Johnson syndrome. Symptoms can include:
  • severe rash
  • discolored skin
  • blisters on your skin
  • pus-filled lesions on your skin
• Encephalitis (swelling in your brain). Symptoms can include:
  • headache
  • fever
  • sensitivity to light
  • weakness
  • confusion
  • seizures
• Infusion reactions (reactions that occur during or shortly after you receive a drug by intravenous [IV] infusion). Symptoms can include:
  • skin rash
  • itchiness
  • low blood pressure
  • trouble breathing
• Immune system reaction (when your immune system attacks your organs). This can cause swelling in other parts of your body, including your:
  • muscles
  • heart
  • nerves
  • stomach
  • eyes

Other serious side effects, which are discussed in detail below, include:

• pneumonitis (inflammation in your lungs)
• colitis (inflammation in your intestines)
• severe allergic reaction

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on several of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after using Opdivo. It’s not known how many people have had allergic reactions to Opdivo. Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have a severe allergic reaction to Opdivo. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Skin rash

You may have a skin rash while using Opdivo. This is one of the most common side effects of the drug.

In clinical studies, between 16% and 40% of people who took Opdivo alone had a skin rash. For people who took other cancer drugs, between 7% and 47% had a skin rash.

The percentage of people who had a skin rash while using Opdivo varied depending on the condition that Opdivo was being used to treat. The percentage also varied depending on whether people were using Opdivo in combination with another cancer treatment.

If you have a skin rash while you’re using Opdivo, talk with your doctor. They will monitor the rash and recommend ways to reduce any discomfort it causes.

Pneumonitis

Pneumonitis (inflammation in your lungs) is a serious, and possibly life threatening, side effect of Opdivo. Symptoms of pneumonitis include:

• fever
• muscle or joint pain
• chills
• dry cough
• tightness in your chest
• fatigue

In clinical studies, pneumonitis was reported in 3.1% of people who took Opdivo alone. Pneumonitis was reported in up to 10% of people who took Opdivo in combination with another cancer treatment called ipilimumab (Yervoy).

Talk with your doctor about how to recognize the symptoms of pneumonitis. Your doctor can discuss with you when you should be concerned about your symptoms and when you should call for help.

If you have pneumonitis, you may need to take corticosteroids (such as prednisone) to reduce the swelling in your lungs. You may also need to stop receiving Opdivo for a while until your symptoms go away. If you have severe pneumonitis while you’re receiving Opdivo, your doctor may recommend that you permanently stop Opdivo treatment.

Joint pain

You many have joint pain while you’re using Opdivo. This is one of the more common side effects of the drug.

In clinical studies, joint pain was reported in up to 21% of people who took Opdivo alone. The percentage of people who had joint pain varied depending on whether Opdivo was used in combination with other drugs. The percentage also differed depending on which condition Opdivo was used to treat.

If you have joint pain while you’re receiving Opdivo, talk with your doctor about ways to manage your pain.

Fatigue

You may have fatigue while you’re receiving Opdivo. This is one of the most common side effects of the drug.

In clinical studies, up to 59% of people who took Opdivo alone had fatigue.

If you have fatigue while you’re receiving Opdivo, tell your doctor. They can recommend ways to improve your energy levels during treatment.

Diarrhea

You may have diarrhea while you’re using Opdivo. This is one of the most common side effects of the drug.

In clinical studies, up to 43% of people who took Opdivo alone had diarrhea. The percentage was usually higher when people took Opdivo in combination with the cancer drug ipilimumab. A similar percentage of people who took cancer treatments other than Opdivo also had diarrhea in clinical studies.

If you have diarrhea while you’re using Opdivo, tell your doctor. They can recommend ways to reduce this side effect. They can also recommend ways to prevent dehydration (low fluid level in your body), which can be caused by diarrhea.

Diarrhea may be a symptom of colitis (see “Colitis” below). This condition is a serious side effect of Opdivo.

Tell your doctor right away if you have severe diarrhea (diarrhea that’s painful or doesn’t stop). Your doctor may stop your Opdivo treatment for a while to allow your colon to heal. If your diarrhea is very severe, your doctor may stop your Opdivo treatment permanently.

Colitis

Colitis (inflammation in your intestines) is a serious side effect of Opdivo. This condition can occur when your immune system attacks the lining of your colon by mistake. This causes diarrhea and swelling in your colon.

Symptoms of colitis include:

• abdominal pain and cramps
• bloating
• diarrhea, with or without blood in it
• blood in your stool
• urgent need to move your bowels
• weight loss

In clinical studies, 2.9% of people who took Opdivo alone had colitis. This condition was seen in up to 26% of people who took Opdivo with the cancer drug ipilimumab.

If you develop colitis while you’re receiving Opdivo, you may need to take corticosteroids, such as prednisone. You may also need to stop Opdivo treatment until your symptoms go away. If you have severe colitis, your doctor may recommend that you permanently stop Opdivo treatment.

If you have concerning symptoms of diarrhea and abdominal pain, talk with your doctor right away.

Back pain

You may have back pain while you’re using Opdivo. This is a common side effect of the drug.

In one clinical study, 21% of people who took Opdivo had back pain. This side effect was seen in 16% of people who took another cancer drug called everolimus (Afinitor).

Muscle pain and bone pain were also commonly reported in studies. In clinical studies, up to 42% of people receiving Opdivo had muscle and bone pain.

The percentage of people who had muscle or bone pain during Opdivo treatment varied depending on whether Opdivo was used in combination with other drugs. It also differed depending on which condition Opdivo was being used to treat.

If you have back pain while you’re receiving Opdivo, talk with your doctor about ways to treat your pain.

Nausea

You may have nausea while you’re using Opdivo. This is a common side effect of the drug.

In clinical studies, up to 34% of people who took Opdivo alone had nausea. The number of people who had nausea varied depending on which condition Opdivo was used to treat, and whether the drug was being used in combination with other treatments.

If you have nausea while you’re receiving Opdivo, talk with your doctor about ways to manage this side effect.

Cough

You may develop a cough while you’re using Opdivo. Cough is one of the common side effects of Opdivo.

In clinical studies, up to 37% of people who took Opdivo had a cough. This number was different depending on which condition Opdivo was treating. It also varied depending on whether Opdivo was used in combination with other medications.

If you have a cough while you’re using Opdivo, talk with your doctor. They’ll check to make sure that your cough isn’t a symptom of a more serious side effect, including pneumonitis. (See the section “Pneumonitis” above.) Your doctor can also recommend ways to help relieve this side effect.

Shortness of breath

You may have shortness of breath while you’re using Opdivo. This is a common side effect of the drug.

In clinical studies, up to 27% of people who took Opdivo had shortness of breath. The number of people who had this side effect varied depending on which condition they were treating, and whether Opdivo was used in combination with other cancer treatments.

If you have shortness of breath while you’re receiving Opdivo, talk with your doctor. They’ll check to make sure that your shortness of breath isn’t a symptom of a more serious side effect, including pneumonitis. (See the section “Pneumonitis” above.) Your doctor can also recommend ways to improve the quality of your breathing.

Headache

You may have headaches while you’re using Opdivo.

In clinical studies, up to 23% of people who took Opdivo reported having a headache. This percentage varied depending on which condition Opdivo was used to treat, and whether the drug was used in combination with other medications.

If you have headaches while you’re using Opdivo, talk with your doctor. They can recommend safe ways to treat your headaches.

Hair loss

Hair loss isn’t a common side effect of Opdivo. However, it could be a symptom of hormonal problems, which are a more serious side effect of Opdivo.

One hormonal problem that can occur with Opdivo use is hypothyroidism (low thyroid hormone levels). Your body needs normal thyroid hormone levels to maintain healthy hair growth. When your thyroid hormone levels are too low, hair loss can occur.

In clinical studies, 8% of people who took Opdivo on its own had low thyroid hormone levels. Of those who took Opdivo with another cancer drug called ipilimumab, 15% to 22% of people had low thyroid hormone levels.

If you have hair loss while you’re receiving Opdivo, talk with your doctor. They will check to see whether your hair loss is related to hormonal problems. If needed, they can prescribe treatment to help regulate your hormone levels.

Side effects in children

Side effects in children are expected to be similar to side effects in adults, when Opdivo is used to treat certain skin or colorectal cancers. These are the only conditions that Opdivo is approved to treat in children.

However, there haven’t been any clinical studies testing the safety of Opdivo or how often side effects occur in children using the drug.

Opdivo for lung cancer

The Food and Drug Administration (FDA) approves prescription drugs such as Opdivo to treat certain conditions. Below you’ll find information on Opdivo for treating certain types of lung cancer. To learn more about Opdivo’s use for this condition, see this article. And you can find more information about this condition in our lung cancer hub.

Opdivo for non-small cell lung cancer

Opdivo is FDA-approved to treat certain types of non-small cell lung cancer (NSCLC), as described below.

Opdivo for metastatic NSCLC

Doctors may prescribe Opdivo for NSCLC that’s metastatic (has spread from the lungs to other parts of the body).

It’s approved for use in adults whose NSCLC has gotten worse during or after treatment with certain chemotherapy drugs. Examples of these chemotherapy drugs include cisplatin and carboplatin.

Some people’s NSCLC has certain genetic changes, called either EGFR or ALK. People with these genetic changes need to receive medication that’s FDA-approved to treat that specific type of cancer before they use Opdivo. Their cancer should have gotten worse during or after treatment with those drugs before they can receive Opdivo.

Opdivo is also approved for previously untreated NSCLC that is metastatic and has a high level of protein called PD-L1 on the surface. For this use, the cancer must not have EGFR or ALK genetic changes. To treat this type of cancer, Opdivo is used in combination with ipilimumab (Yervoy).

The drug may also be used for previously untreated NSCLC that is metastatic or recurrent (comes back) in combination with ipilimumab and certain chemotherapy drugs, such as cisplatin and carboplatin. For this use, the cancer must not have EGFR or ALK genetic changes.

Opdivo for resectable NSCLC

Opdivo is FDA-approved to treat NSCLC that’s resectable (can be removed by surgery) in adults. For this purpose, the drug is used in combination with certain platinum-based chemotherapy drugs prior to surgery to help shrink tumors. Examples of such chemotherapy drugs include cisplatin and carboplatin.

Effectiveness for non-small cell lung cancer

Opdivo has been found effective in treating metastatic NSCLC that has gotten worse during or after treatment with other medications.

A clinical study included people with squamous NSCLC. (Squamous cells are flat cells that line parts of your body, including the airways in your lungs.) The people took either Opdivo or docetaxel (Taxotere). Those using Opdivo had a 41% lower risk of dying compared with people using docetaxel.

In another clinical study, people with non-squamous NSCLC took either Opdivo or docetaxel. In this study, those who took Opdivo had a 27% lower risk of dying compared with people using docetaxel.

Opdivo has also been found effective in treating NSCLC prior to surgery when used in combination with certain chemotherapy drugs. For details, see Opdivo’s prescribing information.

Opdivo other uses

In addition to treating lung cancer (described in the section “Opdivo for lung cancer” just above), the Food and Drug Administration (FDA) has also approved Opdivo to treat other conditions. Opdivo may also be prescribed off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Opdivo for liver cancer

Opdivo is FDA-approved to treat hepatocellular (liver) cancer in adults when used in combination with ipilimumab (Yervoy). It’s used for people who’ve taken the drug sorafenib (Nexavar) in the past to treat their liver cancer.

For this use, Opdivo received accelerated approval from the Food and Drug Administration (FDA). Accelerated approval is based on information from early studies. The FDA’s decision for full approval will be made after additional studies are completed.

To learn more about this condition, see our list of liver cancer articles.

Effectiveness for liver cancer

Opdivo has been found effective in a clinical study to treat liver cancer. In this study, the overall response rate (the percentage of people whose cancer has become smaller or disappeared) is 33% for those who took Opdivo. Of people whose cancer became smaller or disappeared:

• 88% kept this response for at least 6 months
• 56% kept this response for at least 1 year

Opdivo for kidney cancer

Opdivo is FDA-approved to treat advanced renal cell (kidney) cancer in adults. Opdivo is approved for use in the following people:

Those who’ve taken anti-angiogenesis drugs in the past for their kidney cancer. These drugs block the growth of blood vessels in and around cancer cells. This prevents the cancer cells from getting nutrients and oxygen, which they need in order to survive. Examples of anti-angiogenesis drugs include axitinib (Inlyta) and lenalidomide (Revlimid). In this case, Opdivo is used on its own.

Those who haven’t received treatment in the past for their kidney cancer. In these people, Opdivo is used in combination with another drug. Which drug is prescribed depends on whether the kidney cancer is considered intermediate or poor risk. Kidney cancer is considered intermediate or poor risk based on several factors. These factors include your hemoglobin levels and calcium levels.

For kidney cancer that is considered intermediate or poor risk, Opdivo is used with ipilimumab. Otherwise, Opdivo is used with cabozantinib (Cabometyx).

Effectiveness for kidney cancer

Opdivo has been found effective in treating kidney cancer.

One clinical study looked at people whose kidney cancer had gotten worse during or after anti-angiogenesis treatment. The people received either Opdivo or another cancer drug called everolimus (Afinitor).

In this study, half of the people who took Opdivo lived for 25 months or longer. Of those who took everolimus, half of the people lived for 19.6 months or longer. The percentage of people whose cancer became smaller or disappeared was 21.5% in those using Opdivo, and 3.9% in those using everolimus.

Another clinical study looked at people who had kidney cancer that hadn’t been treated in the past and whose kidney cancer is considered intermediate or poor risk. People received either Opdivo with ipilimumab or another cancer drug called sunitinib. In this study, people using the Opdivo treatment combination had a 37% lower risk of dying compared with those who were using sunitinib (Sutent).

Opdivo has also been found to be effective when used with cabozantinib for previously untreated kidney cancer that wasn’t considered intermediate or poor risk. For more information, see the drug’s prescribing information.

Opdivo for bladder cancer

Opdivo is FDA-approved to treat urothelial cancer in adults. This type of cancer starts in the cells that line your bladder, ureters, and urethra. Urothelial cancer is often called bladder cancer.

Opdivo is used to treat bladder cancer that has spread to organs near the bladder (locally advanced cancer). Opdivo is also used to treat bladder cancer that has spread from the bladder to other areas in the body (metastatic cancer).

Opdivo is used in people whose bladder cancer has gotten worse during or after treatment with other cancer drugs. These drugs include cisplatin or carboplatin.

The drug is also used to help prevent certain bladder cancers from returning after surgery when there is a high risk of the cancer coming back.

Effectiveness for bladder cancer

Opdivo has been found effective in treating bladder cancer. In a clinical study, the overall response rate (the percentage of people whose cancer became smaller or disappeared) was measured. This rate was 19.6% in people who took Opdivo. Half of these people maintained this response for 10.3 months or longer.

The drug has also been found effective for helping prevent bladder cancer from returning after surgery when there is a high risk of the cancer coming back. For more information, see the drug’s prescribing information.

Opdivo for colorectal cancer

Opdivo is FDA-approved to treat colorectal cancer (CRC). This type of cancer starts in your colon or rectum.

Opdivo is approved for use in adults and children ages 12 years and older with CRC that:

• is metastatic (has spread from the colon or rectum to other parts of the body)
• has gotten worse after treatment with certain other cancer drugs, such as oxaliplatin (Eloxatin), irinotecan (Camptosar), and a drug that contains fluoropyrimidine, such as capecitabine (Xeloda)
• has certain genetic changes called either microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR)

Opdivo is approved for use on its own, and in combination with ipilimumab, to treat colorectal cancer.

For this use, Opdivo received accelerated approval from the Food and Drug Administration (FDA). Accelerated approval is based on information from early studies. The FDA’s decision for full approval will be made after additional studies are completed.

To learn more about this condition, see our list of colorectal cancer articles.

Effectiveness for colorectal cancer

Opdivo has been found effective in treating metastatic CRC.

In a clinical study, people with metastatic CRC took Opdivo either alone or in combination with ipilimumab. In this study, the overall response rate (the percentage of people whose cancer became smaller or disappeared) was measured. This rate was 38% in people who took Opdivo on its own, and 60% in people who took Opdivo with ipilimumab.

Of people who took Opdivo on its own and whose cancer became smaller or disappeared:

• 86% kept this response for at least 6 months
• 82% kept this response for at least 1 year

Of people who took Opdivo in combination with ipilimumab and whose cancer became smaller or disappeared:

• 89% kept this response for at least 6 months
• 77% kept this response for at least 1 year

Opdivo for head and neck cancer

Opdivo is FDA-approved to treat squamous cell carcinoma of the head and neck (SCCHN) in adults. Squamous cell cancer starts in the flat cells (squamous cells) that make up the surface of your skin, eyes, and other internal organs.

Opdivo is used for SCCHN that has come back after improving with past treatments (recurrent cancer). It’s also used to treat SCCHN that has spread to other organs (metastatic cancer).

Opdivo is approved to treat SCCHN that has gotten worse during or after treatment with certain other cancer drugs. Examples of these drugs include cisplatin and carboplatin.

To learn more about this condition, see our list of head and neck cancer articles.

Effectiveness for head and neck cancer

Opdivo has been found effective in treating locally advanced and metastatic SCCHN.

In a clinical study, people with SCCHN took either Opdivo or another cancer drug. These other cancer drugs could be one of the following: cetuximab (Erbitux), methotrexate (Trexall), or docetaxel (Taxotere). In the study, people using Opdivo had a 30% lower risk of dying compared with the risk in people taking other cancer drugs.

Opdivo for melanoma skin cancer

Opdivo is FDA-approved to treat melanoma skin cancer. Melanoma is a type of cancer that starts in cells that make melanin (the pigment that gives color to your skin). Melanoma can occur in your skin or in other parts of your body. For the types of melanoma Opdivo treats, doctors may prescribe the drug to adults and children ages 12 years and older.

To learn more about this condition, see our skin cancer hub.

Opdivo for unresectable or metastatic melanoma skin cancer

Opdivo is approved to treat melanoma skin cancer that is unresectable (can’t be removed surgically). It’s also approved to treat melanoma that is metastatic (has spread from the area where it first started to other parts of your body).

For these conditions, Opdivo is approved for use on its own, or in combination with another cancer drug called ipilimumab.

Effectiveness for unresectable or metastatic melanoma

Opdivo has been found effective in treating unresectable or metastatic melanoma skin cancer in several studies.

In one clinical study, people with metastatic melanoma skin cancer took Opdivo after their cancer got worse during or after treatment with ipilimumab. The overall response rate (the percentage of people whose cancer became smaller or disappeared) was measured. This rate was 32% in people who took Opdivo. Most of the people whose cancer became smaller or disappeared maintained this response for 2.6 to 10 months.

Another clinical study included people who hadn’t had treatment in the past for their metastatic melanoma skin cancer. These people took either Opdivo or another cancer drug called dacarbazine. Over 1 year, Opdivo reduced people’s risk of dying by 58% compared with the risk in people taking dacarbazine.

A second clinical study looked at people who hadn’t had treatment in the past for their metastatic melanoma skin cancer. In this study, people took either Opdivo with ipilimumab, Opdivo on its own, or ipilimumab on its own. People who took Opdivo with ipilimumab had a 45% lower risk of death than those who took ipilimumab on its own. People who took Opdivo alone had a 37% lower risk of death than people who took ipilimumab on its own.

Opdivo to prevent melanoma skin cancer from returning

Opdivo is also FDA-approved as adjuvant treatment of melanoma skin cancer. Adjuvant treatment is therapy that’s given after surgery or use of other medication. The goal of adjuvant treatment is to reduce the risk of the cancer returning.

Opdivo is approved as adjuvant therapy for melanoma skin cancer that has spread to lymph nodes or other parts of the body (metastatic cancer). Opdivo is approved for this use after surgery to completely remove the cancer.

Effectiveness as adjuvant treatment for melanoma

Opdivo has been found effective as adjuvant treatment of melanoma skin cancer. One clinical study included people who had surgery to remove their cancer within the past 3 months. The people took either Opdivo or ipilimumab. Over about 2 years, people who took Opdivo had a 35% lower risk of their cancer returning than people who took ipilimumab.

Opdivo for classical Hodgkin’s lymphoma

Opdivo is FDA-approved to treat classical Hodgkin’s lymphoma (cHL) in adults. Opdivo is used to treat cHL that has returned or gotten worse after treatment with either:

• autologous hematopoietic stem cell transplant (HSCT) and a drug called brentuximab vedotin (Adcetris), or
• three or more cancer treatments in the past, where one of the treatments was HSCT

An autologous HSCT is a bone marrow transplant that’s done using stem cells that were harvested in the past from your own body. Stem cells work in your body to make new blood cells, which help you stay healthy as you fight off cancer.

For treating cHL, Opdivo received accelerated approval from the Food and Drug Administration (FDA). Accelerated approval is based on information from early studies. The FDA’s decision for full approval will be made after additional studies are completed.

Effectiveness for classical Hodgkin’s lymphoma

Opdivo has been found effective in treating cHL in two studies. In these clinical studies, the overall response rate (the percentage of people whose cancer became smaller or disappeared) was measured. The rate was 66% in people who took Opdivo after past treatment with HSCT and brentuximab vedotin. The overall response rate was 69% in people who took Opdivo after past treatment with HSCT.

Opdivo for pleural mesothelioma

When used in combination with ipilimumab, Opdivo is FDA-approved for previously untreated pleural mesothelioma (cancer of the lining around the lungs) in adults. For this use, the cancer cannot be removed by surgery.

Effectiveness for pleural mesothelioma

Studies found the combination of Opdivo and ipilimumab effective for treating pleural mesothelioma that cannot be removed by surgery. For details, see Opdivo’s prescribing information.

Opdivo for esophageal cancer

Opdivo is FDA-approved to treat certain types of esophageal cancer in adults. This is cancer that occurs in the esophagus, the tube that connects your throat and stomach.

Opdivo is used to treat esophageal cancer that remains after surgery in people who have received chemotherapy and radiation therapy.

The drug is also used to treat esophageal squamous cell carcinoma (ESCC) that is advanced (has spread to nearby areas) or metastatic (has spread from the area to other parts of the body). Squamous cells are flat cells that line parts of your body, including the inside of the esophagus.

For previously untreated advanced or metastatic ESCC that cannot be removed by surgery, Opdivo is used in combination with either:

• a fluoropyrimidine drug, such as capecitabine, and certain chemotherapy drugs, such as cisplatin and carboplatin
• ipilimumab

Opdivo may be used on its own to treat ESCC that:

• is advanced, metastatic, or recurrent (comes back after treatment)
• was previously treated with a fluoropyrimidine drug and certain chemotherapy drugs
• cannot be removed by surgery

Doctors may also prescribe Opdivo to treat esophageal adenocarcinoma, which is cancer in the glands of the esophagus. The adenocarcinoma must be advanced or metastatic. For treating this cancer, Opdivo is used in combination with a fluoropyrimidine, such as capecitabine, and certain other chemotherapy drugs, such as cisplatin and carboplatin.

Effectiveness for esophageal cancer

In studies, Opdivo was found effective for treating the types of esophageal cancer described above when used alone or with certain cancer drugs. For details, see Opdivo’s prescribing information.

Opdivo for gastric cancer

Opdivo is FDA-approved to treat gastric cancer (stomach cancer) as well as gastroesophageal junction cancer (cancer in the area where the esophagus joins the stomach). The cancer must be advanced (has spread to nearby areas) or metastatic (has spread from the area to other parts of the body).

For treating these cancers, Opdivo is used in combination with a fluoropyrimidine, such as capecitabine, and certain other chemotherapy drugs, such as cisplatin and carboplatin.

Effectiveness for gastric cancer

In studies, the combination of Opdivo, a fluoropyrimidine, such as capecitabine, and certain chemotherapy drugs was found effective for treating the cancers listed above when advanced or metastatic. For details, see Opdivo’s prescribing information.

Opdivo for other conditions

In addition to the uses listed above, Opdivo may be used off-label. Off-label drug use is when a drug that’s approved for one use is prescribed for a different one that’s not approved. And you may wonder if Opdivo is used for certain other conditions.

Opdivo for anal cancer (off-label use)

Opdivo is not approved to treat anal cancer. However, sometimes it’s prescribed off-label for this condition.

Opdivo is recommended in treatment guidelines as a preferred option for anal cancer. It’s recommended for use after someone has received treatment with other cancer drugs.

Studies for off-label uses of Opdivo

• Pancreatic cancer. An ongoing study is being done to test Opdivo as a treatment for pancreatic cancer before or after surgery. Opdivo is being tested in combination with cyclophosphamide, an experimental vaccine, for this condition.
• Ovarian cancer. An ongoing study is testing the use of Opdivo on its own and in combination with ipilimumab to treat ovarian cancer.
• Prostate cancer. A clinical study found that Opdivo was effective in treating prostate cancer when combined with ipilimumab. It hasn’t been approved yet for this purpose, but studies are ongoing.
• Breast cancer. Ongoing studies such as this one are looking at the effectiveness of Opdivo for treating certain forms of breast cancer.
• Non-Hodgkin’s lymphoma. Ongoing studies are testing Opdivo’s effectiveness to treat certain forms of non-Hodgkin’s lymphoma.
• Multiple myeloma. Opdivo is part of ongoing studies and has been tested in several early-stage studies to see if it has a role in treating multiple myeloma.

More research is needed to know the safety and effectiveness of Opdivo treatment for each of the conditions listed above.

Opdivo for brain cancer (may not be an appropriate use)

The manufacturer of Opdivo announced in 2019 that this drug wasn’t effective in treating glioblastoma (a type of brain cancer).

Opdivo for children

Opdivo is FDA-approved for use in children ages 12 years and older with colorectal cancer that:

• is metastatic (has spread from the colon or rectum to other parts of the body)
• has certain genetic changes, either microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR)
• became worse during or after treatment with other cancer drugs

See the section above called “Opdivo for colorectal cancer” for more details on this type of cancer.

Opdivo is also approved to treat the following types of melanoma skin cancer in children ages 12 years and older:

• melanoma skin cancer that can’t be removed surgically
• melanoma that is metastatic (has spread from the area where it first started to other parts of the body)

The drug may also be prescribed as adjuvant therapy (therapy that’s given after surgery or use of other medication) for melanoma in children ages 12 years and older. For this purpose, the cancer must have spread to lymph nodes or other parts of the body. Opdivo is approved for this use after surgery to completely remove the cancer.

See the sections above called “Opdivo for colorectal cancer,” ”Opdivo for unresectable or metastatic melanoma skin cancer,” and “Opdivo to prevent melanoma skin cancer from returning” for more details on Opdivo for melanoma in children.

Effectiveness in children

The effectiveness of Opdivo to treat colorectal cancer and melanoma in children hasn’t been tested in children ages 12 through 18 years. However, the drug was approved for this use in people these ages based on clinical studies of Opdivo’s effectiveness in adults with the same condition.

Also, the cancers Opdivo treats in children are expected to be similar to such cancers in adults.

Opdivo was also approved for this use based on how the body processes the drug. Opdivo is expected to be processed in children (ages 12 through 18 years) very similarly to how it’s processed in adults.

Opdivo use with other drugs

Opdivo is approved by the Food and Drug Administration (FDA) to be used in combination with ipilimumab (Yervoy) for certain types of cancer. This combination of treatment is approved to treat specific forms of the following cancers:

• melanoma skin cancer
• lung cancer
• kidney cancer
• colorectal cancer
• mesothelioma
• liver cancer
• esophageal cancer

Opdivo is also approved to be used in combination with a fluoropyrimidine drug, such as capecitabine (Xeloda), and certain chemotherapy drugs, such as cisplatin and carboplatin, for specific types of:

• esophageal cancer
• gastric cancer

In addition, the drug is approved to be used in combination with cabozantinib (Cabometyx) for certain types of kidney cancer.

See “Opdivo for lung cancer” and “Opdivo other uses” above for more details about how Opdivo is used in combination with other drugs.

Alternatives to Opdivo

Other drugs are available that can treat your type of cancer. Some may be better suited for you than others. If you’re interested in finding an alternative to Opdivo, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is prescribed to treat a different condition.

Alternatives for non-small cell lung cancer

Examples of other drugs that may be used to treat non-small cell lung cancer include:

• pembrolizumab (Keytruda)
• atezolizumab (Tecentriq)
• ipilimumab (Yervoy)
• durvalumab (Imfinzi)
• crizotinib (Xalkori)
• vandetanib (Caprelsa)
• gemcitabine
• docetaxel (Taxotere)

Alternatives for liver cancer

Examples of other drugs that may be used to treat liver cancer after it’s been treated with sorafenib (Nexavar) include:

• pembrolizumab (Keytruda)
• regorafenib (Stivarga)
• cabozantinib (Cabometyx, Cometriq)
• ramucirumab (Cyramza)

Alternatives for kidney cancer

Examples of other drugs that may be used to treat kidney cancer include:

• axitinib (Inlyta)
• pembrolizumab (Keytruda)
• pazopanib (Votrient)
• sunitinib (Sutent)
• ipilimumab (Yervoy)
• cabozantinib (Cabometyx, Cometriq)
• avelumab (Bavencio)

Alternatives for bladder cancer

Examples of other drugs that may be used to treat bladder cancer include:

• pembrolizumab (Keytruda)
• atezolizumab (Tecentriq)
• durvalumab (Imfinzi)
• avelumab (Bavencio)
• erdafitinib (Balversa)
• paclitaxel (Abraxane)
• docetaxel (Taxotere)
• gemcitabine

Alternatives for colorectal cancer

Examples of other drugs that may be used to treat colorectal cancer that has certain gene abnormalities (either microsatellite instability-high [MSI-H] or mismatch repair deficient [dMMR]) include:

• pembrolizumab (Keytruda)
• ipilimumab (Yervoy)

Alternatives for head and neck cancer

Examples of other drugs that may be used to treat squamous cell head and neck cancer include:

• pembrolizumab (Keytruda)
• afatinib (Gilotrif)
• cisplatin
• carboplatin
• cetuximab (Erbitux)
• docetaxel (Taxotere)
• paclitaxel (Abraxane)

Alternatives for melanoma skin cancer

Examples of other drugs that may be used to treat melanoma skin cancer include:

• pembrolizumab (Keytruda)
• dabrafenib (Tafinlar)
• trametinib (Mekinist)
• ipilimumab (Yervoy)

Alternatives for classical Hodgkin’s lymphoma

Examples of other drugs that may be used to treat classical Hodgkin’s lymphoma include:

• brentuximab vedotin (Adcetris)
• bendamustine (Belrapzo, Bendeka, Treanda)
• rituximab (Rituxan, Ruxience, Truxima)
• cisplatin
• cytarabine
• etoposide
• vinorelbine

Alternatives for mesothelioma

Examples of other drugs that may be used to treat mesothelioma include:

• ipilimumab (Yervoy)
• pemetrexed (Alimta)

Alternatives for esophageal cancer

Examples of other drugs that may be used to treat esophageal cancer include:

• capecitabine (Xeloda)
• ipilimumab (Yervoy)
• pembrolizumab (Keytruda)

Alternatives for gastric cancer

Examples of other drugs that may be used to treat gastric cancer include:

• capecitabine (Xeloda)
• ramucirumab (Cyramza)
• docetaxel (Taxotere)
• ipilimumab (Yervoy)
• pembrolizumab (Keytruda)
• trastuzumab (Herceptin)
• fluorouracil
• doxorubicin hydrochloride
• trifluridine/tipiracil hydrochloride (Lonsurf)
• fam-trastuzumab deruxtecan-nxki (Enhertu)

Opdivo vs. Keytruda

You may wonder how Opdivo compares with other medications that are prescribed for similar uses. Here we look at how Opdivo and Keytruda are alike and different.

Uses

Opdivo and Keytruda are both approved to treat certain forms of the following types of cancer in adults.

• melanoma skin cancer
• non-small cell lung cancer
• squamous cell head and neck cancer
• classical Hodgkin’s lymphoma
• bladder cancer
• colorectal cancer
• liver cancer
• kidney cancer
• gastric cancer
• esophageal cancer

Opdivo is also approved to treat mesothelioma in adults. Keytruda is also approved to treat certain forms of the following cancers in adults.

• primary mediastinal large B-cell lymphoma (a type of blood cancer)
• cervical cancer
• Merkel cell cancer (a type of skin cancer)
• certain unresectable or metastatic solid tumors

Both drugs are approved to treat colorectal cancer and melanoma in some children. Keytruda is also approved to treat other types of cancer in some children.

Drug forms and administration

Opdivo contains the drug nivolumab. Keytruda contains the drug pembrolizumab.

Opdivo and Keytruda each come as a liquid solution. They’re given by intravenous (IV) infusion. The infusions for each drug last about 30 minutes, and they’re given in a healthcare facility.

Opdivo infusions are given every 2, 3, 4, or 6 weeks. Your infusion schedule will depend on the condition you’re using Opdivo to treat and the dosage your doctor prescribes.

Keytruda infusions are given every 3 weeks or every 6 weeks, depending on the dosage your doctor prescribes.

Side effects and risks

Opdivo and Keytruda contain similar drugs. Therefore, both medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

This list contains examples of more common side effects that can occur with both Opdivo and Keytruda, when they’re taken individually:

• fatigue
• muscle pain
• bone pain
• loss of appetite
• diarrhea
• itchiness
• nausea
• skin rash
• fever
• cough
• shortness of breath
• constipation
• abdominal pain
• back pain
• joint pain
• headache
• weakness
• vomiting
• upper respiratory infections, such as the common cold
• weight loss

Serious side effects

This list contains examples of serious side effects that can occur with both Opdivo and Keytruda, when they’re taken individually:

• pneumonitis (inflammation in your lungs)
• colitis (inflammation in your intestines)
• hepatitis (inflammation in your liver)
• hormonal problems, including changes in your thyroid hormone and cortisol levels
• type 1 diabetes
• kidney damage
• severe skin reactions, including Stevens-Johnson syndrome
• encephalitis (swelling in your brain)
• infusion reactions (reactions that occur during or shortly after you receive a drug infusion)
• immune system reaction (when your immune system attacks your organs), which can cause swelling in other parts of your body, including your muscles, heart, nerves, stomach, and eyes

Effectiveness

Opdivo and Keytruda have different approved uses, but they’re both used to treat the following conditions.

• melanoma skin cancer
• non-small cell lung cancer
• squamous cell head and neck cancer
• classical Hodgkin’s lymphoma
• bladder cancer
• colorectal cancer
• liver cancer
• kidney cancer
• gastric cancer
• esophageal cancer

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Opdivo and Keytruda to be effective for treating these conditions.

Costs

Opdivo and Keytruda are both brand-name drugs. There are currently no biosimilar forms of either drug, both of which are biologic medications. (Biologics are made from living cells. A biosimilar is a drug that’s similar to a brand-name biologic.) Brand-name biologics usually cost more than biosimilars.

The actual price you’ll pay for either drug depends on your insurance plan, your location, and the medical facility where you receive your drug infusions.

Opdivo vs. Tecentriq

You may wonder how Opdivo compares with other medications that are prescribed for similar uses. Here we look at how Opdivo and Tecentriq are alike and different.

Uses

Opdivo and Tecentriq are both approved to treat certain forms of the following types of cancer in adults:

• bladder cancer
• non-small cell lung cancer
• melanoma skin cancer
• liver cancer

Opdivo is approved to treat some children with certain forms of melanoma.

Opdivo is also approved to treat certain forms of the following cancers in adults:

• kidney cancer
• classical Hodgkin’s lymphoma
• squamous cell head and neck cancer
• colorectal cancer
• gastric cancer
• esophageal cancer (cancer in your esophagus, the tube that connects your throat and stomach)

In addition, Opdivo is approved to treat some children with certain forms of colorectal cancer.

Tecentriq is also approved to treat a certain form of soft tissue cancer in adults and some children.

Drug forms and administration

Opdivo contains the drug nivolumab. Tecentriq contains the drug atezolizumab.

Opdivo and Tecentriq each come as a liquid solution. They’re given as an intravenous (IV) infusion.

Opdivo infusions are given every 2, 3, 4, or 6 weeks. These infusions last about 30 minutes.

Tecentriq infusions are given every 2, 3, or 4 weeks. These infusions last either 30 or 60 minutes.

Your schedule for infusions of either drug will depend on the condition you’re using the drug to treat.

Side effects and risks

Opdivo and Tecentriq both contain different drugs. Therefore, both medications can cause some similar side effects and some different side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with both Opdivo and Tecentriq, when they’re taken individually.

• headache
• bone pain
• upper respiratory infections (such as the common cold)
• weight loss
• anemia (low red blood cell level)
• swelling in your feet, lower legs, and hands
• urinary tract infection (UTI)
• fatigue
• weakness
• nausea
• cough
• shortness of breath
• loss of appetite
• abdominal pain
• vomiting
• diarrhea
• constipation
• skin rash
• itchiness
• back pain
• joint pain
• fever
• muscle pain

Serious side effects

These lists contain examples of serious side effects that can occur with Opdivo, with Tecentriq, or with both drugs (when taken individually).

• Can occur with Opdivo:
  • few unique serious side effects
• Can occur with Tecentriq:
  • severe infections, such as pneumonia
• Can occur with both Opdivo and Tecentriq:
  • pneumonitis (inflammation in your lungs)
  • colitis (inflammation in your intestines)
  • hepatitis (inflammation in your liver)
  • hormonal problems, including changes in your thyroid hormone and cortisol levels
  • type 1 diabetes
  • infusion reactions (reactions that occur during or shortly after you receive a drug infusion)
  • immune system reaction (when your immune system attacks your organs), which can cause swelling in other parts of your body, including your muscles, heart, nerves, stomach, and eyes
  • encephalitis (swelling in your brain)
  • kidney damage
  • severe skin reactions, including Stevens-Johnson syndrome

Effectiveness

Opdivo and Tecentriq have different approved uses, but they’re both used to treat certain forms of the following conditions:

• bladder cancer
• non-small cell lung cancer
• melanoma
• liver cancer

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Opdivo and Tecentriq to be effective for treating these conditions.

Costs

Opdivo and Tecentriq are both brand-name drugs. There are currently no biosimilar forms of either drug, both of which are biologic medications. (Biologics are made from living cells. A biosimilar is a drug that’s similar to a brand-name biologic.) Brand-name biologics usually cost more than biosimilars.

The actual price you’ll pay for either drug depends on your insurance plan, your location, and the medical facility where you receive your drug infusions.

Opdivo dosage

The Opdivo dosage your doctor prescribes will depend on several factors. These include:

• the condition you’re using Opdivo to treat
• your treatment schedule (how often you’re receiving Opdivo)
• whether you’re receiving Opdivo in combination with another drug, such as ipilimumab (Yervoy)
• your weight

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

For more information about Opdivo’s dosage, see this article.

Drug forms and strengths

Opdivo contains the active drug nivolumab. It comes as a liquid solution inside vials. The vials contain 10 milligrams (mg) of drug in every milliliter (mL) of solution.

Opdivo is given as an intravenous (IV) infusion.

Opdivo infusions typically last for 30 minutes. They’re given at a healthcare professional’s office or clinic.

Dosage for non-small cell lung cancer

The usual dosage of Opdivo for non-small cell lung cancer (NSCLC) is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for NSCLC when Opdivo is used with other drugs

The usual Opdivo dosage when it’s used in combination with certain chemotherapy drugs, ipilimumab, or both to treat NSCLC is 360 mg every 3 weeks.

Dosage for liver cancer

To treat liver cancer, Opdivo is used in combination with ipilimumab for the first four doses.

Your first four doses of Opdivo depend on your weight. The usual dosage is 1 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 3 weeks.

For example, if a person weighs 68 kilograms (which is about 150 pounds), their dose would be 1 mg of drug multiplied by 68 kilograms. This equals 68 mg of Opdivo, which is given every 3 weeks for the first four doses.

After that, you’ll receive Opdivo alone. The usual dosage of Opdivo is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for kidney cancer

The usual dosage of Opdivo for kidney cancer is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for kidney cancer when Opdivo is used in combination with other drugs

To treat certain types of kidney cancer, Opdivo is used in combination with ipilimumab for the first four doses.

Your first four doses of Opdivo depend on your weight. The usual dosage is 3 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 3 weeks.

After your first four doses of these drugs, you’ll receive Opdivo alone. The usual dosage is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

If you’re receiving Opdivo in combination with cabozantinib (Cabometyx), you may use both throughout treatment. The Opdivo dosage is the same as listed just above.

Dosage for bladder cancer

The usual dosage of Opdivo for bladder cancer is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for colorectal cancer

The usual Opdivo dosage for adults with colorectal cancer is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

The usual dosage for children ages 12 years and older is described in the section below called “Pediatric dosage.”

Dosage for colorectal cancer when Opdivo is used in combination with ipilimumab

To treat certain types of colorectal cancer, Opdivo is used in combination with ipilimumab for the first four doses.

Your first four doses of Opdivo depend on your weight. The usual dosage is 3 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 3 weeks.

After your first four doses of these drugs, you’ll receive Opdivo alone. The usual dosage is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for head and neck cancer

The usual dosage of Opdivo for head and neck cancer is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for melanoma skin cancer

The usual dosage of Opdivo for metastatic melanoma skin cancer in adults is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

This dosage is used as treatment for metastatic melanoma skin cancer and also as adjuvant treatment (treatment given after surgery or use of other medications) of melanoma skin cancer.

The usual dosage for children ages 12 years and older is described in the section below called “Pediatric dosage.”

Dosage for melanoma skin cancer when Opdivo is used in combination with ipilimumab

To treat certain types of colorectal cancer, Opdivo is used in combination with ipilimumab for the first four doses.

Your first four doses of Opdivo depend on your weight. The usual dosage is 1 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 3 weeks.

After your first four doses of these drugs, you’ll receive Opdivo alone. The usual dosage is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for classical Hodgkin’s lymphoma

The usual dosage of Opdivo for classical Hodgkin’s lymphoma is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for mesothelioma

To treat mesothelioma, Opdivo is used in combination with ipilimumab. The usual dosage for Opdivo is 360 mg every 3 weeks, with ipilimumab, which is given every 6 weeks.

Dosage for esophageal cancer

The usual dosage of Opdivo for esophageal cancer is either:

• 240 mg every 2 weeks, or
• 480 mg every 4 weeks

Dosage for esophageal cancer when Opdivo is used in combination with other drugs

To treat certain types of esophageal cancer, Opdivo is used in combination with ipilimumab. You’ll receive ipilimumab every 6 weeks. Depending on your doctor’s recommendation, your dosage of Opdivo may be 360 mg every 3 weeks. Or they may calculate your dosage based on your weight. The usual dosage is 3 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 3 weeks.

For esophageal cancer, Opdivo is also used in combination with a fluoropyrimidine drug, such as capecitabine (Xeloda), and certain chemotherapy drugs, such as cisplatin and carboplatin. The usual dosage for Opdivo is 240 mg every 2 weeks or 480 mg every 4 weeks, with the other drugs given on the same schedule.

To treat esophageal adenocarcinoma, Opdivo is also used in combination with a fluoropyrimidine and certain other chemotherapy drugs. The typical dosage of Opdivo for this use is 240 mg every 2 weeks or 360 mg every 3 weeks, with the other drugs given on the same schedule.

Dosage for gastric cancer

To treat gastric cancer, Opdivo is used in combination with a fluoropyrimidine, such as capecitabine, and certain other chemotherapy drugs, such as cisplatin and carboplatin. The typical dosage of Opdivo for this use is 240 mg every 2 weeks or 360 mg every 3 weeks, with the other drugs given on the same schedule.

Pediatric dosage

Opdivo is prescribed to treat colorectal cancer and melanoma skin cancer in children ages 12 years and older.

Opdivo is given at a healthcare professional’s office. It’s given as an IV infusion that lasts 30 minutes.

Opdivo dosage for colorectal cancer in children

The usual dosage of Opdivo for children with colorectal cancer who weigh 40 kilograms (about 88 pounds) or more is the same as it is for adults. See “Dosage for colorectal cancer” above for details.

The usual dosage for children who weigh less than 40 kilograms is based on their weight. Their dosage of Opdivo is 3 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 2 weeks.

For example, if a child weighs 45 kilograms (which is about 100 pounds), their dose would be 3 mg of drug multiplied by 45 kilograms. This equals 135 mg of Opdivo, which is given every 2 weeks.

Dosage for colorectal cancer when Opdivo is used in combination with ipilimumab

To treat certain types of colorectal cancer in children, Opdivo is used in combination with ipilimumab for the first four doses.

The first four doses of Opdivo depend on a child’s weight. The usual dosage is 3 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 3 weeks.

After the first four doses of Opdivo and ipilimumab, children will receive Opdivo alone. The usual dosage for children who weigh 40 kilograms (about 88 pounds) or more is the same as it is for adults. See “Dosage for colorectal cancer” above for details.

The usual dosage for children who weigh less than 40 kilograms is based on their weight. Their dosage of Opdivo is 3 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 2 weeks.

Opdivo dosage for melanoma skin cancer in children

The usual dosage of Opdivo for children with melanoma skin cancer who weigh 40 kilograms (about 88 pounds) or more is the same as it is for adults. See “Dosage for melanoma skin cancer” above for details.

The usual dosage for children who weigh less than 40 kilograms is based on their weight. Their dosage of Opdivo is 3 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 2 weeks, or 6 mg per kilogram of body weight, given every 4 weeks.

Dosage for melanoma skin cancer when Opdivo is used in combination with ipilimumab

To treat certain types of melanoma in children, Opdivo is used in combination with ipilimumab for the first four doses.

The first four doses of Opdivo depend on a child’s weight. The usual dosage is 1 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 3 weeks.

After the first four doses of Opdivo and ipilimumab, children will receive Opdivo alone. The usual dosage for children who weigh 40 kilograms (about 88 pounds) or more is the same as it is for adults. See “Dosage for melanoma skin cancer” above for details.

The usual dosage for children who weigh less than 40 kilograms is based on their weight. Their dosage of Opdivo is 3 mg of drug per kilogram (about 2.2 pounds) of body weight, given every 2 weeks, or 6 mg per kilogram of body weight, given every 4 weeks.

What if I miss a dose?

Call your doctor’s office right away if you realize that you’ve missed an appointment for your Opdivo infusion. The office staff will reschedule the appointment for you.

To help make sure that you don’t miss a dose, try setting a reminder in your phone.

Will I need to use this drug long term?

Opdivo is meant to be used as a long-term treatment. If you and your doctor determine that Opdivo is safe and effective for you, you’ll likely use it long term.

Common questions about Opdivo

Here are answers to some frequently asked questions about Opdivo.

How long do people using Opdivo treatment live?

That’s different for each person since it depends on many factors. Your life expectancy (the length of time you are expected to survive) depends on:

• the type of cancer you have
• the stage of your cancer
• your age
• other health conditions you may have

See Opdivo the sections “Opdivo for lung cancer” and “Opdivo other uses” above for more details about life expectancy in people with specific types of cancer.

Do I need to follow a certain diet while I’m using Opdivo?

Your doctor may recommend that you follow a certain balanced diet while you’re receiving treatment with Opdivo. However, the recommended diet would be based on the type of cancer you have and on your overall health. It wouldn’t be based on how Opdivo works.

Talk with your doctor about ways to maintain a balanced, nutritious diet that reduces your risk of side effects and helps maintain your energy level during treatment.

Can I receive Opdivo before or after a stem cell transplant?

Yes, you might be able to. Opdivo can be used to treat classical Hodgkin’s lymphoma in people whose cancer has returned or gotten worse after they’ve had a stem cell transplant.

However, some people who took Opdivo before or after a stem cell transplant have had transplant complications. One complication is graft-versus-host disease. With this condition, the transplanted cells attack your healthy cells. This can cause side effects such as skin rash, diarrhea, and liver problems.

Other complications can include blockages in your veins and severe fevers.

Talk with your doctor about whether receiving Opdivo before or after a stem cell transplant is right for you.

Where will I get my Opdivo treatments?

You’ll receive Opdivo as an intravenous (IV) infusion at a healthcare facility. Opdivo infusions last about 30 minutes.

A healthcare professional will administer your infusion and monitor you for any side effects that may occur during your infusion.

Opdivo and alcohol

There aren’t any known interactions between Opdivo and alcohol.

If you drink alcohol, talk with your doctor if you’re concerned about whether drinking it is safe during your treatment.

Opdivo interactions

There aren’t any known drug interactions with Opdivo. However, before taking any drug, it’s always a good idea to talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Opdivo and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Opdivo. However, you should still check with your doctor or pharmacist before using any of these products during Opdivo treatment.

Opdivo cost

As with all medications, the cost of Opdivo can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

For more information about Opdivo and cost, see this article.

Opdivo cost saving coupons

For Optum Perks* coupon options in your area, see below. You can also visit Optum Perks to get price estimates of what you’d pay for Opdivo when using coupons from the site.

If you have questions about how to pay for your prescription or how to find the lowest cost for Opdivo, talk with your doctor or pharmacist.

You can also check out this article to learn more about saving money on prescriptions.

* Optum Perks is a sister site of Medical News Today. Optum Perks coupons cannot be used with insurance copays or benefits.

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Financial and insurance assistance

If you need financial support to pay for Opdivo, or if you need help understanding your insurance coverage, assistance is available.

Bristol-Myers Squibb, the manufacturer of Opdivo, offers a program called BMS Access Support. For more information and to find out if you’re eligible for support, call 800-861-0048 or visit the program website.

How Opdivo is given

A healthcare professional will give Opdivo to you at a doctor’s office or clinic.

Opdivo is given as an intravenous (IV) infusion. Opdivo IV infusions last about 30 minutes.

If you’re using Opdivo in combination with other drugs, such as ipilimumab (Yervoy), your doctor will let you know your dosage schedule.

When to take

When you’ll receive Opdivo infusions depends on what condition you’re using the drug to treat and whether you’ll receive it with other medications.

You and your doctor will determine the dosing schedule that’s best for you. To help make sure that you don’t miss an appointment for your dose, try setting a reminder in your phone.

How Opdivo works

Opdivo is a monoclonal antibody. These drugs are made from immune system cells in a lab. They work by blocking the action of certain substances in your body.

Opdivo belongs to a class of drugs called programmed death receptor-1 (PD-1) inhibitors. PD-1 receptors (attachment sites) are found on immune system cells in your body. When certain proteins bind to these receptors, the immune cells stop making other proteins that attack and kill cancer cells.

Some forms of cancer, like those that Opdivo is used to treat, have higher-than-usual amounts of proteins that bind to PD-1 receptors. This means the cancer is able to prevent your immune system from attacking cancer cells.

Opdivo blocks the activity of the PD-1 receptor. When Opdivo binds to the PD-1 receptor, it prevents other proteins from attaching to it. This allows your immune system to make and release more proteins that attack cancer cells.

Because there are greater numbers of proteins attacking the cancer cells, the cancer shrinks or even disappears, in some cases.

How long does it take to work?

It’s not known exactly how long Opdivo takes to work in your body. Your doctor will recommend that you come to their office every few weeks or months after you start using Opdivo. They’ll monitor your cancer at these appointments to see whether the drug is working for you.

Opdivo and pregnancy

Opdivo isn’t safe to receive during pregnancy. Animal studies have shown harm to fetuses when the pregnant animal received Opdivo. The drug has also been shown to cause pregnancy loss and fetal death.

If you’re able to become pregnant, you’ll need to have a negative pregnancy test before you start Opdivo treatment. This will help make sure you’re not pregnant before you start the drug.

If you become pregnant while you’re using Opdivo, tell your doctor right away. See the section “Opdivo and birth control” for more details.

Opdivo and birth control

Opdivo isn’t safe to receive during pregnancy. If you’re sexually active and can become pregnant, you should use effective birth control during your Opdivo treatment. You should continue to use birth control for at least 5 months after your last dose of Opdivo.

Talk with your doctor about your birth control needs while you’re using Opdivo.

Opdivo and breastfeeding

There aren’t any studies to know how safe Opdivo use is while you’re breastfeeding. It’s not known if Opdivo passes into breast milk.

However, the side effects of Opdivo are severe, and if the drug does appear in breast milk, it may harm a child who consumes it. Because of this, you shouldn’t breastfeed during Opdivo treatment. You also shouldn’t breastfeed for at least 5 months after receiving your last dose of Opdivo.

Talk to your doctor about ways to safely feed your child while you’re receiving Opdivo.

Opdivo precautions

Before using Opdivo, talk with your doctor about your health history. Opdivo may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Stem cell transplant. Opdivo can cause serious complications if it’s received before or after you have an allogenic hematopoietic stem cell transplant (transplant of blood-forming cells from someone who has a similar genetic makeup as you). If you’ve had a stem cell transplant or are planning to have one, talk with your doctor about whether Opdivo is right for you.
• Immune system or nervous system conditions. It’s possible for Opdivo to make your immune system overactive. This could cause side effects such as inflammation. Immune system conditions, such as Crohn’s disease, or nervous system conditions, such as myasthenia gravis, could worsen as a result. If you have an immune system or nervous system condition, tell your doctor before starting treatment with Opdivo. This will help them determine whether Opdivo is a good treatment option for you.
• Chest radiation treatment. Pneumonitis is a serious side effect of Opdivo. People who have had radiation treatment to the chest have an increased risk of developing this side effect. Tell your doctor if you’ve ever had chest radiation treatment. They can recommend whether Opdivo should be part of your treatment plan.
• Pregnancy. Opdivo can cause harm to a growing fetus. You shouldn’t receive Opdivo while pregnant. For more information, please see the “Opdivo and pregnancy” and “Opdivo and birth control” sections above.
• Breastfeeding. You should not breastfeed your child while you’re using Opdivo, or for at least 5 months after your last dose of Opdivo. For more information, please see the “Opdivo and breastfeeding” section above.

Note: For more information about the potential negative effects of Opdivo, see the “Opdivo side effects” section above.