Opdivo Dosage
Medically reviewed by Drugs.com. Last updated on Sep 14, 2021.
Generic name: NIVOLUMAB 10mg in 1mL
Dosage form: injection
Patient Selection
Select patients with metastatic NSCLC for treatment with OPDIVO in combination with ipilimumab based on PD-L1 expression [see Clinical Studies (14.3)].
Information on FDA-approved tests for the determination of PD-L1 expression in NSCLC is available at: http://www.fda.gov/CompanionDiagnostics.
Recommended Dosage
The recommended dosages of OPDIVO as a single agent are presented in Table 1.
|
Indication |
Recommended OPDIVO Dosage |
Duration of Therapy |
|
Unresectable or metastatic melanoma |
240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) |
Until disease progression or unacceptable toxicity |
|
Metastatic non-small cell lung cancer |
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Advanced renal cell carcinoma |
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Classical Hodgkin lymphoma |
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Squamous cell carcinoma of the head and neck |
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Locally advanced or metastatic urothelial carcinoma |
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Esophageal squamous cell carcinoma |
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Adjuvant treatment of melanoma |
240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) |
Until disease recurrence or unacceptable toxicity for up to 1 year |
|
Adjuvant treatment of urothelial carcinoma (UC) |
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Microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer |
Adult patients and pediatric patients age 12 years and older and weighing 40 kg or more: 240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) |
Until disease progression or unacceptable toxicity |
|
Pediatric patients age 12 years and older and weighing less than 40 kg: 3 mg/kg every 2 weeks (30-minute intravenous infusion) |
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Adjuvant treatment of resected esophageal or gastroesophageal junction cancer |
240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) |
Until disease progression or unacceptable toxicity for a total treatment duration of 1 year |
The recommended dosages of OPDIVO in combination with other therapeutic agents are presented in Table 2. Refer to the respective Prescribing Information for each therapeutic agent administered in combination with OPDIVO for the recommended dosage information, as appropriate.
|
Indication |
Recommended OPDIVO Dosage |
Duration of Therapy |
|
Unresectable or metastatic melanoma |
1 mg/kg every 3 weeks (30-minute intravenous infusion) with ipilimumab 3 mg/kg intravenously over 90 minutes on the same day |
In combination with ipilimumab for a maximum of 4 doses or until unacceptable toxicity, whichever occurs earlier |
|
240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) |
After completing 4 doses of combination therapy, administer as single agent until disease progression or unacceptable toxicity |
|
|
Metastatic non-small cell lung cancer expressing PD-L1 |
3 mg/kg every 2 weeks (30-minute intravenous infusion) with ipilimumab 1 mg/kg every 6 weeks (30-minute intravenous infusion) |
In combination with ipilimumab until disease progression, unacceptable toxicity, or up to 2 years in patients without disease progression |
|
Metastatic or recurrent non-small cell lung cancer |
360 mg every 3 weeks (30-minute intravenous infusion) with ipilimumab 1 mg/kg every 6 weeks (30-minute intravenous infusion) and histology-based platinum doublet chemotherapy every 3 weeks |
In combination with ipilimumab until disease progression, unacceptable toxicity, or up to 2 years in patients without disease progression |
|
2 cycles of histology-based platinum-doublet chemotherapy |
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Malignant pleural mesothelioma |
360 mg every 3 weeks (30-minute intravenous infusion) with ipilimumab 1 mg/kg every 6 weeks (30-minute intravenous infusion) |
In combination with ipilimumab until disease progression, unacceptable toxicity, or up to 2 years in patients without disease progression |
|
Advanced renal cell carcinoma |
3 mg/kg every 3 weeks (30-minute intravenous infusion) with ipilimumab 1 mg/kg intravenously over 30 minutes on the same day |
In combination with ipilimumab |
|
240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) Administer OPDIVO in combination with cabozantinib 40 mg orally once daily without food |
OPDIVO: Until disease progression, unacceptable toxicity, or up to 2 years |
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Cabozantinib: Until disease progression or unacceptable toxicity |
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240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) |
After completing 4 doses of combination therapy with ipilimumab, administer as single agent until disease progression or unacceptable toxicity |
|
|
Microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer |
3 mg/kg every 3 weeks (30-minute intravenous infusion) with ipilimumab 1 mg/kg intravenously over 30 minutes on the same day |
In combination with ipilimumab |
|
Adult patients and pediatric patients age 12 years and older and weighing 40 kg or more: 240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) |
After completing 4 doses of combination therapy, administer as single agent until disease progression or unacceptable toxicity |
|
|
Pediatric patients age 12 years and older and weighing less than 40 kg: 3 mg/kg every 2 weeks (30-minute intravenous infusion) |
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|
Hepatocellular carcinoma |
1 mg/kg every 3 weeks (30-minute intravenous infusion) with ipilimumab 3 mg/kg intravenously over 30 minutes on the same day |
In combination with ipilimumab |
|
240 mg every 2 weeks (30-minute intravenous infusion) or 480 mg every 4 weeks (30-minute intravenous infusion) |
After completing 4 doses of combination therapy, administer as single agent until disease progression or unacceptable toxicity |
|
|
Gastric cancer, Gastroesophageal junction cancer, and Esophageal adenocarcinoma |
240 mg every 2 weeks (30-minute intravenous infusion) with fluoropyrimidine- and platinum-containing chemotherapy every 2 weeks or 360 mg every 3 weeks (30-minute intravenous infusion) with fluoropyrimidine- and platinum-containing chemotherapy every 3 weeks |
Until disease progression, unacceptable toxicity, or up to 2 years |
Dose Modifications
No dose reduction for OPDIVO is recommended. In general, withhold OPDIVO for severe (Grade 3) immune-mediated adverse reactions. Permanently discontinue OPDIVO for life-threatening (Grade 4) immune-mediated adverse reactions, recurrent severe (Grade 3) immune-mediated reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone or equivalent per day within 12 weeks of initiating steroids.
Dosage modifications for OPDIVO or OPDIVO in combination for adverse reactions that require management different from these general guidelines are summarized in Table 3 and Table 4.
When OPDIVO is administered in combination with ipilimumab, withhold or permanently discontinue both ipilimumab and OPDIVO for an adverse reaction meeting these dose modification guidelines.
| a Resume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of last dose or inability to reduce prednisone to 10 mg per day (or equivalent) or less within 12 weeks of initiating steroids. b If AST and ALT are less than or equal to ULN at baseline, withhold or permanently discontinue OPDIVO based on recommendations for hepatitis with no liver involvement. c Depending on clinical severity, consider withholding for Grade 2 endocrinopathy until symptom improvement with hormone replacement. Resume once acute symptoms have resolved. ALT = alanine aminotransferase, AST = aspartate aminotransferase, DRESS = Drug Rash with Eosinophilia and Systemic Symptoms, SJS = Stevens Johnson Syndrome, TEN = toxic epidermal necrolysis, ULN = upper limit normal |
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|
Adverse Reaction |
Severity |
Dosage Modification |
|
Immune-Mediated Adverse Reactions [see Warnings and Precautions (5.1)] |
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Pneumonitis |
Grade 2 |
Withholda |
|
Grades 3 or 4 |
Permanently discontinue |
|
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Colitis For colitis in patients treated with combination therapy with ipilimumab, see Table 4. |
Grade 2 or 3 |
Withholda |
|
Grade 4 |
Permanently discontinue |
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Hepatitis with no tumor involvement of the liver For liver enzyme elevations in patients treated with combination therapy with ipilimumab, see Table 4. |
AST/ALT increases to >3 and ≤8 times ULN or Total bilirubin increases to >1.5 and ≤3 times ULN. |
Withholda |
|
AST or ALT increases to >8 times ULN or Total bilirubin increases to >3 times ULN. |
Permanently discontinue |
|
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Hepatitis with tumor involvement of the liverb For liver enzyme elevations in patients treated with combination therapy with ipilimumab, see Table 4. |
Baseline AST/ALT is >1 and ≤3 times ULN and increases to >5 and ≤10 times ULN or Baseline AST/ALT is >3 and ≤5 times ULN and increases to >8 and ≤10 times ULN. |
Withholda |
|
AST/ALT increases to >10 times ULN or Total bilirubin increases to >3 times ULN. |
Permanently discontinue |
|
|
Endocrinopathiesc |
Grade 3 or 4 |
Withhold until clinically stable or permanently discontinue depending on severity |
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Nephritis with Renal Dysfunction |
Grade 2 or 3 increased blood creatinine |
Withholda |
|
Grade 4 increased blood creatinine |
Permanently discontinue |
|
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Exfoliative Dermatologic Conditions |
Suspected SJS, TEN, or DRESS |
Withhold |
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Confirmed SJS, TEN, or DRESS |
Permanently discontinue |
|
|
Myocarditis |
Grades 2, 3, or 4 |
Permanently discontinue |
|
Neurological Toxicities |
Grade 2 |
Withholda |
|
Grade 3 or 4 |
Permanently discontinue |
|
|
Other Adverse Reactions |
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Infusion-Related Reactions |
Grade 1 or 2 |
Interrupt or slow the rate of infusion |
|
Grade 3 or 4 |
Permanently discontinue |
|
| a Resume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of last dose or inability to reduce prednisone to 10 mg per day (or equivalent) or less within 12 weeks of initiating steroids. b If AST and ALT are less than or equal to ULN at baseline, withhold or permanently discontinue OPDIVO in combination with ipilimumab based on recommendations for hepatitis with no liver involvement. c Consider corticosteroid therapy for hepatic adverse reactions if OPDIVO is withheld or discontinued when administered in combination with cabozantinib. d After recovery, rechallenge with one or both of OPDIVO and cabozantinib may be considered. If rechallenging with cabozantinib with or without OPDIVO, refer to cabozantinib Prescribing Information. |
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|
Treatment |
Adverse Reaction |
Severity |
Dosage Modification |
|||
|
OPDIVO in combination with ipilimumab |
Colitis |
Grade 2 |
Withholda |
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|
Grade 3 or 4 |
Permanently discontinue |
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|
Hepatitis with no tumor involvement of the liver or Hepatitis with tumor involvement of the liver/non-HCC |
AST/ALT increases to >3 times ULN and ≤5 times ULN or Total bilirubin increases to ≥1.5 and ≤3 times ULN. |
Withholda |
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|
AST or ALT >5 times ULN or Total bilirubin >3 times ULN. |
Permanently discontinue |
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Hepatitis with tumor involvement of the liverb/HCC |
Baseline AST/ALT is >1 and ≤3 times ULN and increases to >5 and ≤10 times ULN or Baseline AST/ALT is >3 and ≤5 times ULN and increases to >8 and ≤10 times ULN. |
Withholda |
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|
AST/ALT increases to >10 times ULN or Total bilirubin increases to >3 times ULN. |
Permanently discontinue |
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|
OPDIVO in combination with cabozantinib |
Liver enzyme elevations |
ALT or AST >3 times ULN but ≤10 times ULN with concurrent total bilirubin <2 times ULN |
Withholdc both OPDIVO and cabozantinib until adverse reactions recoverd to Grades 0-1 |
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ALT or AST >10 times ULN or >3 times ULN with concurrent total bilirubin ≥2 times ULN |
Permanently discontinuec both OPDIVO and cabozantinib |
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Preparation and Administration
Visually inspect for particulate matter and discoloration. OPDIVO is a clear to opalescent, colorless to pale-yellow solution. Discard if cloudy, discolored, or contains extraneous particulate matter other than a few translucent-to-white, proteinaceous particles. Do not shake.
Preparation
- •
- Withdraw the required volume of OPDIVO and transfer into an intravenous container.
- •
- Dilute OPDIVO with either 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP to prepare an infusion with a final concentration ranging from 1 mg/mL to 10 mg/mL. The total volume of infusion must not exceed 160 mL.
• For adult and pediatric patients with body weight ≥40 kg, do not exceed a total volume of infusion of 160 mL.
• For adult and pediatric patients with body weight <40 kg, do not exceed a total volume of infusion of 4 mL/kg of body weight. - •
- Mix diluted solution by gentle inversion. Do not shake.
- •
- Discard partially used vials or empty vials of OPDIVO.
- •
- The product does not contain a preservative.
- •
- After preparation, store the diluted solution either:
• at room temperature and room light for no more than 8 hours from the time of preparation to end of the infusion. Discard diluted solution if not used within 8 hours from the time of preparation; or
• under refrigeration at 2°C to 8°C (36°F to 46°F) and protected from light for no more than 7 days from the time of preparation to end of infusion. Discard diluted solution if not used within 7 days from the time of preparation. - •
- Do not freeze.
Administration
- •
- Administer the infusion over 30 minutes through an intravenous line containing a sterile, non-pyrogenic, low protein binding in-line filter (pore size of 0.2 micrometer to 1.2 micrometer).
- •
- Administer OPDIVO in combination with other therapeutic agents as follows:
- o
- With ipilimumab: administer OPDIVO first followed by ipilimumab on the same day.
- o
- With platinum-doublet chemotherapy: administer OPDIVO first followed by platinum-doublet chemotherapy on the same day
- o
- With ipilimumab and platinum-doublet chemotherapy: administer OPDIVO first followed by ipilimumab and then platinum-doublet chemotherapy on the same day.
- o
- With fluoropyrimidine- and platinum-containing chemotherapy: administer OPDIVO first followed by fluoropyrimidine- and platinum-containing chemotherapy on the same day.
- •
- Use separate infusion bags and filters for each infusion.
- •
- Flush the intravenous line at end of infusion.
- •
- Do not co-administer other drugs through the same intravenous line.
Frequently asked questions
- How long does it prolong life and what’s the success rate?
- How long does it take to work and how do you know if it's working?
- What is the difference between Opdivo and Keytruda?
- What happens when you stop taking this for melanoma?
- Is Xalkori the same as Opdivo or Keytruda?
- Pembrolizumab vs. nivolumab: how do they compare?
More about Opdivo (nivolumab)
- Side Effects
- During Pregnancy or Breastfeeding
- Patient Tips
- Drug Interactions
- Compare Alternatives
- Pricing & Coupons
- En Español
- 57 Reviews
- Drug class: anti-PD-1 monoclonal antibodies
- FDA Approval History
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Further information
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