[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Immune checkpoint inhibitors](https://durgical.com/en/pharmacology/classes/immune-checkpoint-inhibitors/) › Nivolumab

# Nivolumab

## Immune checkpoint inhibitors?

Immune checkpoint inhibitors

## High alert?

An error with this medicine can cause serious harm: double checks and protocols are used.

An anti-PD-1 antibody used in melanoma, lung, kidney, head and neck and liver cancer and Hodgkin lymphoma, alone or with ipilimumab.

Updated Nov 1, 2026

Also called: anti-PD-1 antibody

## Quick facts

**Group**
[Immune checkpoint inhibitors](https://durgical.com/en/pharmacology/classes/immune-checkpoint-inhibitors/)

**Target**
Programmed cell death protein 1 (PD-1) on T cells

**Used for**
Melanoma · Non-small cell lung cancer

**Key effects**
Fatigue · Rash and itching · Diarrhoea

**Monitor**
Thyroid function · Glucose · Stool frequency

**ATC**
L01FF01

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**Programmed cell death protein 1 (PD-1) on T cells**Nivolumab

ⓘ The crystal shows human PD-1 bound by the nivolumab Fab.

**Target in 3D:** Programmed cell death protein 1 (PD-1) on T cells. PDB structure 5WT9 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/5WT9) · Drag to rotate · pinch to zoom

Nivolumab binds PD-1 on activated T cells and stops PD-L1 and PD-L2 from switching them off. T cells inside the tumour regain their ability to proliferate, release cytokines and kill tumour cells. Combined with the anti-CTLA-4 antibody ipilimumab it acts at two steps of T-cell activation, which raises both response rates and immune toxicity.

- Binds PD-1 on activated T cells
- PD-L1/PD-L2 can no longer switch them off
- T cells attack the tumour
- With ipilimumab: two checkpoints blocked, more effect and toxicity

## Indications

- Melanoma, advanced or after resection. [Melanoma →](https://durgical.com/en/conditions/melanoma/)
- Non-small cell lung cancer. [Lung cancer →](https://durgical.com/en/conditions/lung-cancer/)
- Renal cell carcinoma. [Renal cell carcinoma →](https://durgical.com/en/conditions/renal-cell-carcinoma/)
- Head and neck squamous cell carcinoma. [Head and neck squamous cell carcinoma (oral cavity and oropharynx, HPV) →](https://durgical.com/en/conditions/head-and-neck-squamous-cell-carcinoma/)
- Colorectal cancer with mismatch-repair deficiency or high microsatellite instability. [Colorectal cancer →](https://durgical.com/en/conditions/colorectal-cancer/)
- Hepatocellular carcinoma. [Hepatocellular carcinoma →](https://durgical.com/en/conditions/hepatocellular-carcinoma/)
- Relapsed or refractory classical Hodgkin lymphoma. [Hodgkin lymphoma →](https://durgical.com/en/conditions/hodgkin-lymphoma/)

## Adverse effects

### Common

- Fatigue
- Rash and itching
- Diarrhoea, nausea, decreased appetite
- Cough and breathlessness
- Muscle and joint pain
- Thyroid dysfunction

### Serious (rare, important)

- Immune-mediated pneumonitis
- Immune-mediated colitis
- Immune-mediated hepatitis
- Endocrinopathies: hypophysitis, thyroiditis, adrenal insufficiency, type 1 diabetes
- Immune-mediated nephritis
- Severe skin reactions
- Myocarditis, myositis and neurological reactions (myasthenia, Guillain-Barré syndrome)
- Infusion reactions

## Contraindications

- Previous severe immune-mediated reaction to a checkpoint inhibitor (generally not re-exposed)
- Caution: active autoimmune disease, organ or allogeneic stem-cell transplant

## Key interactions

**Systemic corticosteroids and other immunosuppressants**
Used to treat moderate to severe immune-mediated reactions; they damp the immune response.

**Ipilimumab**
The combination is more effective in some cancers but causes more frequent immune toxicity, including rare fatal myocarditis.

## What is monitored

- Thyroid function (TSH) before starting and regularly
- Liver tests and creatinine before each dose
- Glucose; cortisol if fatigue or low blood pressure
- Stool frequency, cough and breathlessness at each visit
- Signs of myocarditis (chest pain, palpitations) and muscle weakness

## Administration and safety

- Intravenous infusion only, never as a push or bolus, through a line as the product instructions specify.
- Look-alike names: the -mab checkpoint inhibitors (nivolumab, pembrolizumab, atezolizumab, cemiplimab, ipilimumab) are checked by full name; products combined with hyaluronidase for subcutaneous use are not interchangeable with the intravenous ones.
- Watch for infusion reactions (chills, fever, rash, breathlessness) during the infusion.

## Pregnancy and breastfeeding

Blocking PD-1/PD-L1 or CTLA-4 can harm the fetus (IgG antibodies cross the placenta); effective contraception is used during treatment and for months after, and breastfeeding is avoided.

## Nursing care

- Before each dose, ask about diarrhoea, cough, rash, headache, fatigue, dizziness, thirst or passing more urine, and review thyroid, liver, kidney and glucose results.
- Teach the patient that side effects can start weeks or months after a dose, even after treatment ends, and must be reported early.
- Teaching: report diarrhoea or blood in the stool, new cough or breathlessness, yellow skin, severe headache, extreme tiredness, chest pain or muscle weakness at once.
- Make sure the patient carries information that they receive immunotherapy, for any emergency visit.

## Pharmacokinetics

**Absorption**
Intravenous infusion.

**Elimination**
Broken down like natural IgG.

**Half-life**
About 27 days.

## Memory aid

«NIVOlumab and IPIlimumab: NIce pair, Intense Price»: blocking PD-1 and CTLA-4 together works better and inflames more.

## Test yourself

Think of the answer, then tap the question to see it.

## Which two checkpoints are blocked by the nivolumab–ipilimumab combination?

PD-1 (nivolumab) and CTLA-4 (ipilimumab).

## Which rare but often fatal immune toxicity is more frequent with the combination?

Myocarditis.

## How is moderate immune-mediated pneumonitis on nivolumab managed?

The drug is withheld and systemic corticosteroids are given; it is stopped permanently if severe.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/nivolumab/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**High alert**
An error with this medicine can cause serious harm: double checks and protocols are used.

## Connections

## Related drugs 4

- [Pembrolizumab](https://durgical.com/en/pharmacology/pembrolizumab/)
- [Ipilimumab](https://durgical.com/en/pharmacology/ipilimumab/)
- [Cemiplimab](https://durgical.com/en/pharmacology/cemiplimab/)
- [Atezolizumab](https://durgical.com/en/pharmacology/atezolizumab/)

## Related conditions 7

- [Melanoma](https://durgical.com/en/conditions/melanoma/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Renal cell carcinoma](https://durgical.com/en/conditions/renal-cell-carcinoma/)
- [Head and neck squamous cell carcinoma (oral cavity and oropharynx, HPV)](https://durgical.com/en/conditions/head-and-neck-squamous-cell-carcinoma/)
- [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/)
- [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/)
- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)

[← Back to the class: Immune checkpoint inhibitors](https://durgical.com/en/pharmacology/classes/immune-checkpoint-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Nivolumab Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a614056.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01FF01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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