Opdivo (Nivolumab) — NZ Medication Guide | KiwiMeds
✅ Reviewed by Ramon Wong, BPharm, Registered Pharmacist (New Zealand) | May 2026 — This information is for educational purposes only and is not a substitute for personalised advice from your doctor or pharmacist. Always seek professional guidance before making changes to your medications.
What is Opdivo (nivolumab)?
Opdivo (generic name: nivolumab) is an immunotherapy medicine — specifically a PD-1 inhibitor — used to treat several types of cancer including melanoma, lung cancer, kidney cancer, and others. Rather than directly attacking cancer cells, nivolumab works by helping the immune system recognise and destroy cancer cells. It is given as an intravenous (IV) infusion at a hospital or cancer treatment centre.
What is it used for? (NZ context)
In New Zealand, nivolumab (Opdivo) is funded by Pharmac for several cancer types. The latest funding change, effective 1 May 2026, widens access for melanoma:
New — Nivolumab + ipilimumab (combination) before surgery (neoadjuvant):
Funded for adults with resectable stage 3B–4 melanoma — melanoma that has spread to nearby lymph nodes or beyond, but can still be surgically removed. Using immunotherapy before surgery (neoadjuvant) can shrink the tumour and may mean some patients don’t need further treatment after surgery.
Previously funded nivolumab uses in NZ also include: some lung, kidney, head & neck, and oesophageal cancers — your oncologist will advise whether you are eligible.
New Zealand has one of the highest melanoma rates in the world. Around 155 people per year are expected to receive this new combination treatment. See the Pharmac announcement.
How does it work?
Nivolumab is a PD-1 inhibitor — a type of immune checkpoint inhibitor. Normally, cancer cells can hide from the immune system by activating a “checkpoint” called PD-1, which tells immune T-cells to stand down and not attack. Nivolumab blocks the PD-1 protein on T-cells, releasing this brake and allowing the immune system to recognise and attack the cancer cells. This is called releasing the immune checkpoint. When combined with ipilimumab (which blocks a different checkpoint, CTLA-4), the combination releases two separate brakes on the immune system simultaneously, often producing a much stronger anti-cancer response than either medicine alone.
How to take it
Nivolumab (Opdivo) is given as an IV infusion at a hospital or cancer day unit. It cannot be taken at home.
When used in combination with ipilimumab before surgery for melanoma:
- Typically given every 3 weeks for up to 4 cycles (doses)
- Each infusion takes approximately 30–60 minutes
- Your oncologist will plan your specific treatment schedule based on your tumour and response
Common side effects
Because nivolumab activates the immune system, its side effects are different from traditional chemotherapy — they are called “immune-related adverse events” (irAEs):
Common (affecting many patients):
- Fatigue (tiredness)
- Rash or itching (skin reactions)
- Diarrhoea
- Nausea
- Decreased appetite
- Joint pain
- Shortness of breath or cough
- Anaemia (low red blood cells)
Serious side effects to watch for
Because nivolumab can over-activate the immune system, it can cause serious inflammation in almost any organ — called immune-related adverse events (irAEs). These can be severe or even life-threatening if not caught early. Report any new or unusual symptoms to your oncologist promptly.
Seek urgent medical attention for:
- Severe diarrhoea or colitis — more than 3–4 loose stools per day, blood in stools, severe abdominal cramping
- Liver inflammation (hepatitis) — yellowing of skin or eyes, dark urine, right-sided abdominal pain
- Lung inflammation (pneumonitis) — new or worsening cough, chest pain, shortness of breath
- Hormone gland problems — thyroid (fatigue, weight changes), pituitary (severe headache, vision changes), or adrenal gland inflammation
- Kidney inflammation — reduced urine output, swelling
- Severe skin reaction — blistering, peeling, painful widespread rash
- Neurological symptoms — weakness, numbness, confusion
Important drug interactions
- Corticosteroids (prednisone, dexamethasone) — long-term use can reduce nivolumab’s effectiveness. However, corticosteroids are the main treatment for serious immune-related side effects from nivolumab
- Other immunosuppressants — may reduce nivolumab effectiveness
- Live vaccines — not recommended during treatment
Things to avoid while taking it
- Live vaccines — the activated immune system can respond unpredictably to live vaccines
- Immunosuppressant medicines without specialist advice — reduces nivolumab’s effectiveness
- Ignoring new symptoms — immune reactions can develop at any time, even weeks after your last infusion; always report new symptoms promptly
NZ-specific information
Brand name in NZ: Opdivo
Funded: Yes — multiple indications including (from 1 May 2026) nivolumab + ipilimumab for resectable stage 3B–4 melanoma (pre-surgery). Also funded for selected other cancers
How it is given: IV infusion at hospital oncology centre
Special Authority: Required — your oncologist will apply
Prescription type: Hospital specialist (oncologist)
Melanoma has one of the highest incidence rates in New Zealand — our high UV levels and outdoor culture contribute to this. The widening of access to nivolumab + ipilimumab before surgery for resectable melanoma is a significant step forward, with clinical evidence showing that about 2 in 3 patients have major responses (significant tumour shrinkage or very little active disease at surgery), and many may not require further treatment after surgery. This can also reduce pressure on oncology infusion services, saving an estimated 1,000 infusion hours per year.
Frequently asked questions
Is nivolumab a chemotherapy?
No — nivolumab is an immunotherapy, which works very differently to traditional chemotherapy. It does not directly kill cancer cells; instead, it helps your own immune system fight the cancer. The side effect profile is also very different.
How will I know if nivolumab is working?
Your oncologist will monitor your response through imaging (CT or PET scans) and clinical assessment. In some patients, the tumour may initially appear larger on scans before it shrinks (called pseudo-progression) — your oncologist will explain what to watch for.
Can immune side effects happen after I finish treatment?
Yes — immune-related side effects can occur weeks or even months after the last dose. Always report new or unusual symptoms to your oncology team, even after treatment ends.
Will I need nivolumab after surgery?
For many patients receiving nivolumab + ipilimumab before surgery for melanoma, if there is a strong response at surgery, no further treatment may be needed. Your oncologist will assess this based on your surgical results.
Related medications
- Ipilimumab (Yervoy) — given in combination with nivolumab for melanoma