What volume of Normal Saline (NS) infusion is recommended for dilution of 24 mL of Opdivo (nivolumab)?

Opdivo (Nivolumab) Dilution in Normal Saline

For 24 mL of Opdivo (nivolumab), dilute in 100-250 mL of normal saline for intravenous infusion.

Dilution Process for Nivolumab

Nivolumab (Opdivo) requires proper dilution in normal saline before administration. Based on the available evidence, here's the recommended approach:

Concentration and Volume Considerations

• Opdivo comes as a solution for infusion at 10 mg/mL
• For a 24 mL volume (240 mg dose):
  • Optimal dilution is in 100-250 mL of normal saline
  • This creates a final concentration of approximately 1-2.4 mg/mL

Preparation Instructions

1. Withdraw 24 mL of Opdivo from the vial(s)
2. Transfer into an IV bag containing 100-250 mL of normal saline
3. Mix by gentle inversion (do not shake)
4. The diluted solution should appear clear to slightly opalescent

Administration Considerations

• Administer through an intravenous line using a sterile, non-pyrogenic, low-protein binding in-line filter (pore size of 0.2-1.2 μm)
• Infuse over 30-60 minutes
• Do not administer as an IV push or bolus injection

Stability Information

• According to stability studies, the diluted solution is stable for 24 hours at 2-8°C (refrigerated) 1
• Research shows the solution maintains stability even beyond the labeled 24-hour period when stored properly, though adhering to the official 24-hour guideline is recommended for clinical practice 1

Important Precautions

• Do not mix with other medications in the same infusion line
• Use dedicated lines for administration
• Flush the line with normal saline before and after administration
• Monitor for infusion reactions during and after administration

Management of Potential Infusion Reactions

If infusion reactions occur:

• Interrupt the infusion immediately
• Administer appropriate medical therapy as needed
• For severe reactions (anaphylaxis), follow standard protocols including:
  • Epinephrine administration
  • Fluid resuscitation with normal saline (1-2 L at 5-10 mL/kg in first 5 minutes) 2
  • Antihistamines (H1 and H2 blockers) 2

By following these guidelines, you can ensure safe and effective administration of Opdivo (nivolumab) for your patient.