Is Fluconazole Safe In Those With Bigeminy?

Hello and thank you for your question! There is no specific guidance regarding the use of fluconazole in those with bigeminy, a type of abnormal heart rhythm where an irregular timed heartbeat (too early) follows a regular one. It is also described as two heartbeats close together.

In many individuals, these are isolated cases and generally do not require treatment. In fact, most people experience premature heartbeats at some point in their lives.

However, in those in which this is a common occurrence, are experiencing negative symptoms associated with it, or have an underlying heart condition, treatment may be recommended.

The most common treatment is with a class of medications known as beta-blockers, like the drug you mentioned in your question (bisoprolol).

Bisoprolol With Fluconazole

There is no known drug interaction with bisoprolol and fluconazole. They are considered safe to take together.

However, beta-blockers are used to treat a variety of health conditions, including several ones that involve the heart. In many people with these heart conditions, fluconazole may not represent the best option due to the risk the drug could worsen them.

Fluconazole & QT-Prolongation

Fluconazole is associated with causing 'QT prolongation', an abnormality seen on an ECG (electrocardiogram) where the 'QT interval' is prolonged, as shown in the image below.

QT prolongation increases the risk of a rare, but serious (sometimes life-threatening), type of arrhythmia known as torsades de pointes.

The prescribing information for fluconazole warns about this:

Some azoles, including fluconazole, have been associated with prolongation of the QT interval on the electrocardiogram. During post-marketing surveillance, there have been rare cases of QT prolongation and torsade de pointes in patients taking fluconazole. Most of these reports involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications that may have been contributory.

Fluconazole & Bigeminy

As mentioned at the beginning of this answer, there is no specific guidance regarding fluconazole use and those with bigeminy.

While most people experience premature heartbeats at some time or another, if you are being treated for bigeminy, that means it is happening often, you are having symptoms or you have some sort of underlying heart condition. However, since fluconazole carries a warning about QT prolongation and torsade de pointes, its use is generally avoided in those taking other drugs that can cause similar problems, or in those at risk already at risk for arrhythmias.

There is a lot of data out there showing that certain individuals who experience bigeminy are more at risk for developing an arrhythmia, like atrial fibrillation, and even increase your risk of heart failure.

Due to this, fluconazole may not be the ideal choice in those being treated for bigeminy. It may further increase your risk of serious heart arrhythmias, since both fluconazole and bigeminy are associated with it.

Alternatives?

You mentioned you are treating a mild yeast infection.

There are certainly other therapies that may be alternative options for use, including topical products, like miconazole, terconazole, or clotrimazole.

Fluconazole may still be an option for you, but be sure that you let your doctor know of your complete medical history, and other medications you are taking, so the best therapy can be recommended/prescribed for you.

Thank you again for your question!