Confusion and paranoia associated with oral tocainide.

Two middle aged female patients developed hallucinations and severe confusion with paranoid features during oral tocainide administration at recommended dosage levels. Both patients had evidence of impaired renal function. Symptoms were provoked on re-challenge in the first patient. In the second patient the tocainide blood level was higher than the recommended therapeutic range. Both patients reverted to their normal mental state on withdrawal of the drug.