Madonna has been accused of performing her most recent concert while under the influence.

Some fans in Louisville, Kentucky were confused at the singer's antics on Sunday, where she apparently arrived three hours late to her Rebel Heart concert, forgot what city she was performing in and trash-talked the locals.

Celebrity website TMZ says one fan claimed Madonna even "spoke in a fake hillbilly accent".

Another fan, Macauley Miller, said on Twitter the concert was one of the "weirdest experiences" of his life, adding "I'm pretty sure Madonna is hammered drunk on stage".

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In one conversation caught on video and uploaded to YouTube on Sunday, Madonna is heard apologising for confusing Louisville for Oklahoma.

"Maybe someone slipped some bourbon into my throat coat tea or something?" she says.

"I'm mixing everything up. My choreography, my words, I put my skirt on backwards, forgot to zip my shoe. I don't even know who I am."

Other fans lapped up the antics, saying Madonna was quite funny.

Madonna herself seemed to be on the same page, posting a photo on her Instagram of her laying down on stage, with the caption "Working on my stand up laying down. Thanks Louisville! The tears of a clown soon to follow."

Madonna is currently on her Rebel Heart world tour and will be in Auckland on March 6 and 6.

-AAP