both mania and depression. vraylar should not be used in elderly patients with dementia, due to increased risk of death or stroke. call your doctor about fever, stiff muscles, or confusion, which may mean a life-threatening reaction or uncontrollable muscle movements, which may be permanent. side effects may not appear for several weeks. high cholesterol and weight gain; high blood sugar, which can lead to coma or death; decreased white blood cells, which can be fatal; dizziness upon standing; falls; seizures; impaired judgement; heat sensitivity; and trouble swallowing may occur. you're more than just your bipolar i. ask about vraylar.