Peter Loew (Nicolas Cage) is a driven literary agent and an example of the stereotypical narcissistic and greedy yuppie of the 1980s: he works all day and club hops at night, with little in his life but alcohol, one-night stands and the pursuit of money and supposed prestige. However, he is slowly going insane and sees a therapist (Elizabeth Ashley) frequently. During these sessions, his declining mental health becomes clear through a series of increasingly bizarre rants which eventually begin to scare even the psychiatrist. After he takes home a girl he met in a club named Jackie (Kasi Lemmons), a rotund bat flies in through his window, scaring them both. At his next session he mentions to his therapist that the struggle with the bat aroused him, and after visiting an art museum with Jackie the next day, he ditches her, and she leaves an angry message on his phone.
Loew meets Rachel (Jennifer Beals) at a night club, and takes her home. She pins him down, reveals vampire fangs and bites him on the neck. He soon begins to believe that he is slowly turning into a vampire. He stares into a bathroom mirror and fails to see his reflection, he wears dark sunglasses during the day indoors and, when his "fangs" fail to develop, he purchases a pair of cheap plastic vampire novelty teeth. All the while, Rachel apparently visits him nightly in his mind to feed on his blood. Shortly after, Loew experiences severe mood swings and calls Jackie back apologetically, asking to meet her at a bar. As he is about to leave, a jealous Rachel appears and beckons him back inside. A dejected Jackie eventually leaves the bar and leaves an angry note on his door asking him to leave her alone.
A subplot concerns a secretary working at Loew's office, Alva Restrepo (María Conchita Alonso). Loew constantly torments her by forcing her to search through an enormous paper file for a 1963 contract. When she fails to find the contract, he at first browbeats and humiliates her, then visits her at home and tricks her into coming back to work, and finally attacks and attempts to bite her at the workplace after hours. She pulls out a gun, and Loew begs her to shoot him. Since it is only loaded with blanks, she fires at the floor to scare him off. He eventually overpowers her and attempts to bite her on the neck, ripping her shirt open and knocking her down. He takes the gun and fires it into his mouth, but is not harmed by the blanks.
Thinking he has metamorphosed into a vampire, Loew goes out to a club wearing his novelty vampire teeth and moving around erratically like the character Orlok from the film Nosferatu with a crazed look in his eyes. He begins to seduce a woman, but when he gets too grabby she slaps him off, making Loew even more unhinged: he overpowers her (in the same manner as he did earlier to his employee Alva) and bites her neck, having taken out the fangs and using his real teeth. The woman is left seemingly unconscious and bloody. He then puts his plastic novelty fangs back in. Leaving the club, Loew has a brief, heated encounter with Rachel: she admits to knowing him, but gives the impression that they have not been in contact for a long period. He accuses her of being a vampiress, and is expelled from the club by security.
Alva wakes up with her shirt ripped open, possibly thinking she was raped, and eventually tells her brother Emilio (Bob Lujan) about the sexual assault, who is enraged and goes after Loew with Alva to seek revenge. Meanwhile, Loew is wandering the streets, disheveled in a blood-spattered business suit from the previous night, excitedly talking to himself. In a hallucinatory exchange on a street corner, he tells his therapist that he raped someone and also murdered someone else. Based on a newspaper, the latter appears to be true, as the girl he bit on the neck in the club is pronounced dead. As Loew returns to his now-disastrous apartment (which he'd been using as a sort of vampire's lair) Alva points out Loew to a waiting Emilio, who then quietly pursues him inside the apartment block with a tire iron.
In the midst of an abusive argument with an imaginary romantic interest (supposedly a patient of his psychiatrist) Loew begins to retch again from the blood he had swallowed, and crawls under his upturned sofa on the floor, which he sees as his "coffin". Emilio hears flatulent noises, finds him and upturns the sofa, and Loew holds a large broken piece of wood to his chest as a makeshift stake, repeating the gesture he had made earlier to strangers on the street when he had asked them to stake and kill him with the piece of wood from a pallet. Emilio, in a rage, pushes down on the wood and it pierces Loew's chest in a gruesome manner. Realizing he has committed a crime, a scared Emilio flees the apartment. As Loew dies, he envisions the vampiress Rachel staring at him one last time.
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