The Binding of Isaac: Afterbirth

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The Binding of Isaac: Afterbirth is the expansion to The Binding of Isaac: Rebirth. The DLC was released on October 30th, 2015 and costs $10.99/£7.99. It was released on May 10, 2016 on Xbox One and PS4.

For a list of the pre-release blog posts, see The Binding of Isaac: Afterbirth (Pre-Release).

Features[edit | edit source]

Additions[edit | edit source]

Characters[edit | edit source]

Character Lilith App.png
Lilith
Keeper App.png
Keeper
Health Stat Icon.png Health HUD Red Heart.pngHUD Black Heart.pngHUD Black Heart.png HUD Coin Heart.pngHUD Coin Heart.png
Damage Stat Icon.png Damage 3.5 (*1.00) 3.5 (*1.20)
Tears Stat Icon.png Tears Blindfolded
Shot Speed Stat Icon.png Shot Speed Blindfolded 1
Range Stat Icon.png Range Blindfolded 23.75
Speed Stat Icon.png Speed 1.0 0.85
Luck Stat Icon.png Luck 0 -2
Starting Item Icon.png Starting Pickups None x1 Bombs
Needs to be unlocked x1 Coins
Needs to be unlocked Store Key
Starting Item Icon.png Starting Item(s) Incubus,
Needs to be unlocked Cambion Conception,
Box Of Friends
Triple shot,
Needs to be unlocked Wooden Nickel

Items[edit | edit source]

95 new items were added in the expansion: 19 activated items and 76 passive items.

Activated Collectibles[edit | edit source]

Name Icon Description Recharge
Box Of Friends Box Of Friends Icon.pngUpon use, duplicates all of Isaac's familiars for the current room.4
D12 D12 Icon.pngRe-rolls all rocks in the current room into other random objects, such as bomb rocks, metal blocks, TNT, or poop.3
D7 D7 Icon.pngRestarts the current room and brings back all enemies, allowing more rewards to be acquired by completing the room.3
D8 D8 Icon.pngRe-rolls all of Isaac's stats.4
Diplopia Diplopia Icon.pngDuplicates all pickups and item pedestals in the room.One time use
Friendly Ball Friendly Ball Icon.pngThrowing the ball at an enemy instantly kills it and captures it. The captured enemy can later be released and will be charmed until it dies, persisting between floors.3
Glass Cannon Glass Cannon Icon.pngWhen used, reduces Isaac's health to half a heart (including soul and black hearts) and fires one large piercing spectral tear that does a lot of damage. The damage done by Glass Cannon scales with Isaac's damage (at base damage it does 45 damage).4 seconds
Glowing Hour Glass Glowing Hour Glass Icon.pngWhen used, this item will rewind time, put Isaac back in the previous room, and undo anything that happened in the current room. Any health, pickups, or items gained or lost will be reset back to the previous state.2
Jar Of Flies Jar Of Flies Icon.pngEvery time Isaac kills an enemy, a fly will be added to the jar, up to a maximum of 20. Using the Jar of Flies will release all the flies that are currently in the jar as friendly Blue Flies that will damage enemies.0
Kidney Bean Kidney Bean Icon.pngUpon use, Isaac farts, charming all nearby enemies.2
Mega Bean Mega Bean Icon.pngWhen used, the Mega Bean will freeze all enemies in the current room for a couple of seconds, deal 5 damage and poison any enemies near Isaac, and send a wave of spikes that deals 10 damage across the room in the direction Isaac is facing.3
Mega Blast Mega Blast Icon.pngUpon use, Isaac fires a laser similar to the one used by Mega Satan. This laser deals massive damage, lasts for approximately 15 seconds, and persists between rooms. Isaac is pushed backwards by the force of the laser while it is active.12
Mine Crafter Mine Crafter Icon.pngWhen used, places an explosive TNT barrel that can be pushed and used to destroy rocks or damage enemies. If used a second time in the same room while the previous TNT barrel is still intact, it will remotely explode the TNT.1
Mom's Box Mom's Box Icon.pngWhen used, Mom's Box will drop a random trinket on the ground. While held, increases luck by 1 and doubles the effects of trinkets.4
Placebo Placebo Icon.pngWhen used, copies the effect of the pill Isaac is currently holding without consuming it. Does not copy the effects of cards or runes.4
Tear Detonator Tear Detonator Icon.pngWhen used, will detonate any tears currently on the screen and cause each one to split into 6 more tears which will fire in a circle, similar to Tammy's Head.1
Teleport 2.0 Teleport 2.0 Icon.pngWhen used, teleports Isaac to a random room that has not been explored yet. If all rooms are explored, including secret rooms, it will teleport Isaac to the Devil or Angel room. If all rooms are explored, including the Devil or Angel room, it will teleport Isaac to the I AM ERROR room. If used in a room with enemies, it will teleport Isaac out and back into the exact same room.4
Ventricle Razor Ventricle Razor Icon.pngCan be used to place an orange trapdoor and a blue trapdoor. Upon entering a trapdoor, Isaac is teleported to the other trapdoor.0
Wooden Nickel Wooden Nickel Icon.pngWhen used, has a 50% chance to drop one random type of coin (penny, nickel or dime)1

Passive Collectibles[edit | edit source]

Name Icon Description
8 Inch Nails 8 Inch Nails Icon.png+1.5 Damage Up. Replaces Isaac's tears with nails, which have increased knockback.
Athame Athame Icon.pngWhenever Isaac takes damage, a black ring briefly appears around Isaac, dealing damage to all nearby enemies.
Betrayal Betrayal Icon.pngEvery time Isaac takes damage, a charm effect is applied to every enemy in the room, causing them to attack each other rather than Isaac.
Binky Binky Icon.pngTears up, adds 1 soul heart, and decreases Isaac's size.
Black Powder Black Powder Icon.pngIsaac leaves a trail of black powder on the floor. Walking in a circle will spawn a pentagram symbol on the floor, which deals 10 damage per tick to any enemies inside it.
Bomber Boy Bomber Boy Icon.png+5 bombs. Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide). This also affects troll bombs.
Bumbo Bumbo Icon.pngSpawns a beggar familiar which floats around the room and picks up any nearby coins, leveling up after collecting several coins. At level 2, Bumbo gains a body. At level 3, it begins to fire tears. At level 4, Bumbo chases enemies slowly, dealing contact damage.
Bursting Sack Bursting Sack Icon.pngSpider enemies no longer target or deal contact damage to Isaac.
Cambion Conception Cambion Conception Icon.pngAfter taking damage a certain amount of times, a permanent demonic familiar spawns.
Car Battery Car Battery Icon.pngCauses Isaac's activated item to activate twice on each use.
Censer Censer Icon.pngGives Isaac a golden censer familiar which creates a huge aura of light that slows down any enemies inside it.
Chaos Chaos Icon.pngChaos causes items to be chosen from random item pools. When picked up, drops between 1-6 random pickups on the floor.
Charged Baby Charged Baby Icon.pngA familiar baby that drops a battery every 4 rooms. Has a small chance to freeze all enemies in the room when hit.
Circle Of Protection Circle Of Protection Icon.pngGives Isaac a large white halo around him, that deals a bit of damage to any enemies in contact with the ring. Every time an enemy bullet enters the ring, there is a chance it will reflect a homing tear back at the enemy.
Continuum Continuum Icon.png+2.25 Range Up. +1.5 Tear Height. Isaac's tears travel through walls and appear out of the opposite wall. Isaac's tears also travel over rocks and objects.
Crack Jacks Crack Jacks Icon.pngAdds one heart container and drops a random Trinket.
Crown Of Light Crown Of Light Icon.pngGives Isaac a crown that glows blue when active, and turns gray when inactive. While Isaac has no empty red heart containers, Isaac's tears are replaced with blue diamond tears that deal double damage. Regardless of health, the crown will deactivate for the current room when Isaac takes damage.
Curse Of The Tower Curse Of The Tower Icon.pngCauses Isaac to spawn 6 troll bombs on the floor every time he gets hit, similar to the Anarchist Cookbook mechanic.
Dead Eye Dead Eye Icon.pngIsaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.
Deep Pockets Deep Pockets Icon.pngAllows Isaac to carry two cards or pills (or a combination of both) at the same time.
Eden's Blessing Eden's Blessing Icon.pngTears up. Grants a random item at the start of the next run.
Empty Vessel Empty Vessel Icon.pngWhile Isaac has no red hearts, this item grants flight and a random chance to activate an invincibility shield for a few seconds. If Isaac gains any red hearts, these benefits will disappear.
Epiphora Epiphora Icon.pngShooting in one direction increases Isaac's rate of fire until the cap is reached. As soon as Isaac changes direction or stops shooting, rate of fire is reset to its normal amount.
Evil Eye Evil Eye Icon.pngWhile firing tears, Isaac has a chance to fire an eye across the screen with a very slow shot speed, which will fire tears of its own in the same direction as Isaac. The eye will be destroyed if it comes into contact with an enemy or obstacle.
Explosivo Explosivo Icon.pngIsaac's tears have a chance to stick to enemies and explode.
Farting Baby Farting Baby Icon.pngA familiar that follows Isaac and blocks tears. If a tear hits Farting Baby, there is a high chance for it to fart, which will either knock back, poison, or charm all nearby enemies.
Fate's Reward Fate's Reward Icon.pngA blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.
Friend Zone Friend Zone Icon.pngA white orbiting fly which deals 3 contact damage per tick to enemies. This familiar orbits Isaac at a middle length distance somewhere between Distant Admiration and Forever Alone.
Fruit Cake Fruit Cake Icon.pngIsaac's tears gain a random effect that changes every shot.
GB Bug GB Bug Icon.pngA glitch familiar that bounces around the room and applies a random status effect to any enemies it comes into contact with and has a chance to re-roll pickups that it passes over.
Glitter Bombs Glitter Bombs Icon.pngGives Isaac 5 bombs, and makes Isaac's bombs have a chance to drop random pickups or charm enemies when they explode.
God's Flesh God's Flesh Icon.pngTears now have a random chance to apply a shrinking effect, causing enemies to shrink in size and also run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.
Head Of The Keeper Head Of The Keeper Icon.pngIsaac's tears become coins and now have a chance to drop pennies on the floor upon successfully hitting an enemy.
Holy Light! Holy Light! Icon.pngIsaac has a random chance to fire a Holy tear, which when it hits an enemy, will spawn a Crack The Sky style light beam on the same enemy, dealing damage.
Host Hat Host Hat Icon.pngA host familiar that sits on Isaac's head and has a random chance to block enemy shots and retaliate with 3 tears. Grants immunity to explosions.
Immaculate Conception Immaculate Conception Icon.pngUpon picking up a certain amount of health, spawn a permanent angelic familiar.
Incubus Incubus Icon.pngA demonic familiar that follows Isaac and shoots tears identical to Isaac's in terms of damage, range, fire rate, and effects.
Key Bum Key Bum Icon.pngSpawns a portable Key Master that follows Isaac and collects keys, giving random chests in return.
Kidney Stone Kidney Stone Icon.pngRandomly while firing tears, Isaac will stop firing and turn red, where he will charge and release a lot of 'tears' in one go. In the burst of tears is a kidney stone which deals a lot of damage.
Lil' Chest Lil' Chest Icon.pngSpawns a chest familiar that follows Isaac and drops a random pickup every few rooms.
Lil Gurdy Lil Gurdy Icon.pngGives Isaac a Gurdy familiar that will charge around the room dealing contact damage to enemies. Lil Gurdy is charged by holding down a fire button and letting go. The longer the button is held, the faster Lil Gurdy will fling itself across the screen. Lil Gurdy can pass over objects and obstacles in the room.
Lil' Loki Lil' Loki Icon.pngA Loki familiar that follows Isaac and shoots 4 tears in a cross pattern.
Lost Fly Lost Fly Icon.pngA familiar fly that moves in a straight line and attaches itself to the first obstacle or wall it comes into contact with in each room. If any enemies walk into its path, it will deal 7 contact damage per tick. If the obstacle it is attached to is destroyed then it will continue rolling in the direction it was previously travelling until it meets another wall or obstacle.
Lusty Blood Lusty Blood Icon.pngEach time Isaac kills an enemy, Isaac's damage increases for the current room.
Marked Marked Icon.pngIsaac will now fire tears automatically directed at a red target on the ground which is controlled by the player. This allows for a full 360 degree tear firing radius. Can be overridden by other tear modifiers such as Mom's Knife or Brimstone.
Maw Of The Void Maw Of The Void Icon.png+1.0 Damage Up. After continuously firing tears for 3 seconds, a red cross appears on Isaac's head that, upon releasing the fire button, creates a black ring which deals a lot of damage to any enemies inside it. The ring rapidly deals damage equal to Isaac's tear damage to any enemies in contact with it.
Milk! Milk! Icon.pngA glass of milk follows Isaac and spills on the floor upon taking damage. After the milk spills, Isaac gains a tears up that lasts for the rest of the room.
Mom's Pearls Mom's Pearls Icon.png+1.25 Range Up. +0.5 Tear Height. +1 Luck Up.
More Options More Options Icon.pngTwo items spawn in every Treasure Room. Only one can be taken; the other will disappear.
Mr. Dolly Mr. Dolly Icon.pngTears and Range up. Spawns 3 random types of hearts on the floor when picked up
Multidimensional Baby Multidimensional Baby Icon.pngSpawns a familiar that will follow Isaac's movements on a 2.5 second delay. Tears that pass through the baby will be doubled and increase in damage.
My Shadow My Shadow Icon.pngEach time Isaac takes damage, inflicts Fear on all enemies in the room and spawns a black Charger familiar that will attack enemies. The Charger will be killed if it is damaged too much.
Night Light Night Light Icon.pngA cone of light shines in the direction Isaac is moving that slows enemies and enemy shots.
No. 2 No. 2 Icon.pngContinuously firing tears for several seconds causes Isaac to drop a Butt Bomb. Butt Bombs explode for 50 damage like normal bombs, but also deal 10 damage to all enemies in the room and daze them for a short period of time.
Papa Fly Papa Fly Icon.pngA blue fly familiar follows Isaac's movements on a 3 second delay. Papa Fly will fire tears at nearby enemies.
Pay To Play Pay To Play Icon.pngThis item turns all doors that require a key into doors which need a coin to enter instead. This affects shops, item rooms, libraries and other key doors.
PJs PJs Icon.pngAdds 4 Soul Hearts and fully restores Isaac's red health.
Pupula Duplex Pupula Duplex Icon.pngTransforms Isaac's tears into a wide arc shape which gives them a much larger hitbox. Gives Isaac spectral tears which allows them to travel through objects in the environment (i.e. rocks).
Purity Purity Icon.pngThis item will boost one of Isaac's stats depending on the color of the aura around him. The aura will disappear upon taking damage and will reappear with a random color upon entering a new room. A red aura boosts damage, a blue aura boosts rate of fire, a yellow aura boosts speed, and an orange aura boosts range.
Obsessed Fan Obsessed Fan Icon.pngA purple fly familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.
Restock Restock Icon.pngCauses shops to instantly restock their items when they are bought. Granted by default for every character in Greed Mode.
Rune Bag Rune Bag Icon.pngA bag that follows Isaac and drops a random mystic rune every 3 rooms.
Sack Head Sack Head Icon.pngGreatly increases the chance to find sacks.
Scatter Bombs Scatter Bombs Icon.pngAdds 5 bombs. Isaac's bombs explode into 2-4 tiny bombs.
Seraphim Seraphim Icon.pngAn angel familiar which follows Isaac and fires homing tears which deal 10 damage at -25% shot speed and a reduced fire rate.
Serpent's Kiss Serpent's Kiss Icon.pngTears now have a random chance to apply a poison effect, causing 4 or 6 damage per tick to enemies (Similar to The Common Cold item). Isaac now deals poison damage on contact with enemies similar to The Virus item (Damage over time 4 or 6 per tick). Enemies that were poisoned have a chance to drop a black heart when killed.
Sticky Bombs Sticky Bombs Icon.png+5 bombs. Bombs stick to enemies and spawn 2-4 Blue Spiders if they kill an enemy.
Spear Of Destiny Spear Of Destiny Icon.pngIn addition to tears, Isaac now holds a spear in front of him which deals damage equal to 2 times his tear damage, and occasionally inflicts Fear. The spear cannot be thrown, but deals damage while it is in contact with an enemy.
Spider Mod Spider Mod Icon.pngDisplays Isaac's tear damage and enemy health bars. Spawns a gray spider familiar that wanders around and inflicts a random status effect on any enemies it comes into contact with. Occasionally spawns a blue spider upon clearing a room.
Succubus Succubus Icon.pngSpawns a flying familiar that bounces around the room with a black aura, dealing rapid damage to any enemies inside it. While standing in the aura, Isaac gains a 1.5x tear damage multiplier.
Sworn Protector Sworn Protector Icon.pngAn orbital angel which does 7 contact damage per tick and blocks enemy shots. When it blocks a shot, it has a very small chance to drop an eternal heart.
Tech X Tech X Icon.pngTears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.
The Wiz The Wiz Icon.pngTears simultaneously fire out of both eyes diagonally, similar to the effect of the R U A Wizard? pill. Isaac's tears also travel above all obstacles.
Toxic Shock Toxic Shock Icon.pngUpon entering a room, poisons all enemies, dealing double Isaac's tear damage. Killing enemies leaves a small, short lasting pool of green creep on the ground.
Tractor Beam Tractor Beam Icon.pngIsaac emits a beam from his face. Isaac's tears travel in the path of the beam.
Zodiac Zodiac Icon.pngZodiac will give Isaac a random zodiac item effect that changes after every floor.

Trinkets[edit | edit source]

29 new trinkets were added in the expansion.

Item Icon Effect
Blasting Cap Blasting Cap Icon.pngExploding bombs have a chance to drop another bomb pickup.
Black Feather Black Feather Icon.pngIncreases Isaac's damage for possessing certain evil items.
Blind Rage Blind Rage Icon.pngIncreases invincibility time after getting hit.
Blister Blister Icon.pngIncreases knockback of tears.
Brown Cap Brown Cap Icon.pngPoop will explode after being destroyed.
Bob's Bladder Bob's Bladder Icon.pngLeaves a pool of green creep under all bombs Isaac places, which damages enemies that walk over it.
Child Leash Child Leash Icon.pngCauses familiars to stay closer to each other.
Cracked Dice Cracked Dice Icon.pngWhenever Isaac gets hit, there is a chance that the effect of The D6, D8, D12, or D20 gets activated.
Endless Nameless Endless Nameless Icon.pngWhen Isaac uses a pill, card, or rune, there is a chance to spawn another one of the same type.
Error Error Icon.pngGives a random trinket effect each room.
Faded Polaroid Faded Polaroid Icon.pngOccasionally causes Isaac to blend into the ground, which briefly confuses all enemies in the room.
Golden Horse Shoe Golden Horse Shoe Icon.png+15% chance for a Treasure Room with two items to spawn.
Karma Karma Icon.pngDonating to a Donation Machine has a chance to heal Isaac for a full red heart or spawn a Beggar. Increases the chance that donating to a Donation Machine will increase Isaac's luck.
Lazy Worm Lazy Worm Icon.pngTear shot speed is greatly reduced.
Lil Larva Lil Larva Icon.pngSpawns a Blue Fly from every pile of poop Isaac destroys.
Louse Louse Icon.pngOccasionally spawns a Blue Spider.
Mom's Locket Mom's Locket Icon.pngGrants half a red heart each time a key is used. Converts half red heart pickups into full red hearts.
NO! NO! Icon.pngRemoves all active items from every item pool.
Poker Chip Poker Chip Icon.pngChests have a 50% chance of paying out with extra pickups and a 50% chance of paying out with nothing or enemies.
Rainbow Worm Rainbow Worm Icon.pngIsaac's tears gain a random worm effect that changes every 3 seconds.
Rib Of Greed Rib Of Greed Icon.pngPrevents Greed and Super Greed from appearing in Shops and Secret Rooms.
Safety Scissors Safety Scissors Icon.pngTroll Bombs turn into Bomb pickups before they explode. Mega Troll Bombs turn into 1+1 Free Bombs before they explode.
Second Hand Second Hand Icon.pngIncreases the time that status effects stay on enemies.
Shiny Rock Shiny Rock Icon.pngTinted rocks and rocks with Crawl Spaces will flash white every 10 seconds.
Store Key Store Key Icon.pngAutomatically opens all Shops.
Stud Finder Stud Finder Icon.pngIncreases the chance to find a Crawl Space.
Super Magnet Super Magnet Icon.pngPulls enemies and pickups towards isaac.
Tape Worm Tape Worm Icon.pngDoubles Isaac's range and halves his tear height.
Watch Battery Watch Battery Icon.pngIncreased chance of batteries spawning. Has a chance to add an extra charge to Isaac's activated item upon completing a room.

Pickups[edit | edit source]

Pickups & Chests[edit | edit source]

Name Icon Description
Gold Heart GoldHeart.PNG Gold Hearts are the rarest variation of a heart. They are unlocked by completing the challenge DLC Indicator.pngXXXXXXXXL. They always appear as full hearts and, once picked up, drop money the next time Isaac loses a Heart. A Golden Heart appends to the end of the health bar, surrounding it in a golden glow.
Lucky Penny Coin.png A Lucky Penny increases luck by 1 when picked up. Unlocked by donating 1 coin to the Greed Machine. Bumbo and Bum Friend are unable to pick up Lucky Pennies; they instead hover over them attempting to pick them up. Humbling Bundle does not double lucky pennies.
Sticky Nickel Nickel.png A Nickel that will flip upside-down when Isaac tries to collect it. Afterwards, it will get stuck on the ground, unable to be picked up unless blasted off the ground with an explosion. Unlocked by completing Boss Rush with Keeper. It won't reduce the spawn rate of regular Nickels: rather, Pennies have an additional chance to become Sticky Nickels.
Gold Bombs Gold Bomb.png Gold bombs will not add to the player's bomb count, but when picked up, they will give the player unlimited bombs for the duration of the current floor, similarly to Golden Keys. They are unlocked by completing the challenge Blue Bomber.
Angel Chests AngelChest.png Angel Chests are similar in appearance to Gold Chests, except they glow bright blue instead of gold, like a soul heart. They require one key to unlock, but can be reopened a random amount of times, each time requiring another key. They can be found in Angel rooms and rarely in a normal room. Their loot is similar to Golden Chests, but they can also drop nothing upon opening. If they contain nothing or an item, they will no longer be able to be reopened.
Spike Chests SpikeChest.png Spike Chests are purple colored chests with spikes protruding from them that will deal damage to Isaac upon opening (unless he has the Holy Mantle active, which nullifies the damage, or if found in The Chest, where they are free to open). They can be rarely found upon completing a room or in greed mode shops. Their loot is similar to Brown Chests. Unlike other chests, they do not appear on the minimap.
Mystery Sack MysteryBag.png The Mystery Sack will spawn 1-4 pickups upon touching it. Sack Head greatly increases the chances of finding sacks.

Pills[edit | edit source]

Pill Effect
Needs to be unlocked Addicted

Makes Isaac take a full heart of damage from all sources for the current room. Unlocked by completing Challenge #24: PAY TO PLAY.

Friends Till The End!

Spawns three Blue Flies.

Infested!

Destroys all poop in the room and spawns a single Blue Spider under Isaac and on each destroyed poop.

Infested?

Spawns Blue Spiders equal to the number of enemies in the room. If there are no enemies in the room, spawns 1-3 Blue Spiders.

One Makes You Small

Decreases Isaac's size and increases the pitch of his voice. This effect decreases the size of Isaac's hitbox.

One Makes You Larger

Increases Isaac's size and decreases the pitch of his voice. This effect does not increase the size of Isaac's hitbox.

Needs to be unlocked Percs

Gives The Wafer effect while in the room. Unlocked by completing Challenge #24: PAY TO PLAY.

Power Pill

Activates an effect similar to The Gamekid.

Needs to be unlocked Re-Lax

For a short time, poop spawns wherever Isaac moves, like Explosive Diarrhea but with poop. A higher move speed means you can touch more tiles in the same time. A pun on laxatives. Unlocked by completing Challenge #25: Have A Heart.

Retro Vision

Briefly pixelates the screen 3 times over 30 seconds.

Needs to be unlocked ???

Gives the Curse of the Maze effect for the remainder of the floor. The effect can stack with other curses. If no other curses are active for the floor, Curse of the Maze will appear under the level name when TAB is held. This effect cannot be negated by Black Candle. Unlocked by completing Challenge #25: Have A Heart.

Cards & Runes[edit | edit source]

Name Icon Message Effect
? Card DLC Indicator.png48 Q Card Icon.png"Double Active"When used, copies the effect of Isaac's currently held activated collectible item.
Get Out Of Jail Free Card DLC Indicator.png47 Get Out Of Jail Free Card Icon.png"Open sesame"Upon use, opens all doors in the current room (including the golden door at The Chest/Dark Room), similar to Dad's Key.
Emergency Contact DLC Indicator.png50 Emergency Contact Icon.png"Help from above"When used, will cause two Mom's Hands to come down and grab two random enemies.
Dice Shard DLC Indicator.png49 Dice Shard Icon.png"D6 + D20"Upon use, activates the effects of the D6 and the D20 at the same time.
Rune ID Icon Message Unlocked by completing Effect
Blank Rune DLC Indicator.png 40 Blank Rune Icon.png

"???"

30. The Guardian DLC Indicator.png

Grants a random rune effect. Has a 25% chance to spawn another Blank Rune upon use.

Transformations[edit | edit source]

Transformation Appearance Transformation effect Item Icon Item effect Recharge
Bob Bob Transformation.png
Bob's Rotten Head Bob's Rotten Head Icon.pngUpon use, Isaac holds a poison bomb which can be thrown towards any of the four cardinal points and explodes on impact.3
Bob's Brain Bob's Brain Icon.pngSpawns a familiar that charges forward when shooting tears, explodes upon contact with an enemy and poisons them. Respawns after few seconds.
Bob's Curse Bob's Curse Icon.pngGives 5 bombs and grants all bombs poison effect.
Ipecac Ipecac Icon.pngReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.
Conjoined Baby Transformation.png
  • When attacking, the tumor faces shoot tears diagonally outwards, similar to the effect of The Wiz.
  • -0.3 damage.
  • Slightly decreases tears.
Brother Bobby Brother Bobby Icon.pngFollows Isaac around shooting normal tears.
Harlequin Baby Harlequin Baby Icon.pngSpawns a familiar that follows Isaac around and fires two tears at once in a V-pattern.
Headless Baby Headless Baby Icon.pngFamiliar that follows Isaac, leaving blood creep on the ground.
Little Steven Little Steven Icon.pngSpawns a familiar that follows Isaac around and fires homing tears.
Mongo Baby Mongo Baby Icon.pngSummons a familiar that copies the tears of Isaac's other familiars.
Rotten Baby Rotten Baby Icon.pngA familiar that spawns Blue Flies.
Sister Maggy Sister Maggy Icon.pngA Familiar that follows Isaac around shooting blood tears.
Fun Guy Mushroom Transformation.png
God's Flesh God's Flesh Icon.pngTears now have a random chance to apply a shrinking effect, causing enemies to shrink in size and also run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.
Mini Mush Mini Mush Icon.pngIncreases Speed and Shot Height and decreases Isaac's size, but lowers Range.
Magic Mushroom Magic Mushroom Icon.pngIncreases all stats and enlargens Isaac
Odd Mushroom (Thin) Odd Mushroom (Thin) Icon.pngIncreases Tears and Speed while reducing Damage.
Odd Mushroom (Large) Odd Mushroom (Large) Icon.pngGrants an empty heart container. Increases damage, range and shot height while reducing speed.
1up! 1up! Icon.pngGives an extra life. Upon death, you will respawn in the previous room with full health and lose the 1up!.
Blue Cap Blue Cap Icon.pngGrants 1 heart container and increases tears, but decreases shot speed.
Leviathan Evil Angel Transformation.png
The Nail The Nail Icon.pngAdds one Soul Heart and allows the breaking of Rocks and damaging enemies by simply walking over them. Increases Damage and decreases Speed. All effects except for the Soul Heart wear off upon leaving the room.6
The Mark The Mark Icon.pngIncreases Damage and Speed, plus adds one Soul Heart.
The Pact The Pact Icon.pngIncreases damage by 0.5, tears by 0.7 and grants two soul hearts upon pickup.
Pentagram Pentagram Icon.pngIncreases Damage and increases chances of the Devil Room appearing.
Spirit Of The Night Spirit Of The Night Icon.pngGrants spectral tears and flight.
Maw Of The Void Maw Of The Void Icon.png+1.0 Damage Up. After continuously firing tears for 3 seconds, a red cross appears on Isaac's head that, upon releasing the fire button, creates a black ring which deals a lot of damage to any enemies inside it. The ring rapidly deals damage equal to Isaac's tear damage to any enemies in contact with it.
Abaddon Abaddon Icon.pngIncreases damage and speed, removes all red heart containers, grants six black hearts, and adds a chance to shoot fear tears.
Brimstone Brimstone Icon.pngTears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.
Oh Crap Poop Transformation.png
  • Whenever a pile of poop is destroyed, health is replenished by half a heart.
Flush! Flush! Icon.pngChanges all enemies in the room into poop. Does not work on all enemies (Knights and bosses are immune). Instantly kills Dingle, Dangle, and Brownie.6
The Poop The Poop Icon.pngSpawns a pile of poop where the character is standing and knocks nearby monsters back. May yield pickups like regular poop.1
E Coli E Coli Icon.pngGives "Turdy Touch" Effect. Enemies that touch Isaac are changed into Poop.
Seraphim Angel Transformation.png
The Bible The Bible Icon.pngUpon activation, Isaac gains Flight, allowing him to pass over all obstacles in the current room. Instantly kills Mom, Mom's Heart, and It Lives when activated, but will kill Isaac when activated while fighting Satan.6
Dead Dove Dead Dove Icon.pngGrants spectral tears and flight.
Guardian Angel Guardian Angel Icon.pngSpawns an orbital familiar that blocks enemy projectiles, deals contact damage to enemies and increases the speed of all orbital familiars.
Holy Grail Holy Grail Icon.pngGrants flight and one heart container.
Holy Mantle Holy Mantle Icon.pngAutomatically negates first taken damage in every room.
Mitre Mitre Icon.pngGrants a chance of converting any red hearts pickups into soul hearts instead.
Rosary Rosary Icon.pngAdds 3 Soul Hearts and increases the chance for The Bible to appear in any item pool.
Sworn Protector Sworn Protector Icon.pngAn orbital angel which does 7 contact damage per tick and blocks enemy shots. When it blocks a shot, it has a very small chance to drop an eternal heart.
The Halo The Halo Icon.pngGrants one Heart Container, +0.3 Damage, +0.2 Tears, +0.25 Range, +0.3 Speed, and +0.5 Tear Height.
Spun Drugs Transformation.png
Experimental Treatment Experimental Treatment Icon.pngRandomly increases and decreases some of the character's stats. There will always be at least one stat increase and one decrease and the same stats can be increased/decreased multiple times.
Growth Hormones Growth Hormones Icon.pngIncreases damage by 1 and speed by 0.4.
Roid Rage Roid Rage Icon.pngIncreases speed by 0.6, range by 5.25, and tear height by 0.5.
Speed Ball Speed Ball Icon.pngIncreases speed by 0.3 and shot speed by 20%.
Synthoil Synthoil Icon.pngIncreases damage by 1, range by 5.25, and tear height by 0.5.
The Virus The Virus Icon.pngInflicts poison to enemies who make contact with Isaac. Speed down.
Yes, Mother? Mom Transformation.png
  • Isaac gains a stationary knife that trails directly behind him. It synergizes like Mom's Knife would.
Mom's Bottle Of Pills Mom's Bottle Of Pills Icon.pngGives Isaac a random Pill, and will cause him to drop any held Q-slot item (If any). The player will only receive six different pill types in one playthrough.6
Mom's Bra Mom's Bra Icon.pngUpon use, petrifies all enemies in the current room for approximately 4 seconds.3
Mom's Pad Mom's Pad Icon.pngUpon use, inflicts fear to all enemies in the room for 5 seconds.3
Mom's Wig Mom's Wig Icon.pngAdds a chance to spawn Blue Spiders when firing tears. Restores 1 red heart.
Mom's Eye Mom's Eye Icon.pngAllows Isaac to fire tears from the back of his head.
Mom's Purse Mom's Purse Icon.pngAllows Isaac to hold 1 additional trinket.
Mom's Contacts Mom's Contacts Icon.pngAdds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.
Mom's Knife Mom's Knife Icon.pngIsaac's tears are replaced by a knife that pierces enemies, can travel through obstacles, and can hurt enemies while Isaac is holding it. Holding down the fire button before firing increases its range and power.
Mom's Heels Mom's Heels Icon.pngIncreases range.
Mom's Eyeshadow Mom's Eyeshadow Icon.pngTears have a chance to charm enemies.
Mom's Perfume Mom's Perfume Icon.pngAdds a chance to shoot fear tears and increases Tears by 0.16.
Mom's Key Mom's Key Icon.pngSpawns 2 keys. Generates additional pickups from chests.
Mom's Lipstick Mom's Lipstick Icon.pngIncreases range and shot height.
Mom's Underwear Mom's Underwear Icon.pngIncreases range.
Mom's Coin Purse Mom's Coin Purse Icon.pngSpawns 4 random Pills around Isaac.
Mom's Pearls Mom's Pearls Icon.png+1.25 Range Up. +0.5 Tear Height. +1 Luck Up.
Super Bum Super Bum.png
Image depicts the familiar. This transformation does not alter Isaac's appearance.
Bum Friend Bum Friend Icon.pngA portable Beggar who follows Isaac, picks up coins for himself, and occasionally drops a Pickup after collecting a coin. Does not spawn Collectibles.
Dark Bum Dark Bum Icon.pngSpawns a familiar that follows Isaac around and collects Red Hearts. For every one-and-a-half red hearts collected, Dark Bum will generate one Soul Heart, one hostile Spider or one friendly Blue Spider.
Key Bum Key Bum Icon.pngSpawns a portable Key Master that follows Isaac and collects keys, giving random chests in return.

NPCs[edit | edit source]

Monsters[edit | edit source]

Many new monsters were added in the expansion. Additionally, several new champion types were added.

Monster Description
Dart Fly
Dart Fly.png
DLC Indicator.png
Flies towards Isaac and attempts to mimic his movements. Deals contact damage.
Swarm Fly
Swarm Fly.png
DLC Indicator.png
Follows Isaac in large groups and deals contact damage.
Drowned Boom Fly
Drowned Boom Fly.png
DLC Indicator.png
Flies around the room diagonally, dealing touch damage. Upon death, explodes, fires four blood shots in the cardinal directions, and spawns a Drowned Charger.
Corn Dip
Corn Dip.png
DLC Indicator.png
Quickly dashes in random directions, dealing contact damage.
Dank Squirt
Dank Squirt.png
DLC Indicator.png
Dashes towards the player and deals contact damage. Spawns 2 Clots upon death.
Roundy
Roundy.png
DLC Indicator.png
Pops out of the ground in random locations, creating a small rock wave. Fires an explosive Ipecac shot at Isaac if he is in sight.
Ulcer
Ulcer.png
DLC Indicator.png
Pops out of the ground in random locations and spits a blood shot at Isaac or spawns a Dart Fly if Isaac is in sight.
Drowned Hive
Drowned Hive.png
DLC Indicator.png
Walks around the room, avoiding Isaac while spawning Drowned Chargers. Spawns a Drowned Charger upon death.
Dukie
Dukie.png
DLC Indicator.png
Flies around the room diagonally, occasionally spitting out a Dart Fly.
Flaming Gaper
Flaming Gaper.png
DLC Indicator.png
Walks towards Isaac, dealing contact damage. Usually turns into a Pacer or a Gusher upon death.
Cyclopia
Cyclopia.png
DLC Indicator.png
Walks towards Isaac, dealing contact damage and leaving behind a trail of damaging red creep. Occasionally shoots a blood shot towards Isaac.
Black Bony
Black Bony.png
DLC Indicator.png
Wanders around the room and throws three bones in a row at Isaac when he is in sight. Explodes upon death.
Dank Death's Head
Dank Death's Head.png
DLC Indicator.png
Moves diagonally around the room, dealing contact damage. Needs to be killed to complete the room.
Flesh Death's Head
Flesh Death's Head.png
DLC Indicator.png
Moves diagonally around the room, dealing contact damage. Explodes into 6 blood shots in all directions upon death. Can be killed, but also dies when the room is cleared.
Fat Bat
Fat Bat.png
DLC Indicator.png
Slowly flies towards Isaac. Shoots when Isaac aligns diagonally with it and will actively try to avoid Isaac's shots.
Red Ghost
Red Ghost.png
DLC Indicator.png
Disappears, then reappears near Isaac and fires a brimstone laser.
Flaming Fatty
Flaming Fatty.png
DLC Indicator.png
Slowly walks towards Isaac. Occasionally farts, which pushes Isaac and adjacent enemies away. Has a chance to leave behind a damaging flame upon death.
Conjoined Fatty
Conjoined Fatty.png
DLC Indicator.png
Slowly walks towards Isaac. Occasionally spits a line of damaging green creep towards Isaac. Turns into a regular Fatty upon death.
Blue Conjoined Fatty
Blue Conjoined Fatty.png
DLC Indicator.png
Slowly walks towards Isaac and occasionally spits a homing Ipecac shot at Isaac.
Dank Globin
Dank Globin.png
DLC Indicator.png
Chases Isaac, dealing a full heart of contact damage. Upon taking enough damage, it collapses into a pile of goo, spawns a spider, and leaves a puddle of slowing black creep. Will regenerate after a short period of time if not killed quickly.
Black Globin
Black Globin.png
DLC Indicator.png
Chases Isaac, dealing a full heart of contact damage and spawning spiders. Upon taking enough damage, it separates into a head and body. The head slides towards Isaac, leaving a trail of damaging red creep. The body wanders around aimlessly, occasionally spawning spiders.
Black Globin's Body
Black Globin's Body.png
DLC Indicator.png
Walks aimlessly around the room, occasionally spawning spiders.
Bone Knight
Bone Knight.png
DLC Indicator.png
Moves erratically around the room, charges toward Isaac when in line of sight, and leaves behind a trail of damaging red creep. Can only be damaged from behind.
Mega Clotty
Mega Clotty.png
DLC Indicator.png
Slowly moves around the room, occasionally hopping and firing 6 blood shots in all directions. Splits into two Clotties upon death.
Mom's Dead Hand
Mom's Dead Hand.png
DLC Indicator.png
Falls from the ceiling. If it lands on Isaac, it deals damage and teleports the player back to the spawn room of the floor. If it doesn't land on Isaac, it spawns several rock waves that travel outwards. Spawns several spiders upon death. Entering a room containing Mom's Dead Hand will warn the player with Mom's laugh.
Drowned Charger
Drowned Charger.png
DLC Indicator.png
Slowly moves around the room, charging at Isaac when he gets in its line of sight. Explodes into four blood shots in the ordinal directions upon death.
Scarred Para-Bite
Scarred Para-Bite.png
DLC Indicator.png
Moves towards Isaac, dealing contact damage and firing short-range blood shots. Can burrow underground and reappear elsewhere.
Scarred Guts
Scarred Guts.png
DLC Indicator.png
Attaches itself to a wall or obstacle and rolls around it, leaving a trail of damaging red creep.
Scarred Double Vis
Scarred Double Vis.png
DLC Indicator.png
Charges and fires a Brimstone laser which fires from all four sides when Isaac gets in its line of sight.
Meatball
Meatball.png
DLC Indicator.png
Slides around the room, occasionally stopping to spew a fountain of short-range blood shots in all directions or to spit a line of damaging red creep. Spawns a Host upon death.
Imp
Imp.png
DLC Indicator.png
Slowly drifts towards Isaac, frequently firing 5 blood shots in quick succession towards Isaac. Tries to avoid Isaac's shots and occasionally teleports and reappears elsewhere.
Greed Gaper
Greed Gaper.png
DLC Indicator.png
Walks towards Isaac, dealing contact damage.
Blue Gaper
Blue Gaper.png
DLC Indicator.png
Walks towards Isaac, dealing contact damage. Has triple the health of a normal Gaper.
Blue Boil
Blue Boil.png
DLC Indicator.png
Stationary enemy that decreases in size when hit, but regenerates to its full size until fully destroyed. Fires 1-3 blood shots towards Isaac when fully swollen.
Hush Fly
Hush Fly.png
DLC Indicator.png
Gathers with other Hush Flies and flies towards Isaac in certain patterns. Can also orbit Hush.

Bosses[edit | edit source]

Several new bosses were added in the expansion. Additionally, many bosses received new champion variants.

Boss Rag Man.png
Boss Little Horn.png
Boss Dangle.png
Boss Turdlings.png
Rag Man Little Horn Dangle Turdlings
Boss The Frail.png
Boss The Stain.png
Boss The Forsaken.png
Boss Brownie.png
The Frail The Stain The Forsaken Brownie
Boss Hush.png
Boss Ultra Greed.png
Hush Ultra Greed

Beggars[edit | edit source]

Bomb bum.png Bomb Bum

Bomb Bums are extremely rare, and ask for bombs. Each bomb donated has a chance to have him drop 1-2 bomb pickups or an item from the Bomb Bum Item Pool. After spawning a pedestal item, the Bomb Bum will disappear and can no longer be donated to.

Environment[edit | edit source]

Chapters[edit | edit source]

Burning Basement.png Flooded Caves.png
Burning Basement Flooded Caves
Dank Depths.png Scarred Womb.png
Dank Depths Scarred Womb
Blue Womb.png
 ??? (Blue Womb)

Challenges[edit | edit source]

Name Conditions Goal Unlocked by Unlocks
21. XXXXXXXXL Every floor is the size of an XL Womb floor, but does not combine the floors of each chapter.

Treasure rooms available. Shops available.

Mom's Heart Killing Mom for the first time Gold Heart
22. SPEED! Everything is sped up like the Broken Watch effect. 16 minute time limit.

Treasure rooms available. Shops available.

Mom's Heart Killing Mom for the first time Get Out Of Jail Free Card
23. Blue Bomber This challenge is done as ???. Starts with: Pyromaniac, Kamikaze!, Mr. Mega, and Brother Bobby.

Blindfolded (cannot use tears).

No treasure rooms. Shops available.

Satan Unlocking ???, Mr. Mega and It Lives! Gold Bomb
24. PAY TO PLAY Starts with: Sack Of Pennies, Money = Power, 50 cents.

Every door costs 1 cent to enter. Isaac drops money when hit. Isaac dies if you run out of money.

No treasure rooms. Shops available.

Isaac Unlocking Sack Of Pennies and It Lives! 2 new Pills

(Percs! and Addicted!)

25. Have A Heart Starts with: Charm Of The Vampire.

Starts with 12 red heart containers, only 1 of which is filled. Pennies drop instead of red hearts. Many items that restore red hearts have no effect.

Treasure rooms available. Shops available.

Mom's Heart Killing Mom for the first time 2 new Pills

(Re-Lax and ???)

26. I RULE! Starts with: Key Piece 1, Key Piece 2, Trinity Shield, Mom's Knife, The Ladder, The Boomerang.

No treasure rooms. Shops available.

Mega Satan Killing ??? or The Lamb for the first time, and unlocking Mom's Knife. Poker Chip
27. BRAINS! This challenge is done as ???. Starts with: 3 Bob's Brains, Thunder Thighs, The Poop.

Blindfolded (cannot use tears).

No treasure rooms. Shops available.

??? Unlocking The Polaroid Stud Finder
28. PRIDE DAY! Starts with: 3 Dollar Bill, Rainbow Baby, Rainbow Worm.

Cannot drop or replace Rainbow Worm.

No treasure rooms. Shops available.

Mom's Heart Killing Mom for the first time D8
29. Onan's Streak This challenge is done as Judas. Starts with: Chocolate Milk.

Missing a shot deals damage to Judas.

Treasure rooms available. Shops available.

Isaac Unlocking Judas Kidney Stone
30. The Guardian Starts with: Holy Grail, Punching Bag, Isaac's Heart, Spear Of Destiny.

Isaac's Heart will follow the Punching Bag instead of Isaac.

Blindfolded (cannot use tears).

No treasure rooms. Shops available.

Mom's Heart Killing Mom for the first time Blank Rune

Changes[edit | edit source]

Items[edit | edit source]

Activated Collectibles[edit | edit source]

Book Of Revelations

Increases chance for a Devil/Angel Room Door to open by 17.5%.

Passive Collectibles[edit | edit source]

20/20
  • 20 20 Afterbirth Icon.png Its icon is white-tinted.
3 Dollar Bill
  • The type of randomized tear changes every 2-3 seconds. The item appears to select two tear effects at once, perhaps staggering the times at which each of those effects change.
  • If a run is quit, and then continued, 3 Dollar Bill will keep tear effects for the current room.
Abel
  • Abel shoots tears towards Isaac regardless of which direction Isaac is shooting.
Ball Of Bandages
  • Ball of Bandages blocks enemy shots.
Bob's Brain
  • Bob's Brain is fired directly from where it is located in the chain of familiars behind Isaac, making aiming it slightly more difficult.
Bomb Bag
Box
  • Can drop a Gold Bomb.

Interactions & Synergies[edit | edit source]

1st item 2nd item Description
Q Card Icon.png ? Card Blank Card Icon.png Blank Card Teleports you to the I AM ERROR room. This will consume both the Blank Card and the ? Card.
  • An exception is when they are used on Chest, Dark Room or Ultra Greed floors. Using them here consumes both the Blank Card and the ? Card and spawns an I AM ERROR Shopkeeper.
Blank Card Icon.png Blank Card Q Card Icon.png ? Card Teleports you to the I AM ERROR room. This will consume both the Blank Card and the ? Card.
  • An exception is when they are used on Chest, Dark Room or Ultra Greed floors. Using them here consumes both the Blank Card and the ? Card and spawns an I AM ERROR Shopkeeper.
1up! Icon.png 1up! Box Of Friends Icon.png Box Of Friends Familiars are multiplied but do not give Isaac additional lives.
Box Of Friends Icon.png Box Of Friends 1up! Icon.png 1up! Familiars are multiplied but do not give Isaac additional lives.
20 20 Icon.png 20/20 Brimstone Icon.png Brimstone Two brimstone shots are fired, without an increase in charge time.
Brimstone Icon.png Brimstone 20 20 Icon.png 20/20 Two brimstone shots are fired, without an increase in charge time.
20 20 Icon.png 20/20 Epic Fetus Icon.png Epic Fetus Makes two missiles drop one after the other.
Epic Fetus Icon.png Epic Fetus 20 20 Icon.png 20/20 Makes two missiles drop one after the other.
20 20 Icon.png 20/20 The Inner Eye Icon.png The Inner Eye 5 shots are fired with the normal decrease in fire rate.
The Inner Eye Icon.png The Inner Eye 20 20 Icon.png 20/20 5 shots are fired with the normal decrease in fire rate.
20 20 Icon.png 20/20 Mom's Knife Icon.png Mom's Knife Two knives are now thrown instead of one.
Mom's Knife Icon.png Mom's Knife 20 20 Icon.png 20/20 Two knives are now thrown instead of one.
20 20 Icon.png 20/20 Mutant Spider Icon.png Mutant Spider 6 shots are fired with the normal decrease in fire rate.
Mutant Spider Icon.png Mutant Spider 20 20 Icon.png 20/20 6 shots are fired with the normal decrease in fire rate.
20 20 Icon.png 20/20 Technology Icon.png Technology Two technology shots are fired simultaneously.
Technology Icon.png Technology 20 20 Icon.png 20/20 Two technology shots are fired simultaneously.
20 20 Icon.png 20/20 Tractor Beam Icon.png Tractor Beam Both tears are fired along the beam although due to a bug the second tear in each pair is invisible.
Tractor Beam Icon.png Tractor Beam 20 20 Icon.png 20/20 Both tears are fired along the beam although due to a bug the second tear in each pair is invisible.
20 20 Icon.png 20/20 The Wiz Icon.png The Wiz Two tears are fired each direction.
The Wiz Icon.png The Wiz 20 20 Icon.png 20/20 Two tears are fired each direction.
9 Volt Icon.png 9 Volt Wooden Nickel Icon.png Wooden Nickel Infinite coins (if you have the time).
Wooden Nickel Icon.png Wooden Nickel 9 Volt Icon.png 9 Volt Infinite coins (if you have the time).
A Card Against Humanity Icon.png A Card Against Humanity Brown Cap Icon.png Brown Cap All the poop explodes in a chain reaction once one is destroyed.
Brown Cap Icon.png Brown Cap A Card Against Humanity Icon.png A Card Against Humanity All the poop explodes in a chain reaction once one is destroyed.
A Card Against Humanity Icon.png A Card Against Humanity BlueBlue.png Infested! Pill Every pile of poop spawns a blue spider.
BlueBlue.png Infested! Pill A Card Against Humanity Icon.png A Card Against Humanity Every pile of poop spawns a blue spider.
A Card Against Humanity Icon.png A Card Against Humanity Lil Larva Icon.png Lil Larva Every pile of poop spawns a blue Fly.
Lil Larva Icon.png Lil Larva A Card Against Humanity Icon.png A Card Against Humanity Every pile of poop spawns a blue Fly.
A Lump Of Coal Icon.png A Lump Of Coal Brimstone Icon.png Brimstone
No benefit though the beam color is darker.

Beam will gradually increase in size and damage the farther it travels, on a multiplier that is roughly +20% per tile of distance.
Brimstone Icon.png Brimstone A Lump Of Coal Icon.png A Lump Of Coal
No benefit though the beam color is darker.

Beam will gradually increase in size and damage the farther it travels, on a multiplier that is roughly +20% per tile of distance.
A Lump Of Coal Icon.png A Lump Of Coal Mom's Knife Icon.png Mom's Knife Damage increases as the knife travels further.
Mom's Knife Icon.png Mom's Knife A Lump Of Coal Icon.png A Lump Of Coal Damage increases as the knife travels further.
A Lump Of Coal Icon.png A Lump Of Coal Technology Icon.png Technology Damage increases the further away the enemy is, on a multiplier that is roughly +20% per tile of distance.
Technology Icon.png Technology A Lump Of Coal Icon.png A Lump Of Coal Damage increases the further away the enemy is, on a multiplier that is roughly +20% per tile of distance.
A Lump Of Coal Icon.png A Lump Of Coal Tech X Icon.png Tech X Ring size and damage increases as ring travels further from Isaac.
Tech X Icon.png Tech X A Lump Of Coal Icon.png A Lump Of Coal Ring size and damage increases as ring travels further from Isaac.
Anarchist Cookbook Icon.png Anarchist Cookbook Blasting Cap Icon.png Blasting Cap The troll bombs have a chance to drop bomb pickups upon exploding.
Blasting Cap Icon.png Blasting Cap Anarchist Cookbook Icon.png Anarchist Cookbook The troll bombs have a chance to drop bomb pickups upon exploding.
Anarchist Cookbook Icon.png Anarchist Cookbook Bob's Bladder Icon.png Bob's Bladder The troll bombs will leave green creep.
Bob's Bladder Icon.png Bob's Bladder Anarchist Cookbook Icon.png Anarchist Cookbook The troll bombs will leave green creep.
Anarchist Cookbook Icon.png Anarchist Cookbook Bomber Boy Icon.png Bomber Boy The troll bombs will explode in a shape of a cross, making them very powerful but hard to dodge.
Bomber Boy Icon.png Bomber Boy Anarchist Cookbook Icon.png Anarchist Cookbook The troll bombs will explode in a shape of a cross, making them very powerful but hard to dodge.
Anarchist Cookbook Icon.png Anarchist Cookbook Glitter Bombs Icon.png Glitter Bombs Each troll bomb has a chance to drop a pickup.
Glitter Bombs Icon.png Glitter Bombs Anarchist Cookbook Icon.png Anarchist Cookbook Each troll bomb has a chance to drop a pickup.
Anarchist Cookbook Icon.png Anarchist Cookbook Safety Scissors Icon.png Safety Scissors The troll bombs will all be defused and turn into bomb pickups.
Safety Scissors Icon.png Safety Scissors Anarchist Cookbook Icon.png Anarchist Cookbook The troll bombs will all be defused and turn into bomb pickups.
Anarchist Cookbook Icon.png Anarchist Cookbook Scatter Bombs Icon.png Scatter Bombs Each troll bomb will spawn several smaller bombs upon exploding.
Scatter Bombs Icon.png Scatter Bombs Anarchist Cookbook Icon.png Anarchist Cookbook Each troll bomb will spawn several smaller bombs upon exploding.
Anarchist Cookbook Icon.png Anarchist Cookbook Sticky Bombs Icon.png Sticky Bombs If a troll bomb kills a enemy, it will spawn blue spiders.
Sticky Bombs Icon.png Sticky Bombs Anarchist Cookbook Icon.png Anarchist Cookbook If a troll bomb kills a enemy, it will spawn blue spiders.
Ball Of Bandages Icon.png Ball Of Bandages Box Of Friends Icon.png Box Of Friends Upgrades the cube/ball for the current room. This can be used to easily unlock the Super Meat Boy and Bandage Girl achievements.
Box Of Friends Icon.png Box Of Friends Ball Of Bandages Icon.png Ball Of Bandages Upgrades the cube/ball for the current room. This can be used to easily unlock the Super Meat Boy and Bandage Girl achievements.
BBF Icon.png BBF Brimstone Icon.png Brimstone BBF will fire brimstone beams in all directions upon exploding.
Brimstone Icon.png Brimstone BBF Icon.png BBF BBF will fire brimstone beams in all directions upon exploding.
Best Bud Icon.png Best Bud Box Of Friends Icon.png Box Of Friends If used before taking damage, the white fly will circle around Isaac. However, multiple white flies cannot be spawned, so using Box of Friends after taking damage or using it multiple times in a room has no effect.
Box Of Friends Icon.png Box Of Friends Best Bud Icon.png Best Bud If used before taking damage, the white fly will circle around Isaac. However, multiple white flies cannot be spawned, so using Box of Friends after taking damage or using it multiple times in a room has no effect.
BFFS! Icon.png BFFS! Farting Baby Icon.png Farting Baby The baby's increased size will make it easier to trigger the Baby's effect.
Farting Baby Icon.png Farting Baby BFFS! Icon.png BFFS! The baby's increased size will make it easier to trigger the Baby's effect.
BFFS! Icon.png BFFS! Incubus Icon.png Incubus Incubus deals double your damage instead of copying it. Effectively doubles Lilith's damage.
Incubus Icon.png Incubus BFFS! Icon.png BFFS! Incubus deals double your damage instead of copying it. Effectively doubles Lilith's damage.
Black Candle Icon.png Black Candle Cursed Eye Icon.png Cursed Eye Removes teleportation effect of Eye.
Cursed Eye Icon.png Cursed Eye Black Candle Icon.png Black Candle Removes teleportation effect of Eye.
Black Powder Icon.png Black Powder How To Jump Icon.png How To Jump Allows Isaac to quickly jump around the room and create large pentagrams.
How To Jump Icon.png How To Jump Black Powder Icon.png Black Powder Allows Isaac to quickly jump around the room and create large pentagrams.
Blank Card Icon.png Blank Card Dice Shard Icon.png Dice Shard Works as a 4-room recharge The D6 + D20.
Dice Shard Icon.png Dice Shard Blank Card Icon.png Blank Card Works as a 4-room recharge The D6 + D20.
Blind Rage Icon.png Blind Rage Holy Mantle Icon.png Holy Mantle Invincibility from Holy Mantle is extended.
Holy Mantle Icon.png Holy Mantle Blind Rage Icon.png Blind Rage Invincibility from Holy Mantle is extended.
Blind Rage Icon.png Blind Rage Mom's Box Icon.png Mom's Box Doubles the effect of Blind Rage, resulting in extremely long invincibility.
Mom's Box Icon.png Mom's Box Blind Rage Icon.png Blind Rage Doubles the effect of Blind Rage, resulting in extremely long invincibility.
Blind Rage Icon.png Blind Rage Swallowed Penny Icon.png Swallowed Penny Gives you more time to grab a penny with Keeper if you have Mom's Purse or Belly Button.
Swallowed Penny Icon.png Swallowed Penny Blind Rage Icon.png Blind Rage Gives you more time to grab a penny with Keeper if you have Mom's Purse or Belly Button.
Bob's Bladder Icon.png Bob's Bladder Bobby-Bomb Icon.png Bobby-Bomb The bombs will leave trails of green creep while homing in on enemies.
Bobby-Bomb Icon.png Bobby-Bomb Bob's Bladder Icon.png Bob's Bladder The bombs will leave trails of green creep while homing in on enemies.
Bob's Bladder Icon.png Bob's Bladder Dr. Fetus Icon.png Dr. Fetus Bombs from Dr. Fetus leave creep.
Dr. Fetus Icon.png Dr. Fetus Bob's Bladder Icon.png Bob's Bladder Bombs from Dr. Fetus leave creep.
Bob's Bladder Icon.png Bob's Bladder No. 2 Icon.png No. 2 Bombs from No. 2 leave creep.
No. 2 Icon.png No. 2 Bob's Bladder Icon.png Bob's Bladder Bombs from No. 2 leave creep.
Bob's Bladder Icon.png Bob's Bladder Remote Detonator Icon.png Remote Detonator Bombs will continue to leave creep until they are manually detonated, allowing lots of creep to be made by pushing bombs around.
Remote Detonator Icon.png Remote Detonator Bob's Bladder Icon.png Bob's Bladder Bombs will continue to leave creep until they are manually detonated, allowing lots of creep to be made by pushing bombs around.
Bob's Brain Icon.png Bob's Brain Box Of Friends Icon.png Box Of Friends Adds an additional brain. When used upon entering a room, Box of Friends eliminates the item delay, which allows Isaac to launch Bob's Brain immediately.
Box Of Friends Icon.png Box Of Friends Bob's Brain Icon.png Bob's Brain Adds an additional brain. When used upon entering a room, Box of Friends eliminates the item delay, which allows Isaac to launch Bob's Brain immediately.
Bob's Curse Icon.png Bob's Curse Bomber Boy Icon.png Bomber Boy The range for poisoning nearby enemies is much bigger.
Bomber Boy Icon.png Bomber Boy Bob's Curse Icon.png Bob's Curse The range for poisoning nearby enemies is much bigger.
Bob's Rotten Head Icon.png Bob's Rotten Head Continuum Icon.png Continuum Bob's Rotten Head can now travel through walls and appear out of the opposite wall, similar to a portal-type mechanic.
Continuum Icon.png Continuum Bob's Rotten Head Icon.png Bob's Rotten Head Bob's Rotten Head can now travel through walls and appear out of the opposite wall, similar to a portal-type mechanic.
Bobby-Bomb Icon.png Bobby-Bomb Bomber Boy Icon.png Bomber Boy The bombs will home in on enemies and explode in a cross shape, making them useful on groups of enemies.
Bomber Boy Icon.png Bomber Boy Bobby-Bomb Icon.png Bobby-Bomb The bombs will home in on enemies and explode in a cross shape, making them useful on groups of enemies.
Bobby-Bomb Icon.png Bobby-Bomb Curse Of The Tower Icon.png Curse Of The Tower When Isaac takes damage, 6 homing bombs will appear.
Curse Of The Tower Icon.png Curse Of The Tower Bobby-Bomb Icon.png Bobby-Bomb When Isaac takes damage, 6 homing bombs will appear.
Bobby-Bomb Icon.png Bobby-Bomb No. 2 Icon.png No. 2 Butt bombs dropped while firing tears will home in on enemies.
No. 2 Icon.png No. 2 Bobby-Bomb Icon.png Bobby-Bomb Butt bombs dropped while firing tears will home in on enemies.
Bomber Boy Icon.png Bomber Boy Butt Bombs Icon.png Butt Bombs Each explosion counts as an individual Butt Bomb, so this deals 90 damage per explosion to all enemies in the room.
Butt Bombs Icon.png Butt Bombs Bomber Boy Icon.png Bomber Boy Each explosion counts as an individual Butt Bomb, so this deals 90 damage per explosion to all enemies in the room.
Bomber Boy Icon.png Bomber Boy Curse Of The Tower Icon.png Curse Of The Tower The troll bombs spawned by the effect of this item will explode in a large cross pattern, making them more likely to damage both enemies and Isaac.
Curse Of The Tower Icon.png Curse Of The Tower Bomber Boy Icon.png Bomber Boy The troll bombs spawned by the effect of this item will explode in a large cross pattern, making them more likely to damage both enemies and Isaac.
Bomber Boy Icon.png Bomber Boy Dr. Fetus Icon.png Dr. Fetus Bomber Boy also affects the bombs fired by Dr. Fetus.
Dr. Fetus Icon.png Dr. Fetus Bomber Boy Icon.png Bomber Boy Bomber Boy also affects the bombs fired by Dr. Fetus.
Bomber Boy Icon.png Bomber Boy Glitter Bombs Icon.png Glitter Bombs Each explosion has a independent chance of generating a pickup to use.
Glitter Bombs Icon.png Glitter Bombs Bomber Boy Icon.png Bomber Boy Each explosion has a independent chance of generating a pickup to use.
Bomber Boy Icon.png Bomber Boy Hot Bombs Icon.png Hot Bombs Creates fire in a shape of a cross.
Hot Bombs Icon.png Hot Bombs Bomber Boy Icon.png Bomber Boy Creates fire in a shape of a cross.
Bomber Boy Icon.png Bomber Boy Mr. Mega Icon.png Mr. Mega All explosions have a larger radius and will overlap each other more, potentially vastly increasing damage.
Mr. Mega Icon.png Mr. Mega Bomber Boy Icon.png Bomber Boy All explosions have a larger radius and will overlap each other more, potentially vastly increasing damage.
Bomber Boy Icon.png Bomber Boy No. 2 Icon.png No. 2 Each explosion counts as an individual Butt Bomb, so this deals 90 damage per explosion to all enemies in the room.
No. 2 Icon.png No. 2 Bomber Boy Icon.png Bomber Boy Each explosion counts as an individual Butt Bomb, so this deals 90 damage per explosion to all enemies in the room.
Bomber Boy Icon.png Bomber Boy Pyromaniac Icon.png Pyromaniac Each bomb can restore multiple red hearts.
Pyromaniac Icon.png Pyromaniac Bomber Boy Icon.png Bomber Boy Each bomb can restore multiple red hearts.
Bomber Boy Icon.png Bomber Boy Sad Bombs Icon.png Sad Bombs Each of the nine explosions will have its own tear burst.
Sad Bombs Icon.png Sad Bombs Bomber Boy Icon.png Bomber Boy Each of the nine explosions will have its own tear burst.
Bomber Boy Icon.png Bomber Boy Scatter Bombs Icon.png Scatter Bombs Each of the smaller bombs explode in large cross-shaped blasts.
Scatter Bombs Icon.png Scatter Bombs Bomber Boy Icon.png Bomber Boy Each of the smaller bombs explode in large cross-shaped blasts.
Box Of Friends Icon.png Box Of Friends 20px ???'s Soul This familiar is not copied.
20px ???'s Soul Box Of Friends Icon.png Box Of Friends This familiar is not copied.
Box Of Friends Icon.png Box Of Friends Car Battery Icon.png Car Battery Adds two copies of each familiar.
Car Battery Icon.png Car Battery Box Of Friends Icon.png Box Of Friends Adds two copies of each familiar.
Box Of Friends Icon.png Box Of Friends Cube of Meat Icon.png Cube Of Meat Upgrades the cube/ball for the current room. This can be used to easily unlock the Super Meat Boy and Bandage Girl achievements.
Cube of Meat Icon.png Cube Of Meat Box Of Friends Icon.png Box Of Friends Upgrades the cube/ball for the current room. This can be used to easily unlock the Super Meat Boy and Bandage Girl achievements.
Box Of Friends Icon.png Box Of Friends Daddy Longlegs Icon.png Daddy Longlegs Familiar will be copied.
Daddy Longlegs Icon.png Daddy Longlegs Box Of Friends Icon.png Box Of Friends Familiar will be copied.
Box Of Friends Icon.png Box Of Friends 20px Pickup generating familiars The copied familiars will drop pickups independently.
20px Pickup generating familiars Box Of Friends Icon.png Box Of Friends The copied familiars will drop pickups independently.
Box Of Friends Icon.png Box Of Friends Guillotine Icon.png Guillotine Duplicates the Head circling around Isaac's body. Only one head will shoot tears.
Guillotine Icon.png Guillotine Box Of Friends Icon.png Box Of Friends Duplicates the Head circling around Isaac's body. Only one head will shoot tears.
Box Of Friends Icon.png Box Of Friends Incubus Icon.png Incubus Multiple Incubi which share the same tear modifiers as the player.
Incubus Icon.png Incubus Box Of Friends Icon.png Box Of Friends Multiple Incubi which share the same tear modifiers as the player.
Box Of Friends Icon.png Box Of Friends Isaac's Head Icon.png Isaac's Head This familiar is not copied.
Isaac's Head Icon.png Isaac's Head Box Of Friends Icon.png Box Of Friends This familiar is not copied.
Box Of Friends Icon.png Box Of Friends Isaac's Heart Icon.png Isaac's Heart This familiar is not copied.
Isaac's Heart Icon.png Isaac's Heart Box Of Friends Icon.png Box Of Friends This familiar is not copied.
Box Of Friends Icon.png Box Of Friends Key Piece 1 Icon.png Key Piece 1 Key pieces are multiplied, but do not complete the other half.
Key Piece 1 Icon.png Key Piece 1 Box Of Friends Icon.png Box Of Friends Key pieces are multiplied, but do not complete the other half.
Box Of Friends Icon.png Box Of Friends Key Piece 2 Icon.png Key Piece 2 Key pieces are multiplied, but do not complete the other half.
Key Piece 2 Icon.png Key Piece 2 Box Of Friends Icon.png Box Of Friends Key pieces are multiplied, but do not complete the other half.
Box Of Friends Icon.png Box Of Friends Milk! Icon.png Milk! The familiar itself doesn't appear but instead it decreases tear delay by 2 (effective tears up) when used, without needing to take damage.
Milk! Icon.png Milk! Box Of Friends Icon.png Box Of Friends The familiar itself doesn't appear but instead it decreases tear delay by 2 (effective tears up) when used, without needing to take damage.
Box Of Friends Icon.png Box Of Friends Multidimensional Baby Icon.png Multidimensional Baby This familiar is not copied.
Multidimensional Baby Icon.png Multidimensional Baby Box Of Friends Icon.png Box Of Friends This familiar is not copied.
Box Of Friends Icon.png Box Of Friends Smart Fly Icon.png Smart Fly Very useful on Greed mode as each usage will add an attacking fly, killing enemies and bosses very quick.
Smart Fly Icon.png Smart Fly Box Of Friends Icon.png Box Of Friends Very useful on Greed mode as each usage will add an attacking fly, killing enemies and bosses very quick.

Pickups[edit | edit source]

Bombs[edit | edit source]

Troll Bombs
  • Troll Bombs are now given a random amount of time before exploding. Before that they always exploded at a fixed time. This means that if two Troll Bombs spawn at the exact same time right next to each other, there's a high chance one Troll Bomb will blow up before the other, sending that Troll Bomb sliding outwards a bit before exploding.

NPCs[edit | edit source]

Monsters[edit | edit source]

Bony
  • They only leave behind bones when killed.

Environment[edit | edit source]

Rooms[edit | edit source]

Boss Room
  • Double Trouble boss rooms can now contain 2 bosses of different types. Additionally, they can appear as early as Chapter 1.
  • Hush is always fought in a 2x2 room and Ultra Greed is fought in a double-sized one (2x1).
Arcade
  • An Arcade can contain a Bed, a Key Master and 3 hanging dead Shopkeepers.
Angel Room
  • Possible rewards found in the room include:
  • Urns might spawn in the room.
  • Killing Key Masters and Shell Game Beggars no longer applies the 25% bonus.
  • Donating to a Normal Beggar until it pays out with an item on the current floor applies a 10% bonus instead of 25%.
    • Donating to a Devil Beggar until it pays out with an item on the current floor applies a 10% bonus instead of 25%.
  • If this coin flip succeeds, a Devil Room will be generated regardless of the above coin flips.
  • "You feel blessed!" fortune in the Sacrifice Room of the current floor applies a bonus:
    • If the "You feel blessed!" fortune appeared on the 3rd sacrifice, the chance will be 15%.
    • If the "You feel blessed!" fortune appeared on the 5th sacrifice, the chance will be 50%.
    • If both "You feel blessed!" fortunes appeared, the chance will be 65%.
  • Angel Rooms that spawn after Isaac defeats Mom's Heart or It Lives will be normal Angel Rooms with items or pickups.
  • A troll bomb can sometimes appear behind the Angel Statue, blowing it up. If the Angel fights have been unlocked, this will begin the boss fight if the player is not careful or quick enough to move the bomb.
Bedroom
  • The clean bedroom occasionally has two clean beds instead of one.
  • The trapdoor in a dirty bedroom has a chance to lead to a Crawl Space.
  • Occasionally, one Rag Man will spawn inside the dirty bedroom.
Boss Rush

Boss Rush 2.pngBoss Rush 3.pngBoss Rush 4.pngBoss Rush 5.png

  • If a sack spawns for whatever reason, picking it up will start the Boss Rush. The player can still pick up one of the pedestal items.
Black Market
  • Black Market can no longer be accessed in The Chest and The Dark Room, and therefore cannot be used to collect more items.

Other[edit | edit source]

Gallery[edit | edit source]

Trivia[edit | edit source]

  • Afterbirth is the placenta and fetal membranes discharged from the uterus after the birth of offspring, which might be why the title screen is bloody.


SmallIsaac.png The Binding of Isaac: Rebirth SmallIsaac.png

MainPageAchievements.png Achievements MainPageAttributes.png Attributes MainPageBosses.png Bosses TarotCard.png Cards and Runes MainPageChallenges.png Challenges MainPageChapters.png Chapters
Isaac App.png Characters MainPageBabies.png Co-op Magic Mushroom Icon.png Items Isaac's Tears Icon.png Item Pools MainPageMonsters.png Monsters MainPageObjects.png Objects
Red heart.png Pickups BlueBlue.png Pills MainPageRooms.png Rooms MainPageSeeds2.png Seeds Guppy App.png Transformations The Left Hand Icon.png Trinkets