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Hearts Coins Bombs Keys Batteries Pills Cards Chests DLC Indicator.png Sacks

Pills are pickups that can provide useful or inhibiting effects. They take up the same slot as cards and runes.

At the start of each run, an effect is randomly assigned to each color of pill. The pill effect for that color will remain constant throughout the run. (However, it is possible for PHD or Virgo to reassign some of the effects.) The set of pill effects for any given run is usually known as the pill pool.

  • DLC Indicator.png The pill pool for each run has increased from 9 to 13.

Pill Effects[edit | edit source]

Pill Effect
48 Hour Energy

Drops one to two battery charges and fully charges the spacebar item. DLC Indicator.png Can be used with the Placebo to generate infinite batteries.


Replaces the floor map with a ? for the rest of the floor. If no other curses are active for the floor, the Curse of the Lost will appear under the level name when TAB is held. This effect cannot be negated by Black Candle. DLC Indicator.png Also the only pill to have its flavour text appear on a piece of paper, like curses do.

Bad Gas

Isaac farts, poisoning enemies around him.

Bad Trip

Injures Isaac by a full heart. If a Bad Trip pill is used while Isaac only has a single heart left or less, the pill will turn into a Full Health pill instead. (This damage counts as red heart damage for the purposes of getting a Devil Deal.)

Balls of Steel

Grants Isaac two soul hearts.

Bombs Are Key

Switches number of bombs and keys.

Explosive Diarrhea

Spawns five active bombs behind Isaac over a period of five seconds, at one a second.

Full Health

Restores all health.

Health Down

Removes one red heart container upon use. While Isaac has one or fewer red heart containers, it will act as a Health Up pill instead.

Health Up

Adds one empty red heart container upon use.


Empties all but one red heart container and spawns 1-4 full red heart pickups. If Isaac only has half of a heart left, it will heal him to one heart. If used without any red heart containers, no health will be deducted, but red hearts will still spawn. If used in a Black Heart or Eternal Heart-containing Super Secret Room, it will spawn those types of hearts instead.

I Can See Forever

Opens all entrances to the Secret Room and Super Secret Room for the current floor.

I Found Pills

Changes the appearance of Isaac's face. This pill is cosmetic only, and the effect disappears when you leave the room.

Lemon Party

Spawns a large yellow pool (similar to Lemon Mishap) around your character. Greatly damages any enemy that steps on it.

Luck Down

Decreases Isaac's luck by 1.

Luck Up

Increases Isaac's luck by 1.


Prevents Isaac from moving for a short duration.


Charms all enemies in the room for a short period of time.


Causes Isaac to grow four hairs from the top of his head and zits on his face. This pill is cosmetic only, and will stay for the rest of the run.
Afterbirth† Indicator.png Consuming three puberty pills will grant the Adult transformation.

Pretty Fly

Grants 1 fly orbital that circles the player, blocking projectiles and damaging fly-type enemies on touch.

Range Down

Decreases Isaac's range by 2.

Range Up

Increases Isaac's range by 2.5.

R U a Wizard?

Tears are shot diagonally outwards for about one minute. This effect does not reset upon exiting the room.

Speed Down

Decreases Isaac's movement speed by 0.12.

Speed Up

Increases Isaac's movement speed by 0.15.

Tears Down

Decreases Isaac's tears by 0.28.

Tears Up

Increases Isaac's tears by 0.35.


Isaac gets teleported to a random room. Has a small chance to teleport Isaac to the I AM ERROR room, and an extremely small chance to teleport him to the Black Market, like Undefined.

DLC Indicator.png Afterbirth
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.


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


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.

Afterbirth† Indicator.png Afterbirth †
Needs to be unlocked Feels like I'm walking on sunshine!

Temporarily makes Isaac invincible, similar to Unicorn Stump.
Unlocked by acquiring the Sin Collector achievement.

Needs to be unlocked Gulp!

Upon use, any trinkets that the player is holding are destroyed, and their effects are permanently applied to the player.
Unlocked by acquiring the Once More With Feeling! achievement.

Needs to be unlocked Horf!

Upon use, Isaac shoots an explosive tear with the Ipecac effect.
Unlocked by acquiring the Dedication achievement.

I'm Drowsy...

Upon use, slows all enemies for the duration of the room.

I'm Excited!!!

Upon use, increases the speed of all enemies for the duration of the room.

Something's wrong...

Creates a pool of black creep beneath Isaac.

Needs to be unlocked Vurp!

Throws up the last pill you used.
Unlocked by acquiring the U Broke It! achievement. Will spawn itself if no other pills were taken beforehand.


Creates a pool of slippery brown creep underneath Isaac.

Pill Appearances[edit | edit source]

BlueBlue.png RedSpecled.png YellowOrange.png Pill WhiteWhite.png WhiteBlue.png BlueCyan.png OrangeOrange.png WhiteRed.png SpottedwhiteWhite.png

DLC Indicator.png Pill Black White.png Pill Black Yellow.png Pill White Cyan.png Pill White Yellow.png

Notes[edit | edit source]

  • Among the attribute modifying pill effects, only five of the seven visible attributes are covered: health, range, tears, speed, and luck. Both shot speed and damage can't be altered by pills.
  • DLC Indicator.png Pill effects have a chance to be narrated upon use, as are cards and runes.
  • DLC Indicator.png Currently, the "Retro Vision" pill effect can crash the game on some machines, resulting in restarting the current floor when the game is continued.

Strategy[edit | edit source]

  • Use of unidentified pills is recommended for outside of combat as Hematemesis, R U a Wizard, Paralysis, DLC Indicator.png Addicted!, and Afterbirth† Indicator.png I'm Excited!!! can be detrimental mid-fight. However, Afterbirth† Indicator.png I'm Drowsy..., DLC Indicator.png Percs, DLC Indicator.png Power Pill, Lemon Party, Bad Gas, and Pheromones are nearly useless outside of combat.
  • DLC Indicator.png The invincibility effect from Power Pill and Afterbirth† Indicator.png Feels like I'm walking on sunshine! can be utilized to get into Curse Rooms or play Blood Donation machines without taking any damage.

Trivia[edit | edit source]

  • Hematemesis is the vomiting of blood.
  • Lemon Party is an internet shock site featuring a group of elderly men performing oral sex.
  • I Found Pills (and Ate Them), R U a Wizard? and I can see Forever are all image macro memes.
  • Balls of Steel is a reference to Duke Nukem; it is one of Duke's more famous quotes.
  • Explosive Diarrhea is extremely loud and forceful diarrhea. In the original game, the message that displayed when the pill was activated was "Oh No!"
  • In the original game, Wrath of the Lamb, there was another positive pill effect called "Friends Til The End", which summoned 3 blue attack flies. This effect was improved and given to the Rune Berkano in Rebirth.
    • DLC Indicator.png The pill effect was re-added.
    • DLC Indicator.png Note that the "Infested?" and "Infested!" pill effects are similar to the original "Friends Til The End" effect, but instead of spawning three flies, a variable number of spiders spawn.
  • DLC Indicator.png The Friends Till The End! pill is the only non-narrated pill.
    • Afterbirth† Indicator.png The Friends till the End! pill now has narration.
  • 48 Hour Energy is a reference to the drink 5 Hour Energy.
  • DLC Indicator.png "One makes you larger" and "One makes you small" reference the song "White Rabbit" by Jefferson Airplane, which in turn references Alice in Wonderland.
  • DLC Indicator.png "Percs" is a reference to a street name for the prescription drug Percocet, which is more generically known as Oxycodone. This drug is meant to be used to treat pain, but often abused for recreational purposes.
  • DLC Indicator.png The Re-Lax pill effect is a reference to laxatives.
  • DLC Indicator.png When a pill is used, it has a chance to be narrated.
  • DLC Indicator.png The "???" is the only pill which has 3 different narrated voice lines. One is "Question marks?", while the other two are nonsense.

Bugs[edit | edit source]

Bug Bug! "I'm Excited!" pill's effect persists between floors until the player exits from the run and continues it again.

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