Cards and Runes

Pickups

Hearts

Coins

Bombs

Keys

Batteries

Pills

Cards/Runes

Chests

Sacks

Cards and runes are usable items with a wide variety of effects. They take up the same slot as pills.

Runes and special cards are unlocked by completing challenges.

Cards

Major Arcana Cards

When on the ground, these cards look like:

Name	ID	Icon	Message	Effect
0 - The Fool	1		Where journey begins	Teleports Isaac back to the starting room of a floor.
I - The Magician	2		May you never miss your goal	Grants homing tears for the current room.
II - The High Priestess	3		Mother is watching you	Mom's dismembered leg is called down to deal 300 damage to anything it stomps. It will always stomp on the enemy with the most health. If used in an empty room or during the fight with Mom, it will stomp Isaac instead.
III - The Empress	4		May your rage bring power	Triggers the Whore of Babylon effect (+1.5 damage, +0.3 speed) for the current room, but without the need for Isaac to have a red heart or less of health.
IV - The Emperor	5		Challenge me!	Teleports Isaac into the Boss Room of a floor.
V - The Hierophant	6		Two prayers for the lost	Spawns 2 Soul Hearts.
VI - The Lovers	7		May you prosper and be in good health	Spawns 2 Red Hearts. If used in a Black Heart or Eternal Heart-containing Super Secret Room, it will spawn those types of hearts instead.
VII - The Chariot	8		May nothing stand before you	Grants the temporary invulnerability effect of My Little Unicorn.
VIII - Justice	9		May your future become balanced	Spawns one of each consumable drop (a Red Heart, a Key, a Bomb, and a Penny). Hearts have a chance to spawn as either a Half Red Heart or a Double Heart.
IX - The Hermit	10		May you see what life has to offer	Teleports Isaac to the Shop. If there is no Shop, this will act as a random teleport. If the Shop has not yet been accessed, this card will unlock the door without requiring a key (as long as the player exits through the main entrance).
X - Wheel of Fortune	11		Spin the wheel of destiny	Spawns an Arcade machine (Slot Machine or Fortune Telling Machine).
XI - Strength	12		May your power bring rage	Grants the effect of Magic Mushroom (increases all of Isaac's stats except tears), but adds one (temporary) Red Heart container for the current room as opposed to a permanent one.
XII - The Hanged Man	13		May you find enlightenment	Removes Isaac's body, allowing him to fly around for the duration of the room (same effect as Transcendence).
XIII - Death	14		Lay waste to all that oppose you	Deals 40 damage to all enemies in the room (same effect as The Necronomicon).
XIV - Temperance	15		May you be pure in heart	Spawns a Blood Donation Machine. Spawns a Devil Beggar in Greed mode.
XV - The Devil	16		Revel in the power of darkness	Grants Isaac a temporary +2 increase to damage for the current room (same effect as The Book of Belial).
XVI - The Tower	17		Destruction brings creation	Spawns 6 Troll Bombs randomly around the room (same effect as the Anarchist Cookbook).
XVII - The Stars	18		May you find what you desire	Teleports Isaac to the Treasure Room. If there is no Treasure Room, this will act as a random teleport. Randomly chooses a Treasure Room on Curse of the Labyrinth. If the Treasure Room has not yet been accessed, this card will unlock the door without requiring a key (as long as the player exits through the main entrance).
XVIII - The Moon	19		May you find all you have lost	Teleports the player to the Secret Room. This card will open one random wall once inside the Secret Room, so you can leave even if you don't have any bombs available.
XIX - The Sun	20		May the light heal and enlighten you	Restores Isaac's full health, deals 100 damage to all enemies in the room, and reveals the map for the current floor, except the Super Secret Room.
XX - Judgement	21		Judge lest ye be judged	Spawns a Beggar.
XXI - The World	22		Open your eyes and see	Reveals the entire floor, except for the Super Secret Room. Has no effect if under the effect of Curse of the Lost or Amnesia.

Playing Cards

When on the ground, these cards look like:

Name	ID	Icon	Message	Effect
2 of Clubs	23		Item multiplier	Doubles your bombs. If you have no bombs, gives you 2 instead.
2 of Diamonds	24		Item multiplier	Doubles your coins. If you have no coins, gives you 2 instead.
2 of Spades	25		Item multiplier	Doubles your keys. If you have no keys, gives you 2 instead.
2 of Hearts	26		Item multiplier	Doubles Isaac's current number of Red Hearts. Does not affect Eternal Hearts, Soul Hearts, or Black Hearts. Doesn't add new Red Heart containers, just fills empty ones.
Ace of Clubs	27		Convert all	Turns all pickups and chests in the room into Bombs.
Ace of Diamonds	28		Convert all	Turns all pickups and chests in the room into Pennies.
Ace of Spades	29		Convert all	Turns all pickups and chests in the room into Keys.
Ace of Hearts	30		Convert all	Turns all pickups and chests in the room into random heart pickups.
Joker	31		???	Teleports you to the Devil Room or Angel Room.

Special Cards

Magic: The Gathering Card Backs

When on the ground, these cards look like:   

Name	ID	Icon	Message	Effect
Chaos Card	42		???	Throws the card to kill anything in its path. Opens normal doors.
Huge Growth	52		Become immense!	Makes Isaac large for the current room, increasing his range and damage.
Ancient Recall	53		Draw 3 cards	Spawns 3 random cards.
Era Walk	54		Savor the moment	For the current room, enemies are slowed, Isaac's speed is increased, and his shot speed is decreased.

Credit Card Backs

When on the ground, this card looks like:   

Name	ID	Icon	Message	Effect
Credit Card	43		Charge it!	Converts all items in the Shop or Devil Room into pickups or items on pedestals, allowing them to be picked up for free.

Playing Card Backs

When on the ground, these cards look like:

Name	ID	Icon	Message	Effect
Rules Card	44		???	Displays a cryptic statement on the screen, similar to a Fortune Teller. These messages (often) provide hints on bosses, bonus areas, etc.
Suicide King	46		A true ending?	Kills Isaac and spawns lots of pickups, items, and/or chests in the same room.
? Card	48		Double active	When used, copies the effect of Isaac's currently held activated collectible.

Card Against Humanity Back

When on the ground, this card looks like:   

Name	ID	Icon	Message	Effect
A Card Against Humanity	45		Something stinks...	Covers the entire room with poop. The process is not instant, and the room will not get filled if you leave it before it's done filling.

Chance Card Back

When on the ground, this card looks like:   

Name	ID	Icon	Message	Effect
Get out of Jail Free Card	47		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.

Holy Card Back

When on the ground, this card looks like:

Name	ID	Icon	Message	Effect
Holy Card	51		You feel protected	Grants the Holy Mantle effect for the current room.

Runes

Left Pointing Runes

When on the ground, these runes look like:

Rune	ID	Icon	Unlock method	Message	Effect
Hagalaz	32		Complete Pitch Black (challenge #1)	Destruction	Destroys all breakable objects in the room. Does not affect Key Blocks.
Jera	33		Complete High Brow (challenge #2)	Abundance	Clones all pickups and chests in a room (including Shop pickups; the clones can then be picked up for free). Cloned chests will contain exactly the same type of items: if the original contains a pickup, so will the clone; the same is true for collectibles. Cannot clone other Jera runes and trinkets.
Ehwaz	34		Complete Head Trauma (challenge #3)	Passage	Creates a trapdoor leading to the next floor. Has an estimated 1/12 (8%) chance to spawn a door to a Crawl Space instead.
Dagaz	35		Complete Darkness Falls (challenge #4)	Purity	Removes any curses from the current floor and grants a Soul Heart. (This will not remove Curse of the Labyrinth.)

Right Pointing Runes

When on the ground, these runes look like:

Rune	ID	Icon	Unlock method	Message	Effect
Ansuz	36		Complete The Tank (challenge #5)	Vision	Reveals the whole map, including the Secret Room and the Super Secret Room.
Perthro	37		Complete Solar System (challenge #6)	Change	Rerolls all pedestal items in the room. (This is the same effect as The D6.)
Berkano	38		Complete Purist (challenge #20)	Companionship	Summons 3 friendly Blue Flies and 3 friendly Blue Spiders.
Algiz	39		Complete Cat Got Your Tongue (challenge #8)	Resistance	Grants a shield which lasts for 30 seconds.
Blank Rune	40		Complete Onan's Streak (challenge #29) Complete The Guardian (challenge #30)	???	Grants a random rune effect (excluding the Black Rune). Has a 25% chance to spawn another Blank Rune upon use.

Other Runes

Rune	ID	Icon	Unlock method	Message	Effect
Black Rune	41		Defeat Ultra Greedier as Apollyon	Void	Deals 40 damage to all enemies in the room. Consumes all pickups in the room and turns them into Blue Flies and Spiders. Consumes all pedestal items in the room and turns them into random stat upgrades. No effect on shop items.

Other

These are items other than cards and runes (and pills) that take up the consumable slot. When on the ground, each of these items are uniquely identifiable by their respective icon.

Name	ID	Icon	Message	Effect
Dice Shard	49		D6 + D20	Upon use, activates the effects of The D6 and the D20 at the same time.
Emergency Contact	50		Help from above	When used, will cause two Mom's Hands to come down and grab two random enemies.

Notes

• The game counts runes as cards for the purposes of Starter Deck, Blank Card, and Tarot Cloth.
• Using the Blank Card with the ? Card teleports the player to the I AM ERROR room of the current floor. This consumes both the Blank Card and the ? Card.
• The Empress card's effect can be stacked with multiple uses of the same card (including uses by Blank Card), and also stacks with the Whore of Babylon.
  • The damage bonus is the number of uses squared, e.g. +1.5 * 4 * 4 damage for using the card via a Blank Card, with Tarot Cloth and Car Battery equipped.
• The Devil card's effect does not stack with multiple uses, nor does it stack with The Book of Belial. It also does not increase the chance of a Devil or Angel Room appearing when used like with the Book of Belial.
• Using the Joker card in The Womb II or Utero II will instantly teleport the player to the Devil Room or Angel Room with a trapdoor leading to Sheol or to the Cathedral. This can be used to skip Mom's Heart and will not count as a kill.
  • After unlocking It Lives, Devil or Angel Rooms in The Womb II, Utero II, and Scarred Womb II no longer contain trapdoors and instead have their normal contents.
• Using The Joker card can allow Isaac to encounter Devil Rooms or Angel Rooms on floors they otherwise cannot appear on.
• If you use the Strength card with only Soul, Black, or Bone Hearts left, and lose the non-Red Hearts while in the same room, you retain the full Red Heart container that Strength grants after you leave.
• The damage dealt by the foot summoned by The High Priestess counts as explosion damage. Meaning it will not damage the player when possessing Host Hat or Pyromaniac. It can also be effectively used as a bomb without taking damage with a timely dodge to blow up rocks or enter Secret Rooms.
• The Ace cards will also turn opened chests, which would normally disappear after leaving a room, into consumables.
• Using the Strength card as ??? will give you a permanent Soul Heart instead of a temporary one. When Keeper has only one Coin Heart, he can use the Strength card to gain a second one which is also permanent.
• While Curse of the Maze is active, The Fool, Moon, Hermit, and Stars cards may fail and leave the player in a different room than intended. The Joker card still works normally.
• Using the Temperance card can, in rare cases, spawn the Blood Donation Machine directly on the player, forcing them to use it once. Caution should be taken when using Temperance as The Lost (or when on half a heart of health), as this will instantly kill the player regardless of the Holy Mantle.
• The Hagalaz rune will open a Secret Room, but only if it is in the bend of a L-shaped large room.
• All teleportation cards except The Fool are unavailable in Greed Mode.

Unlockable Achievements

• 

  The Necronomicon - Use XIII - Death 4 times.

• 

  Blinding Baby - Use Blank Card while holding XIX - The Sun.

• 

  Ancient Recall - Use cards and runes 20 times.

• 

  Huge Growth - Increase in size 5 times in a single run. Sources of increased size include "One Makes you Larger" pills, XI - Strength, and Magic Mushroom.

• 

  Baby-Bender - Use I - The Magician or Telepathy for Dummies while already having homing tears.

Trivia

• The runes and their names ingame are based on the Elder Futhark alphabet system and its reconstructed Proto-Germanic names. In popular culture, runes often signify that something is in some way magical.
• The Suicide King card is a nickname for the King of Hearts, referred to as such because its artwork depicts a king who seems to be sticking a sword into his own head.
• The Get out of Jail Free card is a reference to a card with the same name that appears in the table game Monopoly.
• The "A Card Against Humanity" card is a reference to the card game "Cards Against Humanity".
• Ancient Recall, Era Walk, Huge Growth, and Chaos Card are all based on cards from Magic: The Gathering.
  • The Chaos Card is a reference to the card "Chaos Orb", which also instantly destroys enemies that it touches.
  • The "Ancient Recall" card is a reference to the card "Ancestral Recall", which also draws three cards.
  • The "Era Walk" card is a reference to the card "Time Walk", which allows players to take an extra turn.
  • The "Huge Growth" card is a reference to the card "Giant Growth", which buffs creatures summoned in the game.
• Many cards were given new unique back sprites in Booster Pack #5, some originating from Antibirth.