Item

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Items are an integral part of game-play in The Binding of Isaac: Rebirth. They modify Isaac's attributes, grant or modify tear effects, and much more.

Items are classified into a number of distinct types and groups. Some items are passive, which add an effect permanently to Isaac, while others only activate when used. The original Binding of Isaac had 196 items. Rebirth has a total of 341 items. Afterbirth added 95 new items, for a total of 436 items. Afterbirth † has added 68 new items, for a total of 504 items. Only 13 items are considered special.

Similar to items are cards and runes, pills, and trinkets.

For a list of which items can potentially appear in a given Special Room, see Item Pool.

For the grids of items that appear in the stats menu, see Collection Page.


Activated Collectibles

Name ID Icon Quote Description
Anarchist Cookbook 65
Anarchist Cookbook
3 rooms
Summon bombs Spawns six troll bombs around the room.
The Bean 111
The Bean
1 rooms
Toot on command Isaac releases bad gas, poisoning any enemy in close vicinity.
Best Friend 136
Best Friend
3 rooms
Friends 'till the end Deploys a decoy Isaac that eventually explodes with an increased blast radius.
The Bible 33
The Bible
6 rooms
Temporary Flight Upon 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.
Blank Card 286
Blank Card
4 rooms
Card Mimic Has the same effect as the card or rune currently held by Isaac.
Blood Rights 186
Blood Rights
Unlimited
Mass enemy damage at a cost Damages all enemies in the room, but deals a heart of damage to Isaac with each use.
Bob's Rotten Head 42
Bob's Rotten Head
3 rooms
Reusable ranged bomb Upon use, Isaac holds a poison bomb which can be thrown towards any of the four cardinal points and explodes on impact.
The Book of Belial 34
The Book of Belial
3 rooms
Temporary DMG up Upon use increases damage by 2 for the current room and by a further +50% if the character also has the Blood of the Martyr.
Removed in Afterbirth Guarantees a Devil Room or Angel Room will be open after beating a boss while holding it.
Added in Afterbirth Increases the chance for a Devil or Angel Room to appear by 12.5%.
Book of Revelations 78
Book of Revelations
6 rooms
Reusable soul protection Adds 1 soul heart, increases the chance for a Devil or Angel Room to appear, and increases the chance for the next boss to be a Horseman (except on XL floors and floors with fixed bosses such as Mom).
Book of Secrets 287
Book of Secrets
6 rooms
?????? Upon use, gives the effect of Treasure Map, The Compass, or Blue Map for the duration of the current floor.
Book of Shadows 58
Book of Shadows
3 rooms
Temporary Invincibility Upon use, creates a protective shield nullifying all types of damage for 10 seconds.
The Book of Sin 97
The Book of Sin
4 rooms
Reusable Item Generator Spawns a random pickup, pill, card, or trinket.
The Boomerang 338
The Boomerang
4 seconds
It will never leave you Throws a short-range boomerang which does a bit of damage and has a high chance to stun the enemy for 2 seconds. Can also be used to grab pickups.
Box of Spiders 288
Box of Spiders
2 rooms
It's a box of spiders Summons 2-4 blue spiders.
Breath of Life 326
Breath of Life
6 seconds
Invincibility at a cost Grants a brief moment of invincibility when the charge bar hits zero. If spacebar is held for an additional second after hitting zero, Isaac will take damage.
Butter Bean 294
Butter Bean
3 seconds
Reusable knock-back Isaac farts and pushes back nearby enemies.
The Candle 164
The Candle
4 seconds
Reusable flame Throws out a blue flame that can pass over gaps (but not through rocks). The flame damages anything in its path.
Converter 296
Converter
Unlimited
Convert your soul When used, converts two soul hearts into a heart container.
Crack the Sky 160
Crack the Sky
4 rooms
Holy white death Summons multiple beams of light in random locations around the room, dealing a large amount of damage to any enemy that touches them.
Crystal Ball 158
Crystal Ball
6 rooms
I see my future Reveals the map (except the Super Secret Room) and drops a random Tarot Card or soul heart.
D4 284
D4
6 rooms
Reroll into something else Rerolls all of Isaac's items.
The D6 105
The D6
6 rooms
Reroll Your Destiny Allows Isaac to re-roll collectible items in the current room into other items, depending on the current room's Item Pool.
D10 285
D10
1 rooms
Rerolls enemies Rerolls the enemies in a room. Only rerolls enemies that are still alive (does not spawn new enemies).
D20 166
D20
6 rooms
Reroll the basics Rerolls all pickups in the current room.
D100 283
D100
6 rooms
REEROLLLLL! Upon use, rerolls all passive items on Isaac like the D4, every pedestal item in the room like The D6, and every pickup like the D20.
Dad's Key 175
Dad's Key
2 rooms
Opens all doors... Opens all doors in the current room when activated, including doors which require a key to open and entrances to secret rooms. Opens the big doors in the first room of both The Chest and the Dark Room.
Dead Sea Scrolls 124
Dead Sea Scrolls
2 rooms
It's a mystery Triggers the effect of a random activated item from a list of possible options (not every activated item is included).
Deck of Cards 85
Deck of Cards
6 rooms
Reusable Card Generator Gives Isaac a random Tarot Card.
Doctor's Remote 47
Doctor's Remote
2 rooms
Reusable Air Strike Sets a big red target on the ground (similar to the Epic Fetus item) which can be controlled with tear controls. After 6 seconds or by pressing space again, a huge explosive missile hits it, which damages all enemies caught in its blast radius.
Flush! 291
Flush!
6 rooms
... Changes all enemies in the room into poop. Does not work on all enemies (Knights and bosses are immune). Instantly kills Dingle, Dangle, and Brownie.
Forget Me Now 127
Forget Me Now
One time use
I don't remember When activated, the level ends and is freshly regenerated with new rooms, monsters, and items. Disappears after use.
The Gamekid 93
The Gamekid
6 rooms
Temporary Man-Pac Upon use, turns the character into a into a Pac-Man-like creature for 5 seconds, granting invulnerability, inflicting fear on all enemies, and replenishing half a red heart container for every two enemies killed.
Guppy's Head 145
Guppy's Head
1 rooms
Reusable fly hive Spawns 2-4 blue flies to damage enemies.
Guppy's Paw 133
Guppy's Paw
Unlimited
Soul converter Removes one red heart container in exchange for gaining 3 Soul Hearts.
Head of Krampus 293
Head of Krampus
6 rooms
Krampus Rage Fires a cross-patterned brimstone shot, just like The Fallen and Krampus shoot.
How to Jump 282
How to Jump
Unlimited
It's about time you learned how Gives Isaac the ability to jump (over gaps, spikes, etc.).
The Hourglass 66
The Hourglass
2 rooms
Temporary enemy slowdown Upon activation, enemies and their projectiles are slowed down for a short duration.
Isaac's Tears 323
Isaac's Tears
6 rooms
Collected tears Shoots 8 tears around Isaac, which retain the damage, shot speed, and special effects of his tears. Each tear shot by Isaac increases item charge by one.
IV Bag 135
IV Bag
Unlimited
Portable blood bank Upon activation, Isaac loses a half-heart (one whole heart in The Womb onwards) for a random amount of coins, similar to the blood donation machine.
The Jar 290
The Jar
Unlimited
Save your life When at full health, up to 4 extra hearts can be stored in the jar.
Kamikaze! 40
Kamikaze!
Unlimited
Become the bomb! Creates an explosion in the same area as Isaac, dealing half a heart of damage to him and also damaging all enemies caught in the blast radius.
Lemon Mishap 56
Lemon Mishap
2 rooms
Oops Creates a small yellow pool of creep, which damages enemies that cross it.
Magic Fingers 295
Magic Fingers
Unlimited
Pay to play For 1 coin, damages all enemies in the room.
Mom's Bottle of Pills 102
Mom's Bottle of Pills
6 rooms
Reusable pill generator Gives 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.
Mom's Bra 39
Mom's Bra
3 rooms
Mass Fear Upon use, petrifies all enemies in the current room for approximately 4 seconds.
Mom's Pad 41
Mom's Pad
3 rooms
Gross... Upon use, inflicts fear to all enemies in the room for 5 seconds.
Monster Manual 123
Monster Manual
3 rooms
Temporary buddy generator Summons a random familiar for the current room. Can summon familiars not yet unlocked.
Monstro's Tooth 86
Monstro's Tooth
3 rooms
Summon Monstro Monstro jumps onto a random enemy, doing area damage. Can damage/kill the player if summoned in an room without enemies.
Mr. Boom 37
Mr. Boom
2 rooms
Reusable bomb buddy Drops a large bomb.
My Little Unicorn 77
My Little Unicorn
6 rooms
Temporary badass Upon use, grants invulnerability and increased speed for five seconds, removing the ability to shoot tears and replacing it with the ability to deal contact damage to enemies.
The Nail 83
The Nail
6 rooms
Temporary demon form Adds 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.
The Necronomicon 35
The Necronomicon
6 rooms
Mass room damage Damages all enemies in the room significantly.
Notched Axe 147
Notched Axe
3 rooms
Rocks don't stand a chance Isaac holds the axe above his head for as long as the spacebar button is held (or until he leaves the room). While holding the axe, Isaac can break any rock he touches, but cannot attack or pick up other items.
Pandora's Box 297
Pandora's Box
One time use
?? Upon use, spawns certain pickups or items depending on the floor it is used on. Single-use.
The Pinking Shears 107
The Pinking Shears
6 rooms
Cut and Run Separates Isaac's head and body for the current room. Isaac's head, which now has flight, will be under the player's control, while his body will seek out enemies to attack by contact damage.
The Pony 130
The Pony
4 rooms
Flight + Dash Attack Passively grants flight and increased speed. Upon use, Isaac charges in the direction the pony is facing, becoming invulnerable during the charge and damaging enemies.
The Poop 36
The Poop
1 rooms
Plop! Spawns a pile of poop where the character is standing and knocks nearby monsters back. May yield pickups like regular poop.
Portable Slot 177
Portable Slot
Unlimited
Gamble 24/7 Upon activation, 1 coin will be consumed, and a random pickup may drop, similar to the slot machine.
Prayer Card 146
Prayer Card
6 rooms
Reusable eternity Grants an eternal heart per use.
Razor Blade 126
Razor Blade
Unlimited
Feel my pain Upon use, deals one heart of damage to Isaac and grants +1.2 damage for the current room.
Red Candle 289
Red Candle
4 seconds
Flame on Throws a persistent flame that deals high damage and diminishes as it damages enemies or blocks shots.
Remote Detonator 137
Remote Detonator
Unlimited
Remote bomb detonation Bombs you place explode only when you use this item. Gives 5 bombs.
Satanic Bible 292
Satanic Bible
6 rooms
Reusable Evil Upon activation, Isaac gains a black heart.
Scissors 325
Scissors
6 roomsDlc a Indicator.png2 rooms
Lose your head Upon use, turns Isaac's head into a stationary familiar for the current room which fires normal tears that deal 3.5 damage.
Shoop Da Whoop! 49
Shoop Da Whoop!
2 rooms
BLLLARRRRGGG! Fires a laser from Isaac's mouth.
Spider Butt 171
Spider Butt
2 rooms
Mass enemy slowdown + damage Damages all enemies in the room and slows them and their projectiles down.
Tammy's Head 38
Tammy's Head
1 rooms
Reusable tear burst Shoots 10 tears in a circle around Isaac, which retain the damage, shot speed, and special effects (such as poison) of Isaac's tears.
Telepathy for Dummies 192
Telepathy for Dummies
2 rooms
Temporary psychic shot Upon activation, grants homing tears for the current room.
Teleport 44
Teleport
2 rooms
Teleport! Teleports you to a random room on the level.
Undefined 324
Undefined
6 rooms
Undefined Teleports Isaac to either the Secret Room, Super Secret Room, Treasure Room, or I AM ERROR.
Unicorn Stump 298
Unicorn Stump
1 rooms
You feel stumped Upon use, grants invulnerability and increased speed for five seconds, but removes the ability to shoot tears.
We Need to Go Deeper! 84
We Need to Go Deeper!
6 rooms
Reusable level skip Creates a trapdoor to go to the next floor. If used in The Womb, it will create a trapdoor to Sheol, even if the player hasn't unlocked it.
White Pony 181
White Pony
6 rooms
Flight + holy death Passively grants flight and increased speed. Upon use, Isaac charges in the direction the pony is facing, becoming invulnerable during the charge and damaging enemies while also casting the effect of Crack the Sky.
Yum Heart 45
Yum Heart
4 rooms
Reusable Regeneration Restores 1 whole red heart.
Added in Afterbirth Box of Friends 357
Box of Friends
4 rooms
Double your friends Upon use, duplicates all of Isaac's familiars for the current room.
Added in Afterbirth D12 386
D12
3 rooms
Rerolls rocks Re-rolls all rocks in the current room into other random objects, such as bomb rocks, metal blocks, TNT, or poops.
Added in Afterbirth D7 437
D7
3 rooms
Reroll rewards! Restarts the current room and brings back all enemies, allowing more rewards to be acquired by completing the room.
Added in Afterbirth D8 406
D8
4 rooms
Reroll stats Re-rolls Isaac's speed, range, tears, and damage.
Added in Afterbirth Diplopia 347
Diplopia
One time use
Double item vision Duplicates all pickups and item pedestals in the room.
Added in Afterbirth Friendly Ball 382
Friendly Ball
3 rooms
Gotta fetch 'em all! Throwing 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.
Added in Afterbirth Glass Cannon 352
Glass Cannon
4 seconds
Be gentle... When 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).
Added in Afterbirth Glowing Hour Glass 422
Glowing Hour Glass
2 rooms
Turn back time When 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.
Added in Afterbirth Jar of Flies 434
Jar of Flies
Unlimited
Gotta catch 'em all? Every 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.
Added in Afterbirth Kidney Bean 421
Kidney Bean
2 rooms
Love toots! Upon use, Isaac farts, charming all nearby enemies.
Added in Afterbirth Mega Bean 351
Mega Bean
3 rooms
Giga fart! When 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.
Added in Afterbirth Mega Blast 441
Mega Blast
12 rooms
Laser breath Upon 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.
Added in Afterbirth Mine Crafter 427
Mine Crafter
1 rooms
Booom! When 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.
Added in Afterbirth Mom's Box 439
Mom's Box
4 rooms
What's inside? When used, Mom's Box will drop a random trinket on the ground. While held, increases luck by 1 and doubles the effects of trinkets.
Added in Afterbirth Placebo 348
Placebo
4 rooms
Pill mimic When used, copies the effect of the pill Isaac is currently holding without consuming it. Does not copy the effects of cards or runes.
Added in Afterbirth Tear Detonator 383
Tear Detonator
1 rooms
Remote tear detonation! When 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.
Added in Afterbirth Teleport 2.0 419
Teleport 2.0
4 rooms
I-Teleport! When 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.
Added in Afterbirth Ventricle Razor 396
Ventricle Razor
Unlimited
Short cutter Can be used to place an orange portal and a blue portal. Upon entering a portal, Isaac is teleported to the other portal.
Added in Afterbirth Wooden Nickel 349
Wooden Nickel
1 rooms
Flip a coin When used, has a 50% chance to drop one random type of coin (penny, nickel, or dime).
Added in Afterbirth † Black Hole 512
Black Hole
4 rooms
Nothing can escape Throws a black hole on the ground which sucks in and damages enemies.
Added in Afterbirth † Brown Nugget 504
Brown Nugget
7 seconds
Friendly fly Spawns a stationary fly familiar that fires tears at nearby enemies.
Added in Afterbirth † Clicker 482
Clicker
6 rooms
Change Transforms Isaac into another random character.
Added in Afterbirth † Compost 480
Compost
2 rooms
Gain more friends! Spawns a blue spider or fly. Turns pickups in the room into blue spiders or flies.
Added in Afterbirth † Coupon 521
Coupon
6 rooms
Allow 6 weeks for delivery Upon use, makes a random item from a shop, devil deal, or black market free.
Added in Afterbirth † Crooked Penny 485
Crooked Penny
4 rooms
50/50 Spawns a penny and has a 50% chance to double all items and pickups in the room. If the effect fails, the items and pickups disappear.
Added in Afterbirth † D1 476
D1
4 rooms
What will it be? Duplicates a random pickup in the room.
Added in Afterbirth † D Infinity 489
D Infinity
2 rooms
Reroll forever Grants a random dice item that changes each use.
Added in Afterbirth † Dataminer 481
Dataminer
4 rooms
109 Displaces enemy sprites for the current room and increases or decreases a random stat.
Added in Afterbirth † Delirious 510
Delirious
12 rooms
Unleash the power! Spawns a random charmed boss.
Added in Afterbirth † Dull Razor 486
Dull Razor
2 rooms
I feel numb... Hurts Isaac without depleting health, activating any items that trigger upon taking damage.
Added in Afterbirth † Eden's Soul 490
Eden's Soul
One time use
... Spawns two item pedestals.
Added in Afterbirth † Mama Mega! 483
Mama Mega!
One time use
BOOOOOOOOOM! Damages all enemies and destroys all obstacles. The effect occurs every time a new room is entered for the rest of the floor. Opens doors to the floor's secret and super secret rooms.
Added in Afterbirth † Metronome 488
Metronome
2 rooms
Waggles a finger Grants a random item effect for the current room.
Added in Afterbirth † Moving Box 523
Moving Box
4 rooms
Pack and unpack If the box is empty, picks up all items and pickups in a room and stores them. If the box is not empty, places all stored items and pickups in the current room.
Added in Afterbirth † Mr. ME! 527
Mr. ME!
4 rooms
Caaan Do! Summons a controllable ghost that can perform various tasks depending on what it targets.
Added in Afterbirth † Mystery Gift 515
Mystery Gift
One time use
Wrapped up nice for you! Upon use, spawns a random item from the current room's item pool, with a chance to spawn A Lump of Coal or The Poop instead.
Added in Afterbirth † Plan C 475
Plan C
One time use
Use with caution Kills all enemies in the room, then kills Isaac three seconds later.
Added in Afterbirth † Potato Peeler 487
Potato Peeler
Unlimited
A pound of flesh Removes a heart container, increases damage and range, and grants a Cube of Meat.
Added in Afterbirth † Pause 478
Pause
2 rooms
Stop! Freezes all enemies until a fire button is pressed.
Added in Afterbirth † Sharp Straw 507
Sharp Straw
8 seconds
More blood! Damages all enemies in the room.
Added in Afterbirth † Smelter 479
Smelter
6 rooms
Trinket melter! Consumes Isaac's currently held trinket and applies its effect permanently.
Added in Afterbirth † Sprinkler 516
Sprinkler
4 rooms
Sprinkles. Upon use, spawns a sprinkler that rotates and fires tears.
Added in Afterbirth † Telekinesis 522
Telekinesis
3 seconds
The power of mind! Upon use, for the next two seconds, any enemy shots that come near Isaac are held in place. After the charge is depleted, they are fired back as tears.
Added in Afterbirth † Void 477
Void
6 rooms
Consume Consumes all pedestal items in the room. Active items will have their effects added to Void, and passive items will grant stat upgrades.
Added in Afterbirth † Wait What? 484
Wait What?
10 seconds
I can't believe it's not Butter Bean! Isaac farts, sending out rock waves.

Passive Collectibles

Name ID Icon Quote Description
<3 15 <3 HP up Grants Isaac one red heart container and fully restores Isaac's health.
???'s Only Friend 320 ???'s Only Friend Controlled friend Summons a big attack fly that can be controlled with the shooting direction-keys.
1up! 11 1up! Extra life Gives an extra life. Upon death, you will respawn in the previous room with full health and lose the 1up!.
20/20 245 20/20 Double shot Grants double shot.
3 Dollar Bill 191 3 Dollar Bill Rainbow tears Gives Isaac a random tear effect every room.
Removed in Afterbirth The effect given changes upon entering a room.
Added in Afterbirth The effect changes every 3 seconds.
9 Volt 116 9 Volt Quicker charge Reduces the charge of any Activated Items by 1. Any 1 charge items instead have timed recharges.
Abaddon 230 Abaddon Evil + DMG up + fear shot Increases damage and speed, removes all red heart containers, grants six black hearts, and adds a chance to shoot fear tears.
Abel 188 Abel Mirrored buddy A familiar that mirrors the player's movements and shoots in the opposite direction.
Anemic 214 Anemic Toxic blood +5 range. After Isaac is damaged, a trail of red creep will be left behind Isaac until he leaves the current room.
Ankh 161 Ankh Eternal life? Upon death, the player will respawn as ??? with 3 soul hearts.
Anti-Gravity 222 Anti-Gravity Antigravity tears + tears up -2 Tear Delay. Tears float in position until firing ceases, after which they will fly off in the direction they were shot in.
Aquarius 308 Aquarius Trail of tears A trail of blue creep is left behind Isaac, which damages enemies.
Aries 300 Aries Ramming speed +0.25 Speed. Running into enemies while at a high speed will deal 18 points of damage. Does not prevent contact damage.
Ball of Bandages 207 Ball of Bandages Gotta lick 'em all! Orbiting familiar that deals damage to enemies. If collected while already having one, makes the familiar evolve. Only drops from Horsemen. Similar to Cube of Meat.
Ball of Tar 231 Ball of Tar Sticky feet... Adds a chance to shoot slowing tears and the character leaves a trail of slowing creep behind as he moves, impeding enemies' speed.
The Battery 63 The Battery Stores energy Activated Items can be "overcharged" to allow for an additional use.
The Belt 28 The Belt Speed up Increases speed by 0.3.
Best Bud 274 Best Bud Sworn protector When hit, summons a white attack fly similar to Distant Admiration for the current room.
BFFS! 247 BFFS! Your Friends Rule! Increases the size and damage of familiars.
BBF 272 BBF Big Beautiful Fly Spawns a familiar that flies around the room in a manner similar to the Boom Fly and explodes on contact with an enemy. Respawns after ten seconds.
Big Fan 279 Big Fan Fat protector Spawns a large orbital familiar that blocks enemy projectiles and deals slight contact damage to enemies.
The Black Bean 180 The Black Bean Toot on touch When taking damage, Isaac farts, causing poison damage to all enemies in range.
Black Candle 260 Black Candle Curse immunity + evil up Prevents curses. Grants one black heart. Increases the chance for a Devil or Angel Room to appear.
Black Lotus 226 Black Lotus HP up x3! Grants the player one red heart container, one soul heart, and one black heart.
Blood Bag 119 Blood Bag HP up Grants one red heart container, restores 5 red hearts, and increases speed by 0.3.
Blood Clot 254 Blood Clot DMG + range up Increases damage by 1 and range by 5 for tears fired from the left eye.
Blood of the Martyr 7 Blood of the Martyr DMG up Increases Damage by 1, and turns Isaac's tears into blood tears.
Bloody Lust 157 Bloody Lust RAGE! Increases damage as Isaac receives damage. Damage increase stays for the whole floor.
Blue Cap 342 Blue Cap HP + tears up + shot speed down Grants 1 heart container and increases tears, but decreases shot speed.
Blue Map 246 Blue Map Secrets Shows secret and super secret room locations on the map.
Bob's Brain 273 Bob's Brain Explosive thoughts Spawns a familiar that charges forward when shooting tears, explodes upon contact with an enemy and poisons them. Respawns after few seconds.
Bob's Curse 140 Bob's Curse +5 poison bombs Gives 5 bombs and grants all bombs poison effect.
Bobby-Bomb 125 Bobby-Bomb Homing bombs! Gives Isaac 5 Bombs, and causes all dropped bombs to home towards the closest enemy.
The Body 334 The Body I feel all Adds 3 heart containers.
Bogo Bombs 250 Bogo Bombs 1+1 boom! All standard bomb pickups become 1+1 bomb pickups.
Bomb Bag 131 Bomb Bag Gives bombs Isaac is followed by a small bag that drops a Bomb, 1+1 Free, or a Troll Bomb every 3 rooms.
Boom! 19 Boom! 10 bombs Grants 10 bombs.
Box 198 Box Stuff Spawns 1 of each (non-collectible) item: 1 coin, 1 key, 1 bomb, 1 heart, 1 card, 1 pill, 1 trinket.
Breakfast 25 Breakfast HP up Grants Isaac one full red heart container.
Brimstone 118 Brimstone Blood laser barrage Tears 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.
Broken Watch 337 Broken Watch I think it's broken Chance upon entering a room to slow down or speed up every enemy and their attacks. The chance to slow enemies is quite higher than the chance to speed them up.
Brother Bobby 8 Brother Bobby Friends 'till the end Follows Isaac around shooting normal tears.
Bucket of Lard 129 Bucket of Lard HP up Grants two empty heart containers and heals Isaac by half a heart, but decreases speed by 0.2.
Bum Friend 144 Bum Friend He's greedy A portable beggar who follows Isaac, picks up coins for himself, and occasionally drops a pickup after collecting a coin. Does not spawn collectibles.
Butt Bombs 209 Butt Bombs Toxic blast +5 bombs Gives +5 bombs and makes all bombs Butt Bombs that fill the room with gas, damaging and confusing all enemies.
Caffeine Pill 340 Caffeine Pill Speed up + size down Increases speed and reduces character size. Also gives a random pill.
Cain's Other Eye 319 Cain's Other Eye Near sighted friend Spawns a familiar that floats slowly around the room on a zig-zag pattern similar to The Peeper and shoots normal tears in the same direction as Isaac.
Cancer 301 Cancer HP up + you feel protected Adds 3 soul hearts. Grants The Wafer effect for the current room upon taking damage.
Capricorn 307 Capricorn All stats up All stats up.
Cat-O-Nine-Tails 165 Cat-O-Nine-Tails Shot speed + damage up Increases Shot Speed and damage.
Celtic Cross 162 Celtic Cross You feel blessed Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 7 seconds.
Ceremonial Robes 216 Ceremonial Robes Sin up Adds 3 black hearts and increases Damage by 1.
Champion Belt 208 Champion Belt DMG + Challenge Up Increases damage, but also increases the chance of champion enemies appearing.
Charm of the Vampire 62 Charm of the Vampire Kills heal Heals the character for half of a red heart for every 13 monsters killed.
Chemical Peel 154 Chemical Peel DMG up Tears fired from left eye do increased damage.
Chocolate Milk 69 Chocolate Milk Charge shots Grants charged tears that deal greater damage when fully charged.
The Common Cold 103 The Common Cold Poison Damage Adds a chance to shoot poison tears, dealing damage over time when inflicted.
The Compass 21 The Compass The end is near Reveals all special rooms (except secret rooms of any kind).
Contract From Below 241 Contract From Below Wealth... but at what cost? Doubles the number of pickups and chests spawned after clearing a room or performing some other triggering action (such as using a blood donation machine), but reduces the chance for any pickups to spawn at all.
Cricket's Body 224 Cricket's Body Tears up + splash damage Grants -1 Tear Delay and reduces Range. When tears hit an object or deplete their range, they spawn 4 smaller tears, whose Range and Damage scale with Isaac's.
Cricket's Head 4 Cricket's Head DMG up Increases damage by 0.5, and multiplies it by 1.5x.
Cube of Meat 73 Cube of Meat Gotta meat 'em all! Orbiting familiar that blocks enemy shots and deals damage to enemies. If collected while already having one, makes the familiar evolve. Only drops from Horsemen. Similar to Ball of Bandages.
Cupid's Arrow 48 Cupid's Arrow Piercing shots Grants Isaac piercing tears that travel through enemies (but not obstacles) instead of breaking on impact with them.
Cursed Eye 316 Cursed Eye Cursed charge shot Grants charged tears that can be fired in a tight burst of four. Getting hit while charging will teleport Isaac into another room.
Daddy Longlegs 170 Daddy Longlegs Daddy's love Daddy Long Legs' shadow follows Isaac and stomps on enemies.
Dark Bum 278 Dark Bum He wants to take your life Spawns 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.
Dark Matter 259 Dark Matter Fear shot Increases Damage by 1 and adds a chance to shoot fear tears.
Dead Bird 117 Dead Bird Protective buddy Spawns a flying familiar for the current room that chases enemies whenever Isaac takes damage.
Dead Cat 81 Dead Cat 9 lives Sets the amount of red heart containers to 1, but gives Isaac 9 extra lives. After dying, Isaac is teleported to the last safe room. New heart containers can be obtained after picking up this item, but after each death, the number of heart containers is set to 1 again.
Dead Dove 185 Dead Dove Flight + spectral tears Grants spectral tears and flight.
Dead Onion 336 Dead Onion Toxic aura tears Grants piercing and spectral tears. Increases tear size (without increasing damage) while greatly reducing range and shot speed.
Death's Touch 237 Death's Touch Penetrative shot + damage up Increases Damage by 1.5, reduces Tears by 0.3 and increases tear size. Grants piercing tears. Tears are replaced by Death's scythes, which is a cosmetic effect only.
Demon Baby 113 Demon Baby Auto-turret friend Follows Isaac and automatically fires at enemies in its reach.
Dessert 24 Dessert HP Up Grants Isaac one full red heart container.
Dinner 23 Dinner HP Up Adds 1 heart container.
Distant Admiration 57 Distant Admiration Attack fly A red attack fly circles further out than the Halo of Flies / Pretty Flies, but closer than Forever Alone. Deals more damage than Forever Alone.
A Dollar 18 A Dollar $$$ Gives Isaac 99 coins. Can be found multiple times in a single playthrough.
Dr. Fetus 52 Dr. Fetus ??? Tears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.
Dry Baby 265 Dry Baby Immortal Friend Spawns a familiar that follows Isaac around and blocks enemy projectiles. Upon blocking a shot, it has a chance of triggering The Necronomicon effect.
E Coli 236 E Coli Turdy touch Gives "Turdy Touch" Effect. Enemies that touch Isaac are changed into poop.
Epic Fetus 168 Epic Fetus On-demand air strike Isaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.
Eve's Mascara 310 Eve's Mascara Shot speed down + DMG up Doubles damage, halves tears stat, and greatly reduces shot speed.
Experimental Treatment 240 Experimental Treatment All stats up, then shuffled Randomly 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.
Fanny Pack 204 Fanny Pack It's filled with goodies! Has a chance to drop a random pickup when Isaac takes damage.
Fate 179 Fate Flight eternal Grants flight and one eternal heart.
Fire Mind 257 Fire Mind Flaming tears Grants flaming tears that deal burning damage over time. Tears have a chance to explode on impact with an enemy, which creates a fire at the location of the explosion.
Forever Alone 128 Forever Alone Attack fly Spawns a blue attack fly that orbits a long distance from Isaac.
Gemini 318 Gemini Conjoined friend Suture becomes attached to Isaac, and does touch damage to enemies within its attacking range.
Ghost Baby 163 Ghost Baby Spectral buddy Spawns a familiar that follows Isaac around and fires spectral tears.
Gimpy 225 Gimpy Sweet Suffering Has a chance of spawning a soul heart or black heart when taking damage. Enemies have a chance to drop a Half Red Heart after being killed.
Gnawed Leaf 210 Gnawed Leaf Unbreakable After standing still and not shooting for a short time, Isaac turns invincible until he moves or shoots.
Goat Head 215 Goat Head He accepts your offering A Devil Room / Angel Room Door will always spawn after every boss fight, excluding the first floor and floors after Utero II/Womb II.
Godhead 331 Godhead God tears Increases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.
Growth Hormones 70 Growth Hormones Speed + DMG up Increases damage by 1 and speed by 0.4.
Guardian Angel 112 Guardian Angel Extra protection Spawns an orbital familiar that blocks enemy projectiles, deals contact damage to enemies, and increases the speed of all orbital familiars.
Guillotine 206 Guillotine An out-of-body experience Isaac's head is removed from his body and floats around him. Increases Damage by 1 and grants -1 Tear Delay.
Guppy's Collar 212 Guppy's Collar Eternal Life? Grants Isaac a permanent 50% chance to respawn with 1/2 of a red heart after death.
Guppy's Hair Ball 187 Guppy's Hair Ball Swing it Loosely follows behind Isaac. Can be swung like a flail by rapidly spinning Isaac in a circle. Grows bigger by killing enemies.
Guppy's Tail 134 Guppy's Tail Cursed? Increases chance of finding gold chests and normal chests, but reduces chance of finding pickups.
Habit 156 Habit Item Martyr When Isaac is hit, 1 point of an item's charge is filled.
The Halo 101 The Halo All stats up Grants one Heart Container, +0.3 Damage, +0.2 Tears, +0.25 Range, +0.3 Speed, and +0.5 Tear Height.
Halo of Flies 10 Halo of Flies Projectile protection Spawns two pretty fly familiars that block enemy shots and deal contact damage to enemies.
Harlequin Baby 167 Harlequin Baby Double shot buddy Spawns a familiar that follows Isaac around and fires two tears at once in a V-pattern.
Headless Baby 269 Headless Baby Bloody Friend Familiar that follows Isaac, leaving blood creep on the ground.
Hive Mind 248 Hive Mind Giant spiders and flies Increases the size of blue spiders and Blue Flies and doubles the amount of damage they deal.
Holy Grail 184 Holy Grail Flight + HP up Grants flight and one heart container.
Holy Mantle 313 Holy Mantle Holy shield Automatically negates first taken damage in every room.
Holy Water 178 Holy Water Splash! When Isaac receives damage, the bottle breaks and a puddle of blue creep forms, which damages non-flying enemies, similar to Lemon Mishap. The bottle is reformed upon entering a different room.
Hot Bombs 256 Hot Bombs Burning blast +5 bombs Grants 5 bombs. Isaac's bombs leave behind fire that damages enemies upon contact.
Humbling Bundle 203 Humbling Bundle 1+1 free 4evar! Gives one extra pickup (1+1 Free version) of Red Hearts, pennies, bombs, and keys. Does not work with blue, black, and half red hearts, nickels, and dimes.
Infamy 242 Infamy Damage Reduction Chance to block projectiles coming from any direction.
Infestation 148 Infestation They grow inside 1-3 Blue flies randomly spawn every time Isaac gets hit.
Infestation 2 234 Infestation 2 Infestation shot Spawns allied blue spiders from killed enemies.
The Inner Eye 2 The Inner Eye Triple shot Grants triple shot but decreases tears.
Ipecac 149 Ipecac Explosive shots Replaces tears with explosive and poisoning projectiles fired in an arc from the mouth.
Iron Bar 201 Iron Bar Concussive tears Increases damage by 0.3 and adds a chance to shoot concussive tears, causing enemies to walk around randomly.
Isaac's Heart 276 Isaac's Heart Protect It Isaac himself is now immune to all damage, and a heart familiar appears and follows Isaac. If the heart is hurt, Isaac is hurt.
Jesus Juice 197 Jesus Juice Damage + range up Increases Damage and Range.
Judas' Shadow 311 Judas' Shadow Sweet revenge Adds an extra life; upon death, it respawns Isaac as Black Judas with only two black hearts.
Juicy Sack 266 Juicy Sack Sticky babies A familiar that follows behind Isaac. It drips a trail of creep, which slows enemies, and spawns 1-2 blue spiders after each room.
Key Piece 1 238 Key Piece 1 ??? Combined with Key Piece 2, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.
Key Piece 2 239 Key Piece 2 ??? Combined with Key Piece 1, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.
The Ladder 60 The Ladder Building bridges Allows Isaac to walk across gaps one square across by automatically placing a ladder between the two walkable sections.
Latch Key 343 Latch Key Luck up Increases Luck by 1, grants 1 Soul Heart and spawns 2 Keys.
Lazarus' Rags 332 Lazarus' Rags Eternal Life? Upon dying, resurrect as Revived Lazarus with one heart container and Anemic item.
Leech 270 Leech Blood sucker Spawns a friendly familiar leech on the ground that hunts down enemies and heals you for half a heart each time it eats one.
Leo 302 Leo Stompy Allows you to crush rocks when you walk over them.
Libra 304 Libra You Feel Balanced Gives 6 coins, 6 bombs, and 6 keys and balances out all attributes.
Lil Brimstone 275 Lil Brimstone Evil Friend A Familiar that shoots a thin Brimstone beam. Must charge like Brimstone before shooting.
Lil Haunt 277 Lil Haunt Fear him A familiar that damages enemies by chasing them as well as inducing the fear effect.
Little Baggy 252 Little Baggy Extra pill room Isaac can hold 2 pills at once and all cards are replaced by pills.
Little C.H.A.D. 96 Little C.H.A.D. Gives kisses A familiar who will drop a half red heart every 2 rooms.
Little Chubby 88 Little Chubby Attack Buddy A familiar that charges forward and deals touch damage to any enemies in its path.
Little Gish 99 Little Gish Sticky friend Spawns a familiar that follows Isaac around and fires slowing tears, impeding enemies' speed.
Little Steven 100 Little Steven Psychic friend Spawns a familiar that follows Isaac around and fires homing tears.
Loki's Horns 87 Loki's Horns Cross Tears Gives a random chance for projectiles to fire in all 4 cardinal directions.
Lord of the Pit 82 Lord of the Pit Demon wings Grants flight and increases speed.
Lost Contact 213 Lost Contact Shielded tears Every tear has a small shield which will allow it to block one enemy projectile.
Lucky Foot 46 Lucky Foot Luck up +1 Luck. Increases chance of winning Shell Game Beggar. (Independent of luck stat)
The Ludovico Technique 329 The Ludovico Technique Controlled Tears Instead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.
A Lump of Coal 132 A Lump of Coal My Xmas Present The more distance tears travel, the more damage they will do.
Lunch 22 Lunch HP Up Adds 1 heart container.
Maggy's Bow 312 Maggy's Bow HP up + you feel healthy Gives one heart container and doubles the healing provided by red hearts.
Magic 8 Ball 194 Magic 8 Ball Shot speed up Increases Shot Speed, and drops a Tarot Card when picked up.
Magic Mushroom 12 Magic Mushroom All Stats Up! Increases all stats and enlargens Isaac.
Magic Scab 253 Magic Scab HP + Luck up Increases luck and HP by 1.
Magneto 53 Magneto Item snatcher Pulls pickups towards Isaac.
The Mark 79 The Mark DMG up Increases Damage and Speed, plus adds one Soul Heart.
Match Book 344 Match Book Evil up Grants Isaac 1 Black Heart and 3 bombs. Can also give troll bombs.
MEAT! 193 MEAT! DMG + HP up Adds a heart container and increases damage.
Midas' Touch 202 Midas' Touch Golden touch Enemies that touch you are stunned and turn gold. Any enemy killed while in this state will drop a coin.
The Mind 333 The Mind I know all Grants the combined effects of the Blue Map, Treasure Map, and The Compass, revealing the floor layout and all special rooms, including Secret Rooms and Super Secret Rooms.
Mini Mush 71 Mini Mush Speed + range up Increases Speed and Shot Height and decreases Isaac's size, but lowers Range.
Missing Page 2 262 Missing Page 2 Evil up. Your enemies will pay! Gives 1 black heart. Upon taking damage that reduces Isaac's health to one heart or less, activates The Necronomicon effect, dealing 40 damage to all enemies in the room.
Missing No. 258 Missing No. Syntax error Randomizes all passive items upon pickup and at the start of each succeeding floor.
Mitre 173 Mitre You Feel Blessed Grants a chance of converting any red hearts pickups into soul hearts instead.
Mom's Coin Purse 195 Mom's Coin Purse What's all this...? Spawns 4 random pills around Isaac.
Mom's Contacts 110 Mom's Contacts Freeze effect Adds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.
Mom's Eye 55 Mom's Eye Eye in the back of your head Allows Isaac to fire tears from the back of his head.
Mom's Eyeshadow 200 Mom's Eyeshadow Charm tears Tears have a chance to charm enemies.
Mom's Heels 30 Mom's Heels Range up Increases range.
Mom's Key 199 Mom's Key Less is now more +2 keys Spawns 2 keys. Generates additional pickups from chests.
Mom's Knife 114 Mom's Knife Stab stab stab Isaac'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 Lipstick 31 Mom's Lipstick Range up Increases range and shot height.
Mom's Perfume 228 Mom's Perfume Fear shot Adds a chance to shoot fear tears and decreases tear delay by 1.
Mom's Purse 139 Mom's Purse More trinket room Allows Isaac to hold 1 additional trinket.
Mom's Underwear 29 Mom's Underwear Range up Increases range.
Mom's Wig 217 Mom's Wig You feel itchy... Adds a chance to spawn blue spiders when firing tears. Restores 1 red heart.
Money = Power 109 Money = Power $$$ = DMG Increases damage by 0.04 for every coin Isaac has, up to +3.96 damage at 99 coins.
Mongo Baby 322 Mongo Baby Mongo Friend Summons a familiar that copies the tears of Isaac's other familiars.
Monstro's Lung 229 Monstro's Lung Charged attack Increases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.
Mr. Mega 106 Mr. Mega Blast damage Gives Isaac 5 bombs, and makes all dropped bombs larger, which have an increased blast radius and increased damage.
The Mulligan 151 The Mulligan They grow inside Tears have a 1/6 chance of spawning allied blue flies when they hit an enemy.
Mutant Spider 153 Mutant Spider Quad shot Grants quadruple shot but decreases tears.
My Reflection 5 My Reflection Boomerang tears Gives Isaac's tears a boomerang effect, and increases range and shot speed.
Mysterious Liquid 317 Mysterious Liquid Toxic Splash Damage Tears leave a small, short lasting pool of creep on impact or when their range is depleted.
Mystery Sack 271 Mystery Sack ? Spawns a familiar that follows Isaac around and has a chance to drop a heart, coin, bomb, or key after clearing a room.
Number One 6 Number One Tears up Tears range is heavily decreased, but the fire rate is greatly increased.
Odd Mushroom 121 Odd Mushroom DMG up Grants an empty heart container. Increases damage, range and shot height while reducing speed.
Odd Mushroom 120 Odd Mushroom Fire rate up Increases Tears and Speed while reducing Damage.
Old Bandage 219 Old Bandage HP up Adds one empty heart container. Whenever Isaac takes damage there's a chance that a Red Heart may drop.
Ouija Board 115 Ouija Board Spectral tears Grants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them.
The Pact 80 The Pact DMG + Tears UP Increases damage by 0.5, tears by 0.7 and grants two soul hearts upon pickup.
Pageant Boy 141 Pageant Boy Ultimate grand supreme Spawns several coins around Isaac.
The Parasite 104 The Parasite Split Shot Isaac's tears split in two when they hit something.
The Peeper 155 The Peeper Plop! Spawns a familiar that floats slowly around the room on a zig-zag pattern similar to Boom Flies damaging enemies it passes through.
Pentagram 51 Pentagram DMG up Increases damage and increases the chance for a Devil or Angel Room to appear.
PHD 75 PHD Better pills Converts all bad pills into good pills, spawns one pill pickup and restores health. Identifies all pills upon pickup.
Pisces 309 Pisces Tears up + knock-back shots -1 Tear Delay, adds knock-back shots and increases tear size.
Piggy Bank 227 Piggy Bank My life savings Gives 3 pennies on pick-up. Every time Isaac is damaged, he will drop one additional penny.
Placenta 218 Placenta HP up + regen Grants a full heart container, and a chance to regenerate a half-heart of health every minute of gameplay.
Polyphemus 169 Polyphemus Mega Tears Makes Isaac shoot one huge tear. Also reduces Tears to minimum. Damage increased . If tear does more damage than an enemy's life, the tear continues to travel with the extra remaining damage.
Proptosis 261 Proptosis Short range mega tears Tears start out massive with high damage, and then shrink down and become weaker over a short range.
Punching Bag 281 Punching Bag Scape Goat Spawns a Mulligan Familiar that will wander the room randomly. Enemies will attack the Mulligan if it's closer.
Pyro 190 Pyro 99 bombs Adds 99 bombs.
Pyromaniac 223 Pyromaniac It hurts so good +5 Bombs Isaac heals 1 heart instead of taking damage from an explosive source. Adds 5 bombs.
A Quarter 74 A Quarter +25 coins Adds 25 to Isaac's coin count, capping at 99.
Rainbow Baby 174 Rainbow Baby Random buddy Spawns a familiar that follows Isaac around and fires tears with random effects.
Raw Liver 16 Raw Liver HP up Grants 2 Heart Containers and completely restores health.
The Relic 98 The Relic Soul generator Isaac is followed by a small blue cross that will drop a Soul Heart every 4 rooms.
Robo-Baby 95 Robo-Baby Friends 'till the bbbbzzzt Follows Isaac around, shooting enemies with an eye laser similar to Technology.
Robo-Baby 2.0 267 Robo-Baby 2.0 We worked out all the kinks Fires lasers at any enemy in its line of sight and moves based on the direction Isaac is firing tears.
Roid Rage 14 Roid Rage Speed and range up Increases speed by 0.6, range by 5.25, and tear height by 0.5.
Rosary 72 Rosary Faith up Adds 3 Soul Hearts and increases the chance for The Bible to appear in any item pool.
Rotten Baby 268 Rotten Baby Infested friend A familiar that spawns blue flies.
Rotten Meat 26 Rotten Meat HP up Adds one heart container.
Rubber Cement 221 Rubber Cement Bouncing tears Tears bounce off walls, enemies, and environmental objects.
Sack of Pennies 94 Sack of Pennies Gives money Isaac is followed by a small bag that drops a coin every 2 rooms.
Sacred Heart 182 Sacred Heart Homing shots + DMG up Increases damage and range while reducing shot speed and grants homing tears. Grants a Heart Container and replenishes all Red Hearts.
Sacrificial Dagger 172 Sacrificial Dagger My fate protects me Dagger orbits Isaac, dealing very high damage.
Sad Bombs 220 Sad Bombs Tear blast +5 bombs +5 Bombs. Upon exploding, bombs shoot 8 tears off in every direction, similar to Tammy's Head. The tears are affected by any tear modifiers Isaac has on his own tears.
The Sad Onion 1 The Sad Onion Tears up Increases Tears by 0.7.
Safety Pin 339 Safety Pin Evil + range + shot speed up Increases range and shot speed, while adding 1 Black Heart.
Sagittarius 306 Sagittarius Penetrative shot + speed up Increases speed by +0.2 and grants piercing tears.
Samson's Chains 321 Samson's Chains The ol' ball and chain Pull a chain and ball behind you that will damage enemies on contact and is able to break stones.
Scapular 142 Scapular You have been blessed Once per room, when Isaac is reduced to his last half red Heart, the aura around his head temporarily vanishes and he is granted one Soul Heart.
Scorpio 305 Scorpio Poison tears Grants poison tears, which deal damage over time when inflicted.
Screw 255 Screw Tears + shot speed up Tears and shot speed up.
Sharp Plug 205 Sharp Plug Charge with blood Using an activated item while it's not charged will charge it and Sharp Plug does 2 full heart damage to Isaac.
Sissy Longlegs 280 Sissy Longlegs She loves you Wanders about the room, occasionally spawning blue spiders.
Sister Maggy 67 Sister Maggy Friends 'till the end A familiar that follows Isaac around shooting blood tears.
Skatole 9 Skatole Fly love All types of fly except Boom Fly and Red Boom Fly become passive and slowly move towards Isaac. Does not prevent contact damage.
Skeleton Key 17 Skeleton Key 99 keys Sets your key count to the maximum of 99.
The Small Rock 90 The Small Rock DMG up Increases damage by 1, increases tears by 0.2, and decreases speed by 0.1.
Smart Fly 264 Smart Fly Revenge fly After Isaac takes damage, this fly will deal continuous touch damage to whatever enemy caused the damage until it is dead. The fly will then systematically attack 1 enemy at a time until the room is cleared.
SMB Super Fan 189 SMB Super Fan All stats up Increases all stats.
A Snack 346 A Snack HP up Grants one full red heart container.
Soy Milk 330 Soy Milk DMG Down + Tears Way Up Tears shrink and do much less damage, but fire in very rapid succession.
The Soul 335 The Soul I am all Grants two soul hearts. Isaac now repels enemy projectiles.
Speed Ball 143 Speed Ball Speed + shot speed up Increases speed by 0.3 and shot speed by 20%.
Spelunker Hat 91 Spelunker Hat See-through doors Reveals type of adjacent rooms, including location for secret rooms and super secret rooms.
Spider Bite 89 Spider Bite Slow effect Adds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them.
Spider Baby 211 Spider Baby Spider revenge When hit, spawns up to 2 blue spiders.
Spirit of the Night 159 Spirit of the Night Scary Grants spectral tears and flight.
Spoon Bender 3 Spoon Bender Homing shots Grants Isaac homing tears.
Squeezy 196 Squeezy Tears up Increases tears by 0.4, and spawns 2 Soul Hearts pickups.
Starter Deck 251 Starter Deck Extra card room Isaac can hold 2 cards at once and all pills are replaced by cards.
Steam Sale 64 Steam Sale 50% off Reduces all Shop prices by 50%, rounded down to 7 coins for an item, rounded up to 2-3 coins for a pickup.
Stem Cells 176 Stem Cells HP up Adds one filled heart container and increases Shot Speed.
Steven 50 Steven DMG up Increases Damage by 1.
Stigmata 138 Stigmata DMG + HP up Increases damage, and adds 1 heart container.
Stop Watch 232 Stop Watch Let's slow this down a bit Removed in Afterbirth Automatically inflicts slow to all enemies in every room.
Added in Afterbirth Upon taking damage, inflicts slow to all enemies for the current room.
Strange Attractor 315 Strange Attractor Magnetic tears Pickups, trinkets, and monsters are magnetically attracted to Isaac's tears.
Super Bandage 92 Super Bandage +2 hearts Grants one Heart Container and gives 2 Soul Hearts.
Synthoil 345 Synthoil DMG up + range Increases damage by 1, range by 5.25, and tear height by 0.5.
Taurus 299 Taurus Speed down + rage is building Speed down; gains speed while in a room with enemies until gaining My Little Unicorn effect for a few seconds.
Tech.5 244 Tech.5 It's still being tested... Grants a unlimited range piercing laser with random rate of fire that does not replace tears. The laser might occasionally fire with the effect of a random item or trinket, such as Hook Worm, Spoon Bender or Tiny Planet.
Technology 68 Technology Laser tears Replaces tears with a piercing laser with unlimited range.
Technology 2 152 Technology 2 Laser Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously.
Tiny Planet 233 Tiny Planet Orbiting tears + range up Range up and makes shot tears revolve around Isaac until they drop.
The Negative 328 The Negative Fate Chosen If the character has half a red heart or no red hearts after taking damage, it triggers The Necronomicon effect, damaging all enemies in the room. Also allows entrance into the Dark Room.
The Polaroid 327 The Polaroid Fate Chosen If the character has half a red heart or no red hearts after taking damage, it triggers the Book Of Shadows effect, creating a shield that nullifies all types of damage for 5 seconds. Also allows entrance into The Chest.
There's Options 249 There's Options More options There will be 2 items available to choose from after defeating a boss. Choosing 1 item causes the other to disappear.
Thunder Thighs 314 Thunder Thighs HP up + speed down + you feel stompy Destroys rocks upon contact with Isaac. Adds one heart container and lowers Speed.
Toothpicks 183 Toothpicks Tears + shot speed up Increases tears and shot speed.
Torn Photo 341 Torn Photo Tears + shot speed up Tears + Shot speed up.
Tough Love 150 Tough Love Tooth shot Adds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears.
Transcendence 20 Transcendence We all float down here... Grants flight.
Treasure Map 54 Treasure Map Full visible map Reveals all rooms for every floor. However, it does not reveal icons or secret rooms.
Trinity Shield 243 Trinity Shield "You feel guarded" Isaac gains a shield that protects him from enemy shots.
The Wafer 108 The Wafer Damage resistance All sources of damage that would cause more than one half heart of damage are reduced to one half heart instead.
Whore of Babylon 122 Whore of Babylon Curse up Increases damage and speed whenever Isaac has half a red heart or less (one red heart for Eve), ignoring any soul or black hearts.
Wire Coat Hanger 32 Wire Coat Hanger Tears up Increases Tears by 0.7.
Wooden Spoon 27 Wooden Spoon Speed up Increases speed by 0.3.
Virgo 303 Virgo You feel refreshed and protected Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 10 seconds. Also converts "bad pills" into "good pills".
The Virus 13 The Virus Poison touch Inflicts poison to enemies who make contact with Isaac. Speed down.
X-Ray Vision 76 X-Ray Vision I've seen everything Reveals and opens all Secret Room and Super Secret Room entrances.
Added in Afterbirth 8 Inch Nails 359 8 Inch Nails Stick it to 'em! +1.5 Damage Up. Replaces Isaac's tears with nails, which have increased knockback.
Added in Afterbirth Athame 408 Athame Call to the void Whenever Isaac takes damage, a black ring briefly appears around Isaac, dealing damage to all nearby enemies.
Added in Afterbirth Betrayal 391 Betrayal Turn your enemy Every time Isaac takes damage, a charm effect is applied to every enemy in the room, causing them to attack each other rather than Isaac.
Added in Afterbirth Binky 438 Binky Memories... Tears up, adds 1 soul heart, and decreases Isaac's size.
Added in Afterbirth Black Powder 420 Black Powder Spin the black circle! Isaac 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.
Added in Afterbirth Bomber Boy 353 Bomber Boy Explosive blast! +5 bombs. Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide). This also affects troll bombs.
Added in Afterbirth Bumbo 385 Bumbo Bumbo want coin! Spawns 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.
Added in Afterbirth Bursting Sack 377 Bursting Sack Spider love Spider enemies no longer target or deal contact damage to Isaac.
Added in Afterbirth Cambion Conception 412 Cambion Conception Feed them hate After taking damage a certain amount of times, a permanent demonic familiar spawns.
Added in Afterbirth Car Battery 356 Car Battery Double charge! Causes Isaac's activated item to activate twice on each use.
Added in Afterbirth Censer 387 Censer Peace be with you Gives Isaac a golden censer familiar which creates a huge aura of light that slows down any enemies and enemy shots inside it.
Added in Afterbirth Chaos 402 Chaos !!! Chaos causes items to be chosen from random item pools. When picked up, drops between 1-6 random pickups on the floor.
Added in Afterbirth Charged Baby 372 Charged Baby Bbbzzzzzt! A familiar that drops a Little Battery every 4 rooms. Has a small chance to freeze all enemies in the room when hit.
Added in Afterbirth Circle of Protection 423 Circle of Protection Protect me from myself Surrounds Isaac with a large white halo around him that pulsates. With each pulse, the halo deals contact damage to enemies equal to Isaac's damage. Each pulse also converts any enemy shots touching the ring into friendly purple homing tears.
Added in Afterbirth Continuum 369 Continuum Transcendent tears +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.
Added in Afterbirth Crack Jacks 354 Crack Jacks Don't swallow the prize! Adds one heart container and drops a random trinket.
Added in Afterbirth Crown of Light 415 Crown of Light The untainted gain power Gives 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.
Added in Afterbirth Curse of the Tower 371 Curse of the Tower You feel cursed... Causes Isaac to spawn 6 troll bombs on the floor every time he gets hit, similar to the Anarchist Cookbook mechanic.
Added in Afterbirth Dead Eye 373 Dead Eye Accuracy brings power! Isaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.
Added in Afterbirth Deep Pockets 416 Deep Pockets More stuff to carry! Allows Isaac to carry two cards or pills (or a combination of both) at the same time.
Added in Afterbirth Eden's Blessing 381 Eden's Blessing Your future shines brighter Tears up. Grants a random item at the start of the next run.
Added in Afterbirth Empty Vessel 409 Empty Vessel I reward an empty vessel While 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.
Added in Afterbirth Epiphora 368 Epiphora Intensifying tears Shooting 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.
Added in Afterbirth Evil Eye 410 Evil Eye Eye shot! While 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.
Added in Afterbirth Explosivo 401 Explosivo Sticky bomb shot! Isaac's tears have a chance to stick to enemies and explode.
Added in Afterbirth Farting Baby 404 Farting Baby It farts! A 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.
Added in Afterbirth Fate's Reward 361 Fate's Reward Your fate beside you A blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.
Added in Afterbirth Friend Zone 364 Friend Zone Friendly fly A 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.
Added in Afterbirth Fruit Cake 418 Fruit Cake Rainbow Effects! Isaac's tears gain a random effect that changes every shot.
Added in Afterbirth GB Bug 405 GB Bug Game breaking bug, right away! A 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.
Added in Afterbirth Glitter Bombs 432 Glitter Bombs Prize Bombs! Gives Isaac 5 bombs, and makes Isaac's bombs have a chance to drop random pickups or charm enemies when they explode.
Added in Afterbirth God's Flesh 398 God's Flesh Shrink shot Tears 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.
Added in Afterbirth Head of the Keeper 429 Head of the Keeper Penny tears! Isaac's tears become coins and now have a chance to drop pennies on the floor upon successfully hitting an enemy.
Added in Afterbirth Holy Light 374 Holy Light Holy shot! Isaac 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.
Added in Afterbirth Host Hat 375 Host Hat Nice hat! A 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.
Added in Afterbirth Immaculate Conception 413 Immaculate Conception Feed them love Upon picking up a certain amount of health, spawn a permanent angelic familiar.
Added in Afterbirth Incubus 360 Incubus Dark friend A demonic familiar that follows Isaac and shoots tears identical to Isaac's in terms of damage, range, fire rate, and effects.
Added in Afterbirth Key Bum 388 Key Bum He wants your keys! Spawns a portable key master that follows Isaac and collects keys, giving random chests in return.
Added in Afterbirth Kidney Stone 440 Kidney Stone Matt's kidney stone Randomly 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.
Added in Afterbirth Lil Chest 362 Lil Chest What's in the box? Spawns a chest familiar that follows Isaac and drops a random pickup every few rooms.
Added in Afterbirth Lil Gurdy 384 Lil Gurdy A gurd of your own! Gives 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.
Added in Afterbirth Lil' Loki 435 Lil' Loki 4-way buddy! A Loki familiar that follows Isaac and shoots 4 tears in a cross pattern.
Added in Afterbirth Lost Fly 365 Lost Fly Lost protector A 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.
Added in Afterbirth Lusty Blood 411 Lusty Blood Their blood brings rage! Each time Isaac kills an enemy, Isaac's damage increases for the current room.
Added in Afterbirth Marked 394 Marked Directed tears Isaac 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.
Added in Afterbirth Maw of the Void 399 Maw of the Void Consume thy enemy! +1.0 Damage Up. After continuously firing tears for 2.5 seconds, a red cross appears on Isaac's head that, upon releasing the fire button, creates a black ring that rapidly deals damage equal to Isaac's tear damage to any enemies in contact with it.
Added in Afterbirth Milk! 436 Milk! Don't cry over it... A glass of milk follows Isaac and spills on the floor upon taking damage. After the milk spills, Isaac's tear delay is decreased by 2 for the rest of the room.
Added in Afterbirth Mom's Pearls 355 Mom's Pearls Range + luck up +1.25 Range Up. +0.5 Tear Height. +1 Luck Up.
Added in Afterbirth More Options 414 More Options There are even more options! Two items spawn in every Treasure Room. Only one can be taken; the other will disappear.
Added in Afterbirth Mr. Dolly 370 Mr. Dolly Range + tears up Tears and Range up. Spawns 3 random types of hearts on the floor when picked up.
Added in Afterbirth Multidimensional Baby 431 Multidimensional Baby ydduB Buddy Spawns 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 speed.
Added in Afterbirth My Shadow 433 My Shadow Me! And my shaaaadow! Each 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.
Added in Afterbirth Night Light 425 Night Light Scared of the dark? A cone of light shines in the direction Isaac is moving that slows enemies and enemy shots.
Added in Afterbirth No. 2 378 No. 2 Uh oh... Continuously 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.
Added in Afterbirth Papa Fly 430 Papa Fly Turret follower A blue fly familiar follows Isaac's movements on a 3 second delay. Papa Fly will fire tears at nearby enemies.
Added in Afterbirth Pay to Play 380 Pay to Play Money talks This 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.
Added in Afterbirth PJs 428 PJs You feel cozy Grants four soul hearts and fully restores Isaac's red health.
Added in Afterbirth Pupula Duplex 379 Pupula Duplex Wide shot Transforms 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).}
Added in Afterbirth Purity 407 Purity Aura stat boost This 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.
Added in Afterbirth Obsessed Fan 426 Obsessed Fan Follows my every move... A purple fly familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.
Added in Afterbirth Restock 376 Restock Never ending stores! Causes shops to instantly restock their items when they are bought. Granted by default for every character in Greed Mode.
Added in Afterbirth Rune Bag 389 Rune Bag Rune generator A bag that follows Isaac and drops a random rune every 3 rooms.
Added in Afterbirth Sack Head 424 Sack Head More sacks! Greatly increases the chance to find sacks.
Added in Afterbirth Scatter Bombs 366 Scatter Bombs 'We put bombs in your bombs!' Adds 5 bombs. Isaac's bombs explode into 2-4 tiny bombs
Added in Afterbirth Seraphim 390 Seraphim Sworn friend An angel familiar which follows Isaac and fires homing tears which deal 10 damage at -25% shot speed and a reduced fire rate.
Added in Afterbirth Serpent's Kiss 393 Serpent's Kiss The kiss of death Tears 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.
Added in Afterbirth Sticky Bombs 367 Sticky Bombs Egg sack bombs! +5 bombs. Bombs stick to enemies and spawn 2-4 blue spiders if they kill an enemy.
Added in Afterbirth Spear of Destiny 400 Spear of Destiny Your destiny In 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.
Added in Afterbirth Spider Mod 403 Spider Mod Mod buddy! Displays 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.
Added in Afterbirth Succubus 417 Succubus Damage booster Spawns 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.
Added in Afterbirth Sworn Protector 363 Sworn Protector Protective friend An 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.
Added in Afterbirth Tech X 395 Tech X Laser ring tears Tears 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.
Added in Afterbirth The Wiz 358 The Wiz Double wiz shot! Tears 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.
Added in Afterbirth Toxic Shock 350 Toxic Shock Mass poison Upon 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.
Added in Afterbirth Tractor Beam 397 Tractor Beam Control your tears Isaac emits a beam from his face. Isaac's tears travel in the path of the beam.
Added in Afterbirth Zodiac 392 Zodiac The heavens will change you Zodiac will give Isaac a random zodiac item effect that changes after every floor.
Added in Afterbirth † 7 Seals 526 7 Seals Lil Harbingers! Grants a random Harbinger familiar that changes every 10 seconds.
Added in Afterbirth † Acid Baby 491 Acid Baby Pills pills pills! Spawns a familiar that drops random pills every 2 rooms cleared. Upon using a pill, all enemies in the room are poisoned.
Added in Afterbirth † Adrenaline 493 Adrenaline Panic - power Increases damage based on how many empty heart containers Isaac has.
Added in Afterbirth † Analog Stick 465 Analog Stick 360 tears! Tears up. Allows Isaac to fire tears diagonally.
Added in Afterbirth † Angelic Prism 528 Angelic Prism Eclipsed by the moon Grants a prism orbital with a large orbital radius. Tears that pass through the prism split into four multi-colored tears.
Added in Afterbirth † Angry Fly 511 Angry Fly He's violent Spawns a fly familiar that orbits around a random enemy and deals 2 damage per tick to enemies it comes in contact with.
Added in Afterbirth † Apple! 443 Apple! Trick or treat? Increases tears. Adds a chance to fire a high-damage razor blade.
Added in Afterbirth † Backstabber 506 Backstabber Watch your back! Has a chance to fire tears that inflict bleeding on enemies, causing them to slowly take damage over time.
Added in Afterbirth † Belly Button 458 Belly Button What's in there? Drops a random trinket. Grants a second trinket slot.
Added in Afterbirth † Big Chubby 473 Big Chubby Chub chub Spawns a familiar that slowly charges forward and damages enemies in its path.
Added in Afterbirth † Bloodshot Eye 509 Bloodshot Eye Bloody friend Spawns an orbiting eye familiar that fires tears every 2 seconds.
Added in Afterbirth † Bozo 513 Bozo Party time! Increases damage by a flat 0.1 and grants a soul heart. Enemies can randomly become briefly charmed or feared. Taking damage has a chance to spawn a rainbow poop.
Added in Afterbirth † Broken Modem 514 Broken Modem LAG! Enemies, enemy shots, tears, and pickups will briefly freeze in place at random intervals.
Added in Afterbirth † Buddy in a Box 518 Buddy in a Box What could it be?! Grants a familiar with a random tear effect. The familiar is randomized at the start of each floor.
Added in Afterbirth † Camo Undies 497 Camo Undies Camo kid Isaac becomes camouflaged at the beginning of each room. Enemies will not attack Isaac until he starts firing tears.
Added in Afterbirth † Compound Fracture 453 Compound Fracture Bone tears! Increases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
Added in Afterbirth † Cone Head 457 Cone Head Hard headed! Grants a soul heart. Adds a chance to block enemy shots.
Added in Afterbirth † Contagion 466 Contagion Outbreak! The first enemy killed in a room explodes and poisons nearby enemies. Poisoned enemies will also explode upon death.
Added in Afterbirth † Dad's Lost Coin 455 Dad's Lost Coin I remember this... Increases range by 1.5. Drops a lucky penny. Other Effects Unknown
Added in Afterbirth † Dark Prince's Crown 442 Dark Prince's Crown Loss is power Increases range, tears, and shot speed when at exactly one red heart.
Added in Afterbirth † Dead Tooth 446 Dead Tooth Halitosis While firing, Isaac gains a green aura that poisons nearby enemies.
Added in Afterbirth † Death's List 530 Death's List Just hope you're not next... Grants a reward if all enemies in a room are killed in the order they are marked.
Added in Afterbirth † Depression 469 Depression :( Spawns a cloud familiar that leaves a trail of tears that damages enemies. Has a chance to spawn damaging beams of light onto enemies that touch the cloud.
Added in Afterbirth † Dog Tooth 445 Dog Tooth Bark at the moon! Increases damage and speed. Upon entering a room adjacent to a secret room, a howl sound effect will play.
Added in Afterbirth † Duality 498 Duality You feel very balanced Whenever a Devil or Angel Room would spawn after defeating a boss, both rooms spawn. Only one can be entered.
Added in Afterbirth † Eucharist 499 Eucharist Peace be with you An Angel Room door will always spawn after every boss fight, excluding the first floor and floors after Utero II/Womb II.
Added in Afterbirth † Euthanasia 496 Euthanasia Needle shot Adds a chance to fire needles. If a needle kills an enemy, it bursts into more needles.
Added in Afterbirth † Eye of Belial 462 Eye of Belial Possessed tears! Grants piercing tears. After piercing one enemy, tears start homing and deal double damage.
Added in Afterbirth † Eye of Greed 450 Eye of Greed Gold tears! Adds a chance to fire tears that temporarily stun enemies and turn them into gold. Any enemy killed while in this state will drop coins.
Added in Afterbirth † Fast Bombs 517 Fast Bombs Faster bomb drops! Grants 7 bombs and allows bombs to be placed rapidly.
Added in Afterbirth † Finger! 467 Finger! Watch where you point that! Spawns a finger familiar that points at enemies, dealing constant damage.
Added in Afterbirth † Ghost Pepper 495 Ghost Pepper Flame tears Adds a chance to shoot a fire that damages enemies and remains in place until it deals enough damage or the room is left.
Added in Afterbirth † Glaucoma 460 Glaucoma Blind tears! Adds a chance to shoot concussive tears, causing enemies to walk around randomly.
Added in Afterbirth † Glyph of Balance 464 Glyph of Balance A gift from above Grants 2 soul hearts and modifies drops from Champion Monsters based on certain conditions.
Added in Afterbirth † Greed's Gullet 501 Greed's Gullet Money = Health! Grants a heart container for every 25 coins Isaac has.
Added in Afterbirth † Haemolacria 531 Haemolacria I'm seeing red... Tears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.
Added in Afterbirth † Hushy 470 Hushy Lil hush! Spawns a Hush familiar that bounces around the room and deals contact damage. While firing tears, it stops moving.
Added in Afterbirth † Jacob's Ladder 494 Jacob's Ladder Electric tears Tears fire sparks of electricity in random directions upon hitting an obstacle or enemy.
Added in Afterbirth † Jumper Cables 520 Jumper Cables Bloody Recharge! Grants an active item charge every 15 enemies killed.
Added in Afterbirth † King Baby 472 King Baby Lord of the dead! Spawns a familiar that follows Isaac and makes other familiars follow it. While firing tears, it stops moving.
Added in Afterbirth † Lachryphagy 532 Lachryphagy Feed them! Isaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.
Added in Afterbirth † Large Zit 502 Large Zit Creep shots Adds a chance to fire a creep shot that deals double damage and leaves a trail of slowing white creep.
Added in Afterbirth † Lead Pencil 444 Lead Pencil He's a bleeder! After every 15 tears fired, Isaac will fire a high-damage cluster of tears.
Added in Afterbirth † Leprosy 525 Leprosy You're tearing me apart! Upon taking damage, grants a body part as an orbital, which blocks enemy shots and deals 7 damage per tick to enemies it comes in contact with. The orbitals will be destroyed if they take enough damage from enemies or enemy shots.
Added in Afterbirth † Lil Delirium 519 Lil Delirium He's delirious Grants a familiar that transforms into another random familiar every 10 seconds.
Added in Afterbirth † Lil Monstro 471 Lil Monstro Ain't he cute? Spawns a familiar that fires clusters of tears. Must be charged before shooting.
Added in Afterbirth † Linger Bean 447 Linger Bean Crying makes me toot Adds a chance to fire a gas cloud that damages nearby enemies.
Added in Afterbirth † Little Horn 503 Little Horn Science! Adds a chance to fire a piercing tear that instantly kills any enemy that it touches.
Added in Afterbirth † Metal Plate 449 Metal Plate It itches... Adds a chance to reflect enemy shots. Grants one soul heart.
Added in Afterbirth † Moldy Bread 456 Moldy Bread Midnight snack! Grants one full red heart container.
Added in Afterbirth † Mom's Razor 508 Mom's Razor It's sharp! Spawns an orbiting razor that damages enemies it touches and inflicts bleeding on enemies, causing them to slowly take damage over time.
Added in Afterbirth † Parasitoid 461 Parasitoid Egg tears! Adds a chance to fire an egg sack which spawns slowing creep and spawns a blue fly or spider upon hitting an enemy.
Added in Afterbirth † Poke Go 505 Poke Go Gotta catch em... Upon entering a room with enemies in it, has a chance to spawn a random charmed enemy that persists across rooms.
Added in Afterbirth † Polydactyly 454 Polydactyly Hold me! Allows Isaac to carry two cards, pills, or any combination of both at the same time. Drops a random card or pill.
Added in Afterbirth † Pop! 529 Pop! Eyeball tears! Replaces Isaac's tears with eyeballs that can bounce off of each other. The eyeballs are not limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle.
Added in Afterbirth † Sack of Sacks 500 Sack of Sacks Gives Sacks! Spawns a sack familiar that has a chance to drop a sack upon clearing a room.
Added in Afterbirth † Schoolbag 534 Schoolbag Extra active item room Allows Isaac to hold two active items.
Added in Afterbirth † Shade 468 Shade It follows Spawns a shadow familiar that follows Isaac's movements on a 1 second delay and deals contact damage to enemies.
Added in Afterbirth † Shard of Glass 448 Shard of Glass Blood and guts! Upon taking damage, Isaac has a chance to drop a full red heart, gain 5 range, and leave a trail of damaging red creep for the current room.
Added in Afterbirth † Sinus Infection 459 Sinus Infection Booger tears! Adds a chance to fire a booger which sticks to enemies and poisons them.
Added in Afterbirth † Sulfuric Acid 463 Sulfuric Acid Acid tears! Increases damage. Adds a chance to fire acidic tears which can destroy obstacles.
Added in Afterbirth † Tarot Cloth 451 Tarot Cloth I see the future Drops a random card or rune. Doubles the effects of cards and runes.
Added in Afterbirth † Technology Zero 524 Technology Zero Static tears! Connects Isaac's tears with electricity that can damage enemies.
Added in Afterbirth † Trisagion 533 Trisagion Smite thy enemy Tears are replaced with piercing white blasts of light.
Added in Afterbirth † Varicose Veins 452 Varicose Veins I'm leaking... Taking damage releases a ring of 10 high damage tears.
Added in Afterbirth † YO LISTEN! 492 YO LISTEN! Yo listen! Increases luck. Spawns a fairy familiar that points out secret room entrances and tinted rocks.

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

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