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

Items are classified into several distinct types and groups. Some items are passive, which add an effect permanently to Isaac, while others only activate when used. The original The Binding of Isaac had 196 items. Rebirth has a total of 341 items. Added in Afterbirth Afterbirth added 95 new items, for a total of 436 items. Added in Afterbirth † Afterbirth † added 111 new items, for a total of 547 items. Of those, 13 items are considered special and will be less likely to appear if the player has already come across other special items.

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.

Not to be confused with cards and runes, pills, and trinkets.

Contents

Activated Collectibles

Unless the player has    Schoolbag, only one activated item can be held at a time, with the old collectible being placed on a pedestal if a new activated item is picked up. Most activated items need to recharge before use, with the recharge bar filling either by clearing rooms or recharging over time. Other activated items do not have a charge bar, and, with a few exceptions (such as   How to Jump), will instead either disappear after a single use or require resources such as coins or health. Some activated items will also grant passive effects as long as they are equipped.


Name ID Icon Quote Description
A Pony 130
 
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.
Anarchist Cookbook 65
 
Summon bombs Spawns six Troll Bombs around the room.
Best Friend 136
 
Friends 'till the end Deploys a decoy Isaac that eventually explodes with an increased blast radius.
Blank Card 286
 
Card Mimic Has the same effect as the card or rune currently held by Isaac.
Blood Rights 186
Mass enemy damage at a cost Isaac takes one full red heart of damage and damages all enemies in the room.
Bob's Rotten Head 42
 
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.
Book of Revelations 78
 
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
 
?????? Upon use, gives the effect of   Treasure Map,   The Compass, or   Blue Map for the duration of the current floor.
Book of Shadows 58
 
Temporary Invincibility Upon use, creates a protective shield nullifying all types of damage for 10 seconds.
Box of Spiders 288
 
It's a box of spiders Summons 2-4 Blue Spiders.
Breath of Life 326
 
Invincibility at a cost Grants a brief moment of invincibility when the charge bar hits zero. If the spacebar is held for an additional second after hitting zero, Isaac will take damage.
Butter Bean 294
 
Reusable knock-back Isaac farts and pushes back nearby enemies (  and projectiles).
Converter 296
Convert your soul When used, converts two Soul Hearts into a Red Heart container.
Crack the Sky 160
 
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
 
I see my future Reveals the map (except the Super Secret Room) and drops a random tarot card or Soul Heart.
D10 285
 
Rerolls enemies Rerolls the enemies in a room. Only rerolls enemies that are still alive (does not spawn new enemies).
D100 283
 
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.
D20 166
 
Reroll the basics Rerolls all pickups in the current room.
D4 284
 
Reroll into something else Rerolls all of Isaac's items.
Dad's Key 175
 
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
 
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
 
Reusable card generator Gives Isaac a random tarot card.
Doctor's Remote 47
 
Reusable Air Strike Creates a crosshair on the ground that can be aimed with tear controls. A missile strikes the spot after 2 seconds, dealing heavy damage.
Flush! 291
 
... Changes all enemies in the room into poop. Does not work on all enemies (Knights and bosses are immune). Instantly kills Dingle, Dangle, Brownie, and other poop-themed enemies.
Forget Me Now 127
I don't remember When activated, the level ends and is freshly regenerated with new rooms, monsters, and items. Disappears after use.
Guppy's Head 145
 
Reusable fly hive Spawns 2-4 Blue Flies to damage enemies.
Guppy's Paw 133
Soul converter Removes one Red Heart container in exchange for gaining 3 Soul Hearts.
Head of Krampus 293
 
Krampus Rage Fires a cross-patterned brimstone shot, just like The Fallen and Krampus shoot.
  Has a 50% chance to rotate all beams around the player 90 degrees.
How to Jump 282
It's about time you learned how Gives Isaac the ability to jump (over gaps, spikes, etc.).
Isaac's Tears 323
 
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
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.
Kamikaze! 40
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
 
Oops... Creates a small yellow pool of creep, which damages enemies that cross it.
Magic Fingers 295
Pay to play For 1 coin, damages all enemies in the room.
Mom's Bottle of Pills 102
 
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
 
Mass Fear Upon use, petrifies all enemies in the current room for approximately 4 seconds.
Mom's Pad 41
 
Gross... Upon use, inflicts fear to all enemies in the room for 5 seconds.
Monster Manual 123
 
Temporary buddy generator Summons a random familiar for the current room. Can summon familiars not yet unlocked.
Monstro's Tooth 86
 
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
 
Reusable bomb buddy Drops a large bomb.
My Little Unicorn 77
 
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.
Notched Axe 147
 
Rocks don't stand a chance Isaac destroys obstacles and opens secret room doors by walking into them while the item is active; it stays so until it is used again or he takes damage. He also cannot shoot or pick up items during this time.
Pandora's Box 297
?? Upon use, spawns certain pickups or items depending on the floor it is used on. Single-use.
Portable Slot 177
Gamble 24/7 Consumes 1 coin and has a chance to drop a random pickup, like a slot machine.
Prayer Card 146
 
Reusable eternity Grants an eternal heart per use.
Razor Blade 126
Feel my pain Upon use, deals one heart of damage to Isaac and grants +1.2 damage for the current room.
Red Candle 289
 
Flame on Throws a persistent flame that deals high damage and diminishes as it damages enemies or blocks shots.
Remote Detonator 137
Remote bomb detonation Bombs placed by Isaac only explode when Remote Detonator is used. Gives 5 bombs.
Satanic Bible 292
 
Reusable Evil Upon activation, Isaac gains a black heart.
Scissors 325
   
   
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
 
BLLLARRRRGGG! Fires a laser from Isaac's mouth.
Spider Butt 171
 
Mass enemy slowdown + damage Damages all enemies in the room and slows them and their projectiles down.
Tammy's Head 38
 
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
 
Temporary psychic shot Upon activation, grants homing tears for the current room.
Teleport 44
 
Teleport! Teleports Isaac to a random room on the level.
The Bean 111
 
Toot on command Isaac releases bad gas, poisoning any enemy in close vicinity.
The Bible 33
 
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.
The Book of Belial 34
 
Temporary DMG up Increases damage by 2 for the current room, also granting a 1.5x damage multiplier if Isaac has Blood of the Martyr.
  Guarantees a Devil Room or Angel Room will be open after beating a boss while holding it.   Increases the chance by 12.5%.
The Book of Sin 97
 
Reusable Item Generator Spawns a random pickup, pill, card, or trinket.
The Boomerang 338
 
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.
The Candle 164
 
Reusable flame Throws out a blue flame that can pass over gaps (but not through rocks). The flame damages anything in its path.
The D6 105
 
Reroll Your Destiny Re-rolls all items in the current room into other items, depending on the current room's Item Pool.
The Gamekid 93
 
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.
The Hourglass 66
 
Temporary enemy slowdown Upon activation, enemies and their projectiles are slowed down for a short duration.
The Jar 290
Save your life When at full health, up to 4 extra hearts can be stored in the jar.
The Nail 83
 
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
 
Mass room damage Damages all enemies in the room significantly.
The Pinking Shears 107
 
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 Poop 36
 
Plop! Spawns a pile of poop where the character is standing and knocks nearby monsters back. May yield pickups like regular poop.
Undefined 324
 
Undefined Teleports Isaac to either the Secret Room, Super Secret Room, Treasure Room, or I AM ERROR.
Unicorn Stump 298
 
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
 
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
 
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
 
Reusable Regeneration Restores 1 whole red heart.
  Box of Friends 357
 
Double your friends Upon use, duplicates all of Isaac's familiars for the current room.
  D12 386
 
Rerolls rocks Re-rolls all rocks in the current room into other random objects, such as bomb rocks, metal blocks, TNT, or poops.
  D7 437
 
Reroll rewards! Restarts the current room and brings back all enemies, allowing more rewards to be acquired by completing the room.
  D8 406
 
Reroll stats Re-rolls Isaac's speed, range, tears, and damage.
  Diplopia 347
Double item vision Duplicates all pickups and item pedestals in the room.
  Friendly Ball 382
 
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 friendly, fighting for Isaac and persisting between rooms.
  Glass Cannon 352
 
Be gentle... Reduces Isaac's health to half a heart (including Soul and Black Hearts) and fires a large piercing spectral tear that does very high damage.
  Glowing Hour Glass 422
 
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.
  Jar of Flies 434
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.
  Kidney Bean 421
 
Love toots! Upon use, Isaac farts, charming all nearby enemies.
  Mega Bean 351
 
Giga fart! Freezes all enemies in the current room for a couple of seconds, poisons any enemies near Isaac, and sends a rock wave across the room in the direction Isaac is facing.
  Mega Blast 441
 
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.
  Mine Crafter 427
 
Booom! Places an explosive TNT barrel that can be pushed and used to destroy rocks or damage enemies when used. If used a second time in the same room while the previous TNT barrel is still intact, it will remotely explode the TNT.
  Mom's Box 439
 
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.
  Placebo 348
 
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.
  Tear Detonator 383
 
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.
  Teleport 2.0 419
 
I-Teleport! Teleports Isaac to a random room that has not been explored yet when used. 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 same room.
  Ventricle Razor 396
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.
  Wooden Nickel 349
 
Flip a coin When used, has a 50% chance to drop one random type of coin (Penny, Nickel, or Dime).
  Black Hole 512
 
Nothing can escape Throws a black hole on the ground which sucks in and damages enemies.
  Book of the Dead 545
 
Rise from the grave Upon use, spawns a friendly Bony or an orbital bone for each enemy killed in the current room.
  Broken Shovel 550
 
It feels cursed While held, causes multiple Mom's Foots to come down and stomp on Isaac. One of two parts necessary to create Mom's Shovel.
  Brown Nugget 504
 
Friendly fly Spawns a stationary fly familiar that fires tears at nearby enemies.
  Clicker 482
 
Change Transforms Isaac into a random character and removes the last item collected.
  Compost 480
 
Gain more friends! Doubles Isaac's Blue Spiders and Flies, or spawns one if Isaac has none. Turns pickups in the room into Blue Spiders or Flies.
  Coupon 521
 
Allow 6 weeks for delivery Upon use, makes a random item from a Shop, Devil deal, or Black Market free.
  Crooked Penny 485
 
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.
  D Infinity 489
 
Reroll forever Grants a random dice item that changes each use.
  D1 476
 
What will it be? Duplicates a random pickup in the room.
  Dataminer 481
 
109 Displaces enemy sprites for the current room, randomly increases one stat and decreases another.
  Delirious 510
 
Unleash the power! Spawns a random charmed boss.
  Dull Razor 486
 
I feel numb... Hurts Isaac without depleting health, activating any items that trigger upon taking damage.
  Eden's Soul 490
 
... Spawns two item pedestals then is consumed. Begins with no charges.
  Mama Mega! 483
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.
  Metronome 488
 
Waggles a finger Grants a random item effect for the current room.
  Mom's Shovel 552
 
Lost but not forgotten Spawns a trapdoor that leads to the next floor upon activation. Unlocks The Forgotten when used on a mound of dirt that appears in   Dark Room.
  Moving Box 523
 
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.
  Mr. ME! 527
 
Caaan do! Summons a controllable ghost that can perform various tasks depending on what it targets.
  Mystery Gift 515
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.
  Pause 478
 
Stop! Freezes all enemies until a fire button is pressed.
  Plan C 475
Use with caution Kills all enemies in the room, then kills Isaac three seconds later.
  Potato Peeler 487
A pound of flesh Removes a heart container, increases damage and range, and grants a Cube of Meat.
  Sacrificial Altar 536
He demands a sacrifice Upon use, sacrifices up to 2 familiars and spawns an item from the Devil Room Pool for each familiar sacrificed.
  Sharp Straw 507
 
More blood! Damages all enemies in the room. Has a chance to drop a half red heart or half soul heart if an enemy is hit.
  Smelter 479
 
Trinket melter! Consumes Isaac's currently held trinket and applies its effect permanently.
  Sprinkler 516
 
Sprinkles. Upon use, spawns a sprinkler that rotates and fires tears.
  Telekinesis 522
 
Power of the 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.
  Void 477
 
Consume Consumes all pedestal items in the room. Active items will have their effects added to Void, and passive items will grant stat upgrades.
  Wait What? 484
 
I can't believe it's not Butter Bean! Isaac farts, sending out rock waves.

Passive Collectibles

An unlimited amount of passive collectibles can be held at a time, and the effects they grant are permanent. Their effects are vast and diverse, from simple stat and health increases to completely changing the way Isaac's tears behave.


Name ID Icon Quote Description
???'s Only Friend 320   Controlled friend Summons a big attack fly that can be controlled with the shooting direction-keys.
<3 15   HP up Grants Isaac one red heart container and fully restores Isaac's health.
1up! 11   Extra life Gives Isaac an extra life. Upon death, he will respawn in the previous room with full health and lose the 1up!.
20/20 245   Double shot Grants double shot.
3 Dollar Bill 191   Rainbow tears Gives Isaac a random tear effect every room.
  The effect given changes upon entering a room.
  The effect changes every 3 seconds.
9 Volt 116   Quicker charge Reduces the charge of any activated item by 1. Any 1 charge items instead have timed recharges.
A Dollar 18   $$$ Gives Isaac 99 coins. Can be found multiple times in a single playthrough.
A Lump of Coal 132   My Xmas Present The more distance tears travel, the more damage they will do.
A Quarter 74   +25 coins Adds 25 to Isaac's coin count, capping at 99.
A Snack 346   HP up Grants one full red heart container.
Abaddon 230   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   Mirrored buddy A familiar that mirrors the player's movements and shoots in the opposite direction.
Anemic 214   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   Eternal life? Upon death, the player will respawn as ??? with 3 Soul Hearts.
Anti-Gravity 222   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   Trail of tears A trail of blue creep is left behind Isaac, which damages enemies.
Aries 300   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   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   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.
BBF 272   Big Beautiful Fly Spawns a familiar that flies around the room like the Boom Fly and explodes on contact with an enemy. Respawns after ten seconds.
Best Bud 274   Sworn protector When hit, summons a white attack fly similar to   Distant Admiration for the current room.
BFFS! 247   Your Friends Rule! Increases the size and effectiveness of most familiars.
Big Fan 279   Fat protector Spawns a large orbital familiar that blocks enemy projectiles and deals slight contact damage to enemies.
Black Candle 260   Curse immunity + evil up Prevents curses. Grants one Black Heart. Increases the chance for a Devil or Angel Room to appear.
Black Lotus 226   HP up x3! Grants the player one Red Heart container, one Soul Heart, and one Black Heart.
Blood Bag 119   HP up Grants one full Red Heart container, restores 4 Red Hearts, and increases speed by 0.3.
Blood Clot 254   DMG + range up Increases damage by 1 and range by 5 for tears fired from the left eye.
Blood of the Martyr 7   DMG up Increases Damage by 1, and turns Isaac's tears into blood tears.
Bloody Lust 157   RAGE! Increases damage as Isaac receives damage. Damage increase stays for the whole floor.
Blue Cap 342   HP + tears up + shot speed down Grants 1 Red Heart container and increases tears, but decreases shot speed.
Blue Map 246   Secrets Shows Secret and Super Secret Room locations on the map.
Bob's Brain 273   Explosive thoughts Spawns a familiar that charges forward when shooting tears and explodes upon contact with an enemy, damaging and poisoning them. The familiar respawns after a few seconds.
Bob's Curse 140   +5 poison bombs Gives 5 bombs and grants all bombs poison effect.
Bobby-Bomb 125   Homing bombs! Gives Isaac 5 Bombs and causes all dropped bombs to home towards the closest enemy.
Bogo Bombs 250   1+1 boom! All Bomb pickups become Double Bombs.
Bomb Bag 131   Gives bombs Isaac is followed by a small bag that drops a Bomb, a Double Bomb, a Troll Bomb, or a   Golden Bomb every 3 rooms.
Boom! 19   10 bombs Grants 10 bombs.
Box 198   Stuff Spawns 1 of each (non-collectible) item: 1 Penny, 1 Key, 1 Bomb, 1 Red Heart, 1 card, 1 pill, 1 trinket.
Breakfast 25   HP up Grants Isaac one full Red Heart container.
Brimstone 118   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   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   Friends 'till the end Follows Isaac around shooting normal tears.
Bucket of Lard 129   HP up Grants two empty Red Heart containers and heals Isaac by half a Red Heart, but decreases speed by 0.2.
Bum Friend 144   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   Toxic blast +5 bombs +5 bombs. Bombs now cloud up the screen, briefly damaging and confusing all enemies.
Caffeine Pill 340   Speed up + size down Increases speed and reduces character size. Also gives a random pill.
Cain's Other Eye 319   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   HP up + you feel protected Adds 3 Soul Hearts. Grants The Wafer effect for the current room upon taking damage.
Capricorn 307   All stats up All stats up.
Cat-O-Nine-Tails 165   Shot speed + damage up Increases shot speed and damage.
Celtic Cross 162   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   Sin up Adds 3 Black Hearts and increases damage by 1.
Champion Belt 208   DMG + Challenge Up Increases damage, but also increases the chance of champion enemies appearing.
Charm of the Vampire 62   Kills heal Heals the character for half of a Red Heart for every 13 monsters killed.
Chemical Peel 154   DMG up Tears fired from left eye do increased damage.
Chocolate Milk 69   Charge shots Grants charged tears that deal greater damage when fully charged.
Contract From Below 241   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   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   DMG up Increases damage by 0.5, and multiplies it by 1.5x.
Cube of Meat 73   Gotta meat 'em all! Orbiting familiar that blocks enemy shots and deals damage to enemies. If collected while already having one, it makes the familiar evolve. Only drops from Horsemen. Similar to Ball of Bandages.
Cupid's Arrow 48   Piercing shots Grants Isaac piercing tears that travel through enemies (but not obstacles) instead of breaking on impact with them.
Cursed Eye 316   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's love Daddy Long Legs' shadow follows Isaac and stomps on enemies.
Dark Bum 278   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   Fear shot Increases damage by 1 and adds a chance to shoot fear tears.
Dead Bird 117   Protective buddy Spawns a flying familiar for the current room that chases enemies whenever Isaac takes damage.
Dead Cat 81   9 lives Sets Isaac's Red Heart containers to 1, but gives Isaac 9 extra lives. After dying, Isaac respawns with 1 Red Heart in the last safe room.
Dead Dove 185   Flight + spectral tears Grants spectral tears and flight.
Dead Onion 336   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   Penetrative shot + damage up +1.5 damage, -0.3 tears. Tears are replaced with large piercing scythes.
Demon Baby 113   Auto-turret friend Follows Isaac and automatically fires at enemies in its reach.
Dessert 24   HP Up Grants Isaac one full Red Heart container.
Dinner 23   HP Up Adds 1 Red Heart container.
Distant Admiration 57   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.
Dr. Fetus 52   ??? Tears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired.
Dry Baby 265   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   Turdy touch Gives "Turdy Touch" effect. Enemies that touch Isaac are changed into poop.
Epic Fetus 168   On-demand air strike Isaac's tears are replaced with guided missiles, like those used by the   Doctor's Remote.
Eve's Mascara 310   Shot speed down + DMG up Doubles damage, halves tears stat, and greatly reduces shot speed.
Experimental Treatment 240   All stats up, then shuffled Randomly increases and decreases some of the character's stats.
Fanny Pack 204   It's filled with goodies! Has a chance to drop a random pickup when Isaac takes damage.
Fate 179   Flight eternal Grants flight and one Eternal Heart.
Fire Mind 257   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   Attack fly Spawns a blue attack fly that orbits a long distance from Isaac.
Gemini 318   Conjoined friend Suture becomes attached to Isaac, and does touch damage to enemies within its attacking range.
Ghost Baby 163   Spectral buddy Spawns a familiar that follows Isaac around and fires spectral tears.
Gimpy 225   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   Unbreakable After standing still and not shooting for a short time, Isaac turns invincible until he moves or shoots.
Goat Head 215   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   God tears Increases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.
Growth Hormones 70   Speed + DMG up Increases damage by 1 and speed by 0.4.
Guardian Angel 112   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   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   Eternal Life? Grants Isaac a permanent 50% chance to respawn with 1/2 of a Red Heart after death.
Guppy's Hair Ball 187   Swing it Loosely follows behind Isaac. It can be swung like a flail by rapidly spinning Isaac in a circle. Grows bigger by killing enemies.
Guppy's Tail 134   Cursed? Increases chance of finding Locked Chests and normal Chests, but reduces chance of finding pickups.
Habit 156   Item Martyr When Isaac is hit, 1 point of an item's charge is filled.
Halo of Flies 10   Projectile protection Spawns two Pretty Flies that block enemy shots and deal contact damage to enemies.
Harlequin Baby 167   Double shot buddy Spawns a familiar that follows Isaac around and fires two tears at once in a V-pattern.
Headless Baby 269   Bloody Friend Familiar that follows Isaac, leaving blood creep on the ground.
Hive Mind 248   Giant spiders and flies Increases the size of Blue Spiders and Blue Flies and doubles the amount of damage they deal.
Holy Grail 184   Flight + HP up Grants flight and one Red Heart container.
Holy Mantle 313   Holy shield Upon entering a room, grants a shield that negates the first damage taken.
Holy Water 178   Splash! Spawns a bottle familiar that breaks when Isaac takes damage, leaving a puddle of blue creep. The bottle is reformed upon entering a different room.
Hot Bombs 256   Burning blast +5 bombs Grants 5 bombs. Isaac's bombs leave behind fire that damages enemies upon contact.
Humbling Bundle 203   1+1 free 4evar! Replaces all regular red hearts, pennies, keys, and bombs with double versions worth twice as much.
Infamy 242   Damage Reduction Chance to block projectiles coming from any direction.
Infestation 148   They grow inside 1-3 Blue Flies randomly spawn every time Isaac gets hit.
Infestation 2 234   Infestation shot Spawns allied Blue Spiders from killed enemies.
Ipecac 149   Explosive shots Replaces tears with explosive and poisoning projectiles fired in an arc from the mouth.
Iron Bar 201   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   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   Damage + range up Increases Damage and Range.
Judas' Shadow 311   Sweet revenge Adds an extra life; upon death, it respawns Isaac as Black Judas with only two black hearts.
Juicy Sack 266   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   ??? 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   ??? Combined with Key Piece 1, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.
Latch Key 343   Luck up Increases Luck by 1, grants 1 Soul Heart and spawns 2 Keys.
Lazarus' Rags 332   Eternal Life? Upon dying, resurrect as Revived Lazarus with one heart container and Anemic item.
Leech 270   Blood sucker Spawns a friendly familiar leech on the ground that hunts down enemies. Isaac heals for half a heart whenever Leech kills an enemy.
Leo 302   Stompy Isaac can destroy rocks by walking into them.
Libra 304   You Feel Balanced Gives 6 coins, 6 bombs, and 6 keys and balances out all attributes.
Lil Brimstone 275   Evil Friend A Familiar that shoots a thin Brimstone beam. Must charge like Brimstone before shooting.
Lil Haunt 277   Fear him A familiar that damages enemies by chasing them as well as inducing the fear effect.
Little Baggy 252   Extra pill room Isaac can hold 2 pills at once and all cards are replaced by pills.
Little C.H.A.D. 96   Gives kisses A familiar who will drop a half red heart every 3 rooms.
Little Chubby 88   Attack Buddy A charger familiar that charges forward and deals touch damage to any enemies in its path.
Little Gish 99   Sticky friend Spawns a familiar that follows Isaac around and fires slowing tears, impeding enemies' speed.
Little Steven 100   Psychic friend Spawns a familiar that follows Isaac around and fires homing tears.
Loki's Horns 87   Cross Tears Gives a random chance for projectiles to fire in all 4 cardinal directions.
Lord of the Pit 82   Demon wings Grants flight and increases speed.
Lost Contact 213   Shielded tears Every tear has a small shield which will allow it to block one enemy projectile.
Lucky Foot 46   Luck up +1 Luck. Increases chance of winning Shell Game Beggar. (Independent of luck stat)
Lunch 22   HP Up Adds 1 heart container.
Maggy's Bow 312   HP up + you feel healthy Gives one heart container and doubles the healing provided by red hearts.
Magic 8 Ball 194   Shot speed up Increases Shot Speed, and drops a tarot card when picked up.
Magic Mushroom 12   All Stats Up! Increases most stats, enlarges Isaac, grants a heart container and restores all health.
Magic Scab 253   HP + Luck up Increases luck and HP by 1.
Magneto 53   Item snatcher Pulls pickups towards Isaac.
Match Book 344   Evil up Grants Isaac 1 Black Heart and 3 bombs. Can also give troll bombs.
MEAT! 193   DMG + HP up Adds a heart container and increases damage.
Midas' Touch 202   Golden touch Enemies that touch Isaac are temporarily frozen and turn to gold. Any enemy killed while in this state will drop coins.
Mini Mush 71   Speed + range up Increases Speed and Shot Height and decreases Isaac's size, but lowers Range.
Missing No. 258   Syntax error Randomizes all passive items and stats upon pickup and at the start of each succeeding floor.
Missing Page 2 262   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.
Mitre 173   You Feel Blessed Grants a chance of converting any red hearts pickups into soul hearts instead.
Mom's Coin Purse 195   What's all this...? Spawns 4 random pills around Isaac.
Mom's Contacts 110   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   Eye in the back of your head Allows Isaac to fire tears from the back of his head.
Mom's Eyeshadow 200   Charm tears Tears have a chance to charm enemies.
Mom's Heels 30   Range up Increases range.
Mom's Key 199   Less is now more +2 keys Spawns 2 keys. Generates additional pickups from chests.
Mom's Knife 114   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   Range up Increases range and shot height.
Mom's Perfume 228   Fear shot Adds a chance to shoot fear tears and decreases tear delay by 1.
Mom's Purse 139   More trinket room Allows Isaac to hold 1 additional trinket.
Mom's Underwear 29   Range up Increases range.
Mom's Wig 217   You feel itchy... Adds a chance to spawn blue spiders when firing tears. Restores 1 red heart.
Money = Power 109   $$$ = DMG Increases damage by 0.04 for every coin Isaac has, up to +3.96 damage at 99 coins.
Mongo Baby 322   Mongo Friend Summons a familiar that copies the tears of Isaac's other familiars.
Monstro's Lung 229   Charged attack Increases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.
Mr. Mega 106   Blast damage Gives Isaac 5 bombs, and makes all dropped bombs larger, which have an increased blast radius and increased damage.
Mutant Spider 153   Quad shot Grants quadruple shot but decreases tears.
My Reflection 5   Boomerang tears Gives Isaac's tears a boomerang effect, and increases range and shot speed.
Mysterious Liquid 317   Toxic Splash Damage Tears leave a small, short lasting pool of creep on impact or when their range is depleted.
Mystery Sack 271   ? Spawns a familiar that drops a heart, coin, bomb, or key every 5-6 rooms.
Number One 6   Tears up +1.5 tears, -17.62 range
Odd Mushroom 121   DMG up Grants an empty heart container. Increases damage, range and shot height while reducing speed.
Odd Mushroom 120   Fire rate up +1.7 tears, +0.3 speed, reduces damage.
Old Bandage 219   HP up Adds one empty heart container. Whenever Isaac takes damage there's a chance that a Red Heart may drop.
Ouija Board 115   Spectral tears Grants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them.
Pageant Boy 141   Ultimate grand supreme Spawns several coins around Isaac.
Pentagram 51   DMG up Increases damage and increases the chance for a Devil or Angel Room to appear.
PHD 75   Better pills Converts all bad pills into good pills, spawns one pill pickup and restores health. Identifies all pills upon pickup.
Piggy Bank 227   My life savings Gives 3 pennies on pick-up. Every time Isaac is damaged, he will drop one additional penny.
Pisces 309   Tears up + knock-back shots -1 Tear Delay, adds knock-back shots and increases tear size.
Placenta 218   HP up + regen Grants a full heart container, and a chance to regenerate a half-heart of health every minute of gameplay.
Polyphemus 169   Mega Tears Isaac fires huge tears that deal massive damage but fire rate is greatly decreased. If a tear kills an enemy, the tear travels on with any leftover damage.
Proptosis 261   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   Scape Goat Spawns a Mulligan Familiar that will wander the room randomly. Enemies will attack the Mulligan if it's closer.
Pyro 190   99 bombs Adds 99 bombs.
Pyromaniac 223   It hurts so good +5 Bombs Isaac heals 1 heart instead of taking damage from an explosive source. Adds 5 bombs.
Rainbow Baby 174   Random buddy Spawns a familiar that follows Isaac around and fires tears with random effects.
Raw Liver 16   HP up Grants 2 Heart Containers and completely restores health.
Robo-Baby 95   Friends 'till the bbbbzzzt Follows Isaac around, shooting enemies with an eye laser similar to Technology.
Robo-Baby 2.0 267   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   Speed and range up Increases speed by 0.6, range by 5.25, and tear height by 0.5.
Rosary 72   Faith up Adds 3 Soul Hearts and increases the chance for The Bible to appear in any item pool.
Rotten Baby 268   Infested friend A familiar that spawns blue flies.
Rotten Meat 26   HP up Adds one heart container.
Rubber Cement 221   Bouncing tears Tears bounce off walls, enemies, and environmental objects.
Sack of Pennies 94   Gives money Isaac is followed by a small bag that drops a coin every 2 rooms.
Sacred Heart 182   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   My fate protects me A dagger orbits Isaac, dealing very high damage and blocking enemy shots.
Sad Bombs 220   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.
Safety Pin 339   Evil + range + shot speed up Increases range and shot speed, while adding 1 Black Heart.
Sagittarius 306   Penetrative shot + speed up Increases speed by +0.2 and grants piercing tears.
Samson's Chains 321   The ol' ball and chain Spawns a ball and chain familiar Isaac pulls behind him that damages enemies, blocks shots, and destroys rocks.
Scapular 142   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   Poison tears Grants poison tears, which deal damage over time when inflicted.
Screw 255   Tears and shot speed up. +0.5 tears up, +0.2 shot speed up.
Sharp Plug 205   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   She loves you Wanders about the room, occasionally spawning Blue Spiders.
Sister Maggy 67   Friends 'till the end A familiar that follows Isaac around shooting blood tears.
Skatole 9   Fly love Flies become harmless or less dangerous depending on the type.
Skeleton Key 17   99 keys Gives Isaac 99 keys.
Smart Fly 264   Revenge fly After Isaac takes damage, this fly will do 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   All stats up Increases all stats.
Soy Milk 330   DMG Down + Tears Way Up Tears shrink and do much less damage, but fire in very rapid succession.
Speed Ball 143   Speed + shot speed up Increases speed by 0.3 and shot speed by 20%.
Spelunker Hat 91   See-through doors Reveals type of adjacent rooms, including location for secret rooms and super secret rooms.
Spider Baby 211   Spider revenge When hit, spawns up to 2 Blue Spiders.
Spider Bite 89   Slow effect Adds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them.
Spirit of the Night 159   Scary Grants spectral tears and flight.
Spoon Bender 3   Homing shots Grants Isaac homing tears.
Squeezy 196   Tears up Increases tears by 0.4, and spawns 2 Soul Hearts pickups.
Starter Deck 251   Extra card room Isaac can hold 2 cards at once and all pills are replaced by cards.
Steam Sale 64   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   HP up Adds one filled heart container and increases Shot Speed.
Steven 50   DMG up Increases Damage by 1.
Stigmata 138   DMG + HP up Increases damage, and adds 1 heart container.
Stop Watch 232   Let's slow this down a bit   Automatically inflicts slow to all enemies in every room.
  Upon taking damage, inflicts slow to all enemies for the current room.
Strange Attractor 315   Magnetic tears Pickups, trinkets, and monsters are magnetically attracted to Isaac's tears.
Super Bandage 92   +2 hearts Grants one Heart Container and gives 2 Soul Hearts.
Synthoil 345   DMG up + range Increases damage by 1, range by 5.25, and tear height by 0.5.
Taurus 299   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   It's still being tested... Isaac occasionally fires an unlimited range piercing laser alongside his normal tears. The laser can glitch, mimicking the effects of certain items and trinkets.
Technology 68   Laser tears Replaces tears with a piercing laser with unlimited range.
Technology 2 152   Laser Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously.
The Battery 63   Stores energy Activated collectibles can be "overcharged" to allow for an additional use.
The Belt 28   Speed up Increases speed by 0.3.
The Black Bean 180   Toot on touch When taking damage, Isaac farts, causing poison damage to all enemies in range.
The Body 334   I feel all Adds 3 Heart Containers.
The Common Cold 103   Poison Damage Adds a chance to shoot poison tears, dealing damage over time when inflicted.
The Compass 21   The end is near Reveals all special rooms (except secret rooms of any kind).
The Halo 101   All stats up Grants one Heart Container, +0.3 Damage, +0.2 Tears, +0.25 Range, +0.3 Speed, and +0.5 Tear Height.
The Inner Eye 2   Triple shot Grants triple shot but decreases tears.
The Ladder 60   Building bridges Allows Isaac to walk across gaps one square across by automatically placing a ladder between the two walkable sections.
The Ludovico Technique 329   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.
The Mark 79   DMG up Increases Damage and Speed, plus adds one Soul Heart.
The Mind 333   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.
The Mulligan 151   They grow inside Tears have a 1/6 chance of spawning allied blue flies when they hit an enemy.
The Negative 328   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 Pact 80   DMG + Tears UP Increases damage by 0.5, tears by 0.7 and grants two soul hearts upon pickup.
The Parasite 104   Split Shot Isaac's tears split in two when they hit something.
The Peeper 155   Plop! Spawns a familiar that floats slowly around the room on a zig-zag pattern similar to Boom Flies damaging enemies it passes through.
The Polaroid 327   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.
The Relic 98   Soul generator Isaac is followed by a small blue cross that will drop a Soul Heart every 5-6 rooms.
The Sad Onion 1   Tears up Increases Tears by 0.7.
The Small Rock 90   DMG up Increases damage by 1, increases tears by 0.2, and decreases speed by 0.1.
The Soul 335   I am all Grants two soul hearts. Isaac gains a pulsing aura that repels enemies and projectiles.
The Virus 13   Poison touch Inflicts poison to enemies who make contact with Isaac. Speed down.  Poisoned enemies have a chance to drop a black heart when killed.
The Wafer 108   Damage resistance All sources of damage that would cause more than one-half heart of damage are reduced to one-half heart instead.
There's Options 249   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   HP up + speed down + you feel stompy Destroys rocks upon contact with Isaac. Adds one heart container and lowers Speed.
Tiny Planet 233   Orbiting tears + range up Range up and makes shot tears revolve around Isaac until they drop.
Toothpicks 183   Tears + shot speed up +0.7 tears, +16% shot speed.
Torn Photo 341   Tears + shot speed up Tears + Shot speed up.
Tough Love 150   Tooth shot Adds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears.
Transcendence 20   We all float down here... Grants flight.
Treasure Map 54   Full visible map Reveals all rooms for every floor. However, it does not reveal icons or secret rooms.
Trinity Shield 243   "You feel guarded" Isaac gains a shield that protects him from enemy shots.
Virgo 303   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".
Whore of Babylon 122   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   Tears up Increases Tears by 0.7.
Wooden Spoon 27   Speed up Increases speed by 0.3.
X-Ray Vision 76   I've seen everything Reveals and opens all Secret Room and Super Secret Room entrances.
  8 Inch Nails 359   Stick it to 'em! +1.5 Damage Up. Replaces Isaac's tears with nails, which have increased knockback.
  Athame 408   Call to the void Whenever Isaac takes damage, a black ring briefly appears around Isaac, dealing damage to all nearby enemies.
  Betrayal 391   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.
  Binky 438   Memories... Tears up, adds 1 Soul Heart, and decreases Isaac's size.
  Black Powder 420   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.
  Bomber Boy 353   Explosive blast! +5 bombs. Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide). This also affects player-spawned Troll Bombs.
  Bumbo 385   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, doing contact damage.
  Bursting Sack 377   Spider love Spider enemies no longer target or deal contact damage to Isaac.
  Cambion Conception 412   Feed them hate After taking damage a certain amount of times, a permanent demonic familiar spawns.
  Car Battery 356   Double charge! Causes Isaac's activated item to activate twice on each use.
  Censer 387   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.
  Chaos 402   !!! Chaos causes items to be chosen from random item pools. When picked up, drops between 1-6 random pickups on the floor.
  Charged Baby 372   Bbbzzzzzt! A battery familiar that occasionally drops a Lil' Battery, gives an active item charge, or freezes all enemies in the room.
  Circle of Protection 423   Protect me from myself Surrounds Isaac with a large white halo. Once per second, the halo deals Isaac's tear damage to enemies inside it. It may also convert enemy shots entering the halo into friendly purple homing tears.
  Continuum 369   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.
  Crack Jacks 354   Don't swallow the prize! Adds one Red Heart container and drops a random trinket.
  Crown of Light 415   The untainted gain power +2 soul hearts. While Isaac has no damaged red heart containers, grants diamond tears that deal double damage and have increased range and reduced shot speed. Regardless of health, the crown will deactivate for the current room when Isaac takes damage.
  Curse of the Tower 371   You feel cursed... Causes Isaac to spawn 6 Troll Bombs on the floor every time he gets hit, similar to the   Anarchist Cookbook mechanic.
  Dead Eye 373   Accuracy brings power! Isaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.
  Deep Pockets 416   More stuff to carry! Allows Isaac to carry two cards or pills (or a combination of both) at the same time.
  Eden's Blessing 381   Your future shines brighter +0.7 tears up. Grants a random item at the start of the next run.
  Empty Vessel 409   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.
  Epiphora 368   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.
  Evil Eye 410   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.
  Explosivo 401   Sticky bomb shot! Isaac's tears have a chance to stick to enemies and explode.
  Farting Baby 404   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 knockback, poison, or charm all nearby enemies.
  Fate's Reward 361   Your fate beside you A blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.
  Friend Zone 364   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.
  Fruit Cake 418   Rainbow effects! Isaac's tears gain a random effect that changes every shot.
  GB Bug 405   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.
  Glitter Bombs 432   Prize bombs! Gives Isaac 5 bombs, and makes Isaac's bombs have a chance to drop random pickups or charm enemies when they explode.
  God's Flesh 398   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.
  Head of the Keeper 429   Penny tears! Isaac's tears become coins and now have a chance to drop Pennies on the floor upon successfully hitting an enemy.
  Holy Light 374   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.
  Host Hat 375   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.
  Immaculate Conception 413   Feed them love Upon picking up a certain amount of health, spawn a permanent angelic familiar.
  Incubus 360   Dark friend A demonic familiar that follows Isaac and shoots tears identical to Isaac's in terms of damage, range, fire rate, and effects.
  Key Bum 388   He wants your keys! Spawns a portable key master that follows Isaac and collects keys, giving random chests in return.
  Kidney Stone 440   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.
  Lil Chest 362   What's in the box? Spawns a chest familiar that follows Isaac and drops a random pickup every few rooms.
  Lil Gurdy 384   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.
  Lil' Loki 435   4-way buddy! A Loki familiar that follows Isaac and shoots 4 tears in a cross pattern.
  Lost Fly 365   Lost protector A familiar fly that moves in a straight line and attaches itself to the first obstacle or wall it comes into contact within each room. If any enemies walk into its path, it will do 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 traveling until it meets another wall or obstacle.
  Lusty Blood 411   Their blood brings rage! Each time Isaac kills an enemy, Isaac's damage increases for the current room.
  Marked 394   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. It can be overridden by other tear modifiers such as Mom's Knife or Brimstone.
  Maw of the Void 399   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.
  Milk! 436   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.
  Mom's Pearls 355   Range + luck up +1.25 Range Up. +0.5 Tear Height. +1 Luck Up.
  More Options 414   There are even more options! Two items spawn in every Treasure Room. Only one can be taken; the other will disappear.
  Mr. Dolly 370   Range + tears up Tears and Range up. Spawns 3 random types of hearts on the floor when picked up.
  Multidimensional Baby 431   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.
  My Shadow 433   Me! And my shaaaadow! Each time Isaac takes damage, inflicts fear on all enemies in the room and spawns a black friendly Charger that will attack enemies. The Charger will be killed if it is damaged too much.
  Night Light 425   Scared of the dark? A cone of light shines in the direction Isaac is moving that slows enemies and enemy shots.
  No. 2 378   Uh oh... Continuously firing tears for several seconds causes Isaac to drop a Butt Bomb. Butt Bombs explode for 60 damage like normal bombs, but also deal 10 damage to all enemies in the room and daze them for a short period of time.
  Obsessed Fan 426   Follows my every move... A purple fly familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.
  Papa Fly 430   Turret follower A blue fly familiar follows Isaac's movements on a 3 second delay. Papa Fly will fire tears at nearby enemies.
  Pay to Play 380   Money talks +5 coins. Turns all doors that require a single key into doors which need a coin to enter instead. This affects shops, item rooms and libraries.
  PJs 428   You feel cozy Grants four soul hearts and fully restores Isaac's red health.
  Pupula Duplex 379   Wide shot Gives Isaac spectral tears and gives his tears a wide arc shape, increasing their size.
  Purity 407   Aura stat boost Boosts one of Isaac's stats depending on the color of the aura around him. The aura disappears upon taking damage and reappears with a random color upon entering a new room. Red boosts damage, blue boosts tears, yellow boosts speed, and orange boosts range.
  Restock 376   Never ending stores! Causes shops to instantly restock their items when they are bought. Granted by default for every character in Greed Mode.
  Rune Bag 389   Rune generator A bag that follows Isaac and drops a random rune every 5-6 rooms.
  Sack Head 424   More sacks! 1/3 of all pickups not spawned by sacks become sacks.
  Scatter Bombs 366   We put bombs in your bombs! Adds 5 bombs. Isaac's bombs explode into 2-4 tiny bombs.
  Seraphim 390   Sworn friend An angel familiar which follows Isaac and fires homing tears which deal 10 damage and have -25% shot speed.
  Serpent's Kiss 393   The kiss of death Tears have a random chance to apply a poison effect to enemies. Isaac now deals poison damage on contact. Enemies that were poisoned have a chance to drop a black heart when killed.
  Spear of Destiny 400   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.
  Spider Mod 403   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.
  Sticky Bombs 367   Egg sack bombs! +5 bombs. Bombs stick to enemies and spawn 2-4 Blue Spiders if they kill an enemy.
  Succubus 417   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.
  Sworn Protector 363   Protective friend An orbital angel which does 7 contact damage per tick and attracts and blocks enemy shots. Upon blocking 10 shots in a room it drops an Eternal Heart.
  Tech X 395   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.
  The Wiz 358   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.
  Toxic Shock 350   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.
  Tractor Beam 397   Control your tears Increases tears, range, and shot speed. Isaac emits a beam from his face that his tears follow along.
  Zodiac 392   The heavens will change you Gives Isaac a random zodiac item effect that changes every floor.
  7 Seals 526   Lil harbingers! Grants a random Harbinger familiar that changes every 10 seconds. Harbingers have different behaviors and spawn themed Locusts.
  Acid Baby 491   Pills pills pills! Spawns a familiar that drops random pills every 3 rooms cleared. Upon using a pill, all enemies in the room are poisoned.
  Adrenaline 493   Panic = power Increases damage based on how many empty Red Heart containers Isaac has.
  Analog Stick 465   360 tears! +0.3 tears up. Allows Isaac to fire tears diagonally.
  Angelic Prism 528   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.
  Angry Fly 511   He's violent Spawns a fly familiar that orbits around a random enemy and deals 5 damage per tick to enemies it comes in contact with.
  Apple! 443   Trick or treat? Increases tears. Adds a chance to fire a high-damage razor blade.
  Backstabber 506   Watch your back! Isaac's tears deal double damage and inflict bleeding on enemies if they're facing away from Isaac.
  Belly Button 458   What's in there? Drops a random trinket. Grants a second trinket slot.
  Big Chubby 473   Chub chub Spawns a fat charger familiar that slowly charges forward, blocking shots and damaging enemies in its path.
  Blanket 535   You feel Safe Grants one Soul Heart. Upon entering a boss room, grants a shield that blocks one hit, then disappears.
  Bloodshot Eye 509   Bloody friend Spawns an orbiting eye familiar that deals contact damage and fires tears every 2 seconds.
  Bozo 513   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.
  Brittle Bones 549   Everything hurts Replaces all Red Hearts with 6 empty Bone Hearts. Upon losing a Bone Heart, Isaac fires bones in 8 directions and permanently gains a tears up.
  Broken Modem 514   Lag! Enemies, enemy shots, tears, and pickups will briefly freeze in place at random intervals.
  Broken Shovel 551   It feels cursed One of two parts necessary to create Mom's Shovel.
  Buddy in a Box 518   What could it be?! Grants a familiar with a random tear effect. The familiar is randomized at the start of each floor.
  Camo Undies 497   Camo kid Isaac becomes camouflaged at the beginning of each room. Until he shoots, all non-boss enemies will be confused.
  Compound Fracture 453   Bone tears! Increases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
  Cone Head 457   Hard headed! Grants a Soul Heart. Gives Isaac a chance to ignore any damage taken.
  Contagion 466   Outbreak! The first enemy killed in a room explodes and poisons nearby enemies. Poisoned enemies will also explode upon death.
  Dad's Lost Coin 455   I remember this... Increases range by 1.5. Drops a Lucky Penny.
  Dad's Ring 546   Father's blessing Creates a ring of light around Isaac that petrifies enemies in contact.
  Dark Prince's Crown 442   Loss is power Increases range, tears, and shot speed when at exactly one red heart.
  Dead Tooth 446   Halitosis While firing, Isaac gains a green aura that poisons nearby enemies.
  Death's List 530   Just hope you're not next... Grants a reward if all enemies in a room are killed in the order they are marked.
  Depression 469   :( 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.
  Divorce Papers 547   Tears up + you feel empty Spawns a Mysterious Paper, increases tears, and grants a bone heart.
  Dog Tooth 445   Bark at the moon! +0.3 damage and +0.1 speed. When Isaac enters a room, a howling sound can be heard if there's a connected secret room, and a barking sound can be heard if there's a crawl space under a rock.
  Duality 498   You feel very balanced Whenever a Devil or Angel Room would spawn after defeating a boss, both rooms spawn. Only one can be entered.
  Eucharist 499   Peace be with you An Angel Room door will always spawn after every boss fight, excluding the first floor and floors after   The Womb II/  Utero II.
  Euthanasia 496   Needle shot Adds a chance to fire needles that instantly kill basic enemies and deal triple damage to bosses. If a needle kills an enemy, it bursts into more tears/needles.
  Eye of Belial 462   Possessed tears! Grants piercing tears. After piercing one enemy, tears start homing and deal double damage.
  Eye of Greed 450   Gold tears! Every 20 tears, Isaac loses 1 penny and shoots an additional gold tear that freezes enemies and turns them into gold. Any enemy killed while in this state will drop coins.
  Fast Bombs 517   Rapid bomb drops Grants 7 bombs and allows bombs to be placed rapidly.
  Finger! 467   Watch where you point that! Spawns a finger familiar that points at enemies, dealing constant damage.
  Flat Stone 540   Skipping tears Tears bounce off the floor, creating splashes. Splashes deal 25% of Isaac's tear damage to all enemies in a small area.
  Ghost Pepper 495   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.
  Glaucoma 460   Blind tears! Adds a chance to shoot tears that confuse enemies for an extremely long time.
  Glyph of Balance 464   A gift from above Grants 2 Soul Hearts and modifies drops from Champion monsters based on certain conditions.
  Greed's Gullet 501   Money = health! Grants a Red Heart container for every 25 coins Isaac has.
  Haemolacria 531   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.
  Hallowed Ground 543   Portable sanctuary Spawns a white poop familiar, which turns into a white poop when Isaac is hurt. White poop has an aura that halves tear delay and can block enemy shots.
  Hushy 470   Lil hush! Spawns a Hush familiar that bounces around the room and deals contact damage. While firing tears, it stops moving.
  Jacob's Ladder 494   Electric tears Tears fire sparks of electricity in random directions upon hitting an obstacle or enemy.
  Jaw Bone 548   Fetch! Spawns a familiar that flies the room while firing, dealing a flat 7 damage to enemies that come in contact and retrieving pickups.
  Jumper Cables 520   Bloody recharge Grants an active item charge every 15 enemies killed.
  King Baby 472   Lord of the dead! Spawns a familiar that follows Isaac and makes other familiars follow it. While firing tears, it stops moving.
  Lachryphagy 532   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.
  Large Zit 502   Creep shots Adds a chance to fire a creep shot that deals double damage and leaves a trail of slowing white creep.
  Lead Pencil 444   He's a bleeder! After every 15 tears fired, Isaac will fire a high-damage cluster of tears.
  Leprosy 525   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.
  Lil Delirium 519   Delirious friend Grants a familiar that transforms into another random familiar every 10 seconds.
  Lil Monstro 471   Ain't he cute? Spawns a familiar that fires clusters of tears. Must be charged before shooting.
  Lil Spewer 537   Puking buddy Spawns a random pill, and grants a small Spewer familiar that charges up and fires creep. Using pills changes the creep type.
  Linger Bean 447   Crying makes me toot Constantly shooting causes Isaac to release gas clouds that can be pushed by his tears and damage nearby enemies.
  Little Horn 503   Science! Adds a chance to fire a piercing tear that instantly kills any enemy that it touches.
  Marbles 538   Choking hazard Spawns 3 random trinkets. Taking damage has a small chance to swallow Isaac's currently held trinket, gaining its effect permanently.
  Marrow 541   HP up? Grants one bone heart and spawns three red heart pickups.
  Metal Plate 449   It itches... Grants one soul heart. Enemy shots have a chance to be reflected at the shooter as confusing tears.
  Moldy Bread 456   Midnight snack! Grants one full red heart container.
  Mom's Razor 508   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.
  Mystery Egg 539   Sacrificial insemination Spawns an egg familiar, which cracks and turns into a random friendly enemy when Isaac is hurt. The egg regenerates upon entering a different room.
  Parasitoid 461   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.
  Pointy Rib 544   Stabbing time Spawns a bone familiar that can be aimed with the fire buttons and does contact damage.
  Poke Go 505   Gotta catch em... Upon entering a room with enemies in it, has a chance to spawn a random friendly enemy that persists across rooms.
  Polydactyly 454   Hold me! Allows Isaac to carry two cards, pills, or any combination of both at the same time. Drops a random card or pill.
  Pop! 529   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.
  Sack of Sacks 500   Gives sacks Spawns a sack familiar that drops a sack every 5-6 rooms cleared.
  Schoolbag 534   Extra active item room Allows Isaac to hold two active items.
  Shade 468   It follows Spawns a shadow familiar that follows Isaac's movements on a 1 second delay and deals contact damage to enemies. After dealing enough damage, it is absorbed by Isaac and spawns friendly Chargers.
  Shard of Glass 448   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.
  Sinus Infection 459   Booger tears! Adds a chance to fire a booger that sticks to enemies and deals damage over time.
  Slipped Rib 542   Projectile shield Spawns a bone familiar that circles around Isaac and reflects enemy shots.
  Sulfuric Acid 463   Acid tears! +0.3 damage. Adds a chance to fire acidic tears which can destroy obstacles.
  Tarot Cloth 451   I see the future Drops a random card or rune. Doubles the effects of cards and runes.
  Technology Zero 524   Static tears! Connects Isaac's tears with electricity that can damage enemies.
  Tonsil 474   Gross... Grants a familiar that can block enemy shots.
  Trisagion 533   Smite thy enemy Damage down. Tears are replaced with piercing white blasts of light that can damage the same enemy multiple times.
  Varicose Veins 452   I'm leaking... Taking damage releases a ring of 10 high damage tears.
  YO LISTEN! 492   Yo listen! +1 luck. Spawns a fairy familiar that points out secret room entrances and tinted rocks.

Trivia

  •   Wiggle Worm was an item in the original The Binding of Isaac; however, in Rebirth, it was changed into a trinket.
    •   The Polaroid was a trinket in the original The Binding of Isaac, but it was changed into an item. Interestingly, these changes keep the count of items and trinkets from the original game the same.
  •   Afterbirth+'s original item count was 89. The Booster Packs added 42 items.


  The Binding of Isaac: Rebirth  
  Achievements   Attributes   Bosses   Cards and Runes   Challenges   Chapters
  Characters   Co-op   Items   Item pools   Monsters   Objects
  Pickups   Pills   Rooms   Seeds   Transformations   Trinkets