Items

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. Afterbirth added 95 new items, for a total of 436 items. 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 Delirium as a random friendly boss that fights for Isaac.
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	Isaac fires two tears at once, one from each eye.
3 Dollar Bill	191		Rainbow tears	Gives Isaac a random tear effect every room. Gives Isaac a random tear effect every few 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	Increases health, damage, speed, and range, lowers tear delay, and gives one coin, bomb, and key.
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 flies.
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. The Bible will 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	Adds a chance to give a shield that nullifies all incoming damage for 10 seconds upon taking damage. 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. The burst of tears also includes 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!	Isaac's damage increases for the current room each time he kills an enemy.
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. Continuously firing for 2.5 seconds then releasing the fire button creates a black ring around Isaac that rapidly deals damage and can cause enemies to drop Black hearts.
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!	Coins, bombs, keys, cards, runes and batteries have a chance to 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.
• There are a total of 123 active items, with 74 in Rebirth, 19 in Afterbirth, and 30 in Afterbirth+. Of those, 101 items utilize a charge bar, with 61 items in Rebirth, 16 in Afterbirth, and 24 in Afterbirth+.
• There are a total of 424 passive items, with 267 in Rebirth, 76 in Afterbirth, and 81 in Afterbirth+.
  • From Rebirth to Afterbirth+, there has been about a 1:4 ratio of active items to passive items.
• Afterbirth+'s original item count was 89. The Booster Packs added 42 items.