At the start of each run, an effect is randomly assigned to each color of pill. The pill effect for that color will remain constant throughout the run. (However, it is possible for PHD or Virgo to reassign some of the effects, such that 2 different colored pills will have the same effect.) The set of pill effects for any given run is usually known as the pill pool.
- The pill pool for each run has increased from 9 to 13.
Pill Effects[edit | edit source]
Isaac farts, poisoning enemies around him.
Injures Isaac by a full heart. If a Bad Trip pill is used while Isaac only has a single heart left or less, the pill will turn into a Full Health pill instead. (This damage counts as red heart damage for the purposes of getting a Devil Deal.)
|2||Balls of Steel|
Grants Isaac two soul hearts.
|3||Bombs Are Key|
Swaps the values of Isaac's bombs and keys.
Spawns five active bombs behind Isaac over a period of five seconds, at one a second.
Restores all health.
Removes one red heart container upon use. While Isaac has one or fewer red heart containers, it will act as a Health Up pill instead.
Adds one empty red heart container upon use.
|8||I Found Pills|
Changes the appearance of Isaac's face. This pill is cosmetic only, and the effect disappears when you leave the room.
Causes Isaac to grow four hairs from the top of his head and zits on his face. This pill is cosmetic only, and will stay for the rest of the run.
Grants 1 fly orbital that circles the player, blocking projectiles and damaging fly-type enemies on touch.
Decreases Isaac's range by 2.
Increases Isaac's range by 2.5.
Decreases Isaac's movement speed by 0.12.
Increases Isaac's movement speed by 0.15.
Decreases Isaac's tears by 0.28.
Increases Isaac's tears by 0.35.
Decreases Isaac's luck by 1.
Increases Isaac's luck by 1.
|20||48 Hour Energy|
Empties all but one red heart container and spawns 1-4 full red heart pickups. If Isaac only has half of a heart left, it will heal him to one heart. If used without any red heart containers, no health will be deducted, but red hearts will still spawn. If used in a Black Heart or Eternal Heart-containing Super Secret Room, it will spawn those types of hearts instead.
Prevents Isaac from moving for a short duration.
|23||I can see forever!|
Charms all enemies in the room for a short period of time.
Replaces the floor map with a ? for the rest of the floor. If no other curses are active for the floor, the Curse of the Lost will appear under the level name when the map key is held. This effect cannot be negated by Black Candle. Also the only pill to have its flavour text appear on a piece of paper, like curses do.
Spawns a large yellow pool (similar to Lemon Mishap) around your character. Greatly damages any enemy that steps on it, for 22 damage per tick or 66 damage per second.
|27||R U a Wizard?|
Tears are shot diagonally outwards for about one minute. This effect does not reset upon exiting the room.
Makes Isaac take a full heart of damage from all sources for the current room. Unlocked by completing Challenge #24: PAY TO PLAY.
For a short time, poop spawns wherever Isaac moves, like Explosive Diarrhea but with poop. A higher move speed means you can touch more tiles in the same time. A pun on laxatives. Unlocked by completing Challenge #25: Have a Heart.
Gives the Curse of the Maze effect for the remainder of the floor. The effect can stack with other curses. If no other curses are active for the floor, Curse of the Maze will appear under the level name when TAB is held. This effect cannot be negated by Black Candle. Unlocked by completing Challenge #25: Have a Heart.
|32||One makes you larger|
Increases Isaac's size and decreases the pitch of his voice. This effect does not increase the size of Isaac's hitbox. These pills contribute to the Stompy transformation.
|33||One makes you small|
Decreases Isaac's size and increases the pitch of his voice. This effect decreases the size of Isaac's hitbox.
Destroys all poop in the room and spawns a single Blue Spider under Isaac and on each destroyed poop.
Spawns Blue Spiders equal to the number of enemies in the room. If there are no enemies in the room, spawns 1-3 Blue Spiders.
Activates an effect similar to The Gamekid.
Briefly pixelates the screen 3 times over 30 seconds.
|38||Friends Till The End!|
Spawns three Blue Flies.
Creates a pool of slippery brown creep underneath Isaac.
|40||Something's wrong...|| |
Creates a pool of black creep beneath Isaac.
Upon use, slows all enemies for the duration of the room.
|42||I'm Excited!!!|| |
Upon use, increases the speed of all enemies for the duration of the room. The effect triggers again 30 seconds after use and 60 seconds after use.
Upon use, any trinkets that the player is holding are destroyed, and their effects are permanently applied to the player.
|45||Feels like I'm walking on sunshine!|
Throws up the last pill you used. Will spawn itself if no other pills were taken beforehand.
Pill Appearances[edit | edit source]
Notes[edit | edit source]
- Among the attribute modifying pill effects, only five of the seven visible attributes are covered: health, range, tears, speed, and luck. Both shot speed and damage can't be altered by pills.
- Pill effects have a chance to be narrated upon use, as do cards and runes.
- Currently, the "Retro Vision" pill effect can crash the game on some machines, resulting in restarting the current floor when the game is continued.
- The "Addicted!" pill will have no effect if Isaac has The Wafer.
- Despite this, if one takes both the "Addicted!" pill with "Percs!" in the same room, Isaac will take a full heart of damage from all sources.
- Having Midas' Touch and using a "Re-Lax" pill has a chance to spawn golden poop.
- Having Meconium and using a "Re-Lax" pill has a chance to spawn black poop.
- Using an "Infested!" pill on red poop will spawn blue spiders and the red poop will regenerate.
- Using a "Gulp!" pill while holding two trinkets (with Belly Button, Mom's Purse, etc.) will cause both trinkets to be absorbed.
Strategy[edit | edit source]
- Use of unidentified pills is recommended for outside of combat as Hematemesis, R U a Wizard, Paralysis, Addicted!, and I'm Excited!!! can be detrimental mid-fight. However, I'm Drowsy..., Percs, Lemon Party, Bad Gas, and Pheromones are nearly useless outside of combat.
- The invincibility effect from Power Pill and Feels like I'm walking on sunshine! can be utilized to get into Curse Rooms or play Blood Donation machines without taking any damage.
Unlockable achievements[edit | edit source]
- Huge Growth - Increase in size 5 times in a single run. Sources of increased size include "One Makes you Larger" pills, XI - Strength, and Magic Mushroom.
- Marbles - Use 5 Gulp! pills in one run.
Trivia[edit | edit source]
- Hematemesis is the vomiting of blood.
- Lemon Party is an internet shock site featuring a group of elderly men performing oral sex.
- The Vurp! pill is a portmanteau of the words vomit and burp.
- Power Pills activating the Gamekid effect is a reference to Pacman in which the "Super-Pac" powerup is obtained by eating a Power Pellet.
- I Found Pills (and Ate Them), R U a Wizard?, and I can see Forever are all image macro memes.
- Despite being called I Can See Forever, the effects only last for the rest of that floor.
- The Feels like I'm walking on sunshine! pill is a reference to the 80s song Walking on Sunshine.
- Balls of Steel is a reference to Duke Nukem; it is one of Duke's more famous quotes.
- Explosive Diarrhea is extremely loud and forceful diarrhea. In the original game, the message that displayed when the pill was activated was "Oh No!"
- Even though it plays a negative "buzzer" sound effect when used, Explosive Diarrhea could potentially be useful. The same goes for Puberty, which is completely neutral and has a positive effect in Afterbirth+.
- In the original game, Wrath of the Lamb, there was another positive pill effect called "Friends Til The End", which summoned 3 blue attack flies. This effect was improved and given to the Rune Berkano in Rebirth.
- The pill effect was re-added.
- Note that the "Infested?" and "Infested!" pill effects are similar to the original "Friends Til The End" effect, but instead of spawning three flies, a variable number of spiders spawn.
- The Friends Till The End! pill is the only non-narrated pill.
- The Friends till the End! pill now has narration.
- 48 Hour Energy is a reference to the drink 5 Hour Energy.
- "One makes you larger" and "One makes you small" are references to Alice in Wonderland, and the specific wording is a reference to the song White Rabbit by Jefferson Airplane.
- "Percs" is a reference to a street name for the prescription drug Percocet, which is more generically known as Oxycodone. This drug is meant to be used to treat pain, but often abused for recreational purposes.
- It may also be be a play on the word "perk".
- The "Re-Lax" and "X-Lax" pill effects are references to laxatives.
- The "???" is the only pill which has 3 different narrated voice lines.
- The "Amnesia" pill is a reference to amnesia, the loss of memory.
- The "Bad Gas" pill is a reference to farts.
- The "Paralysis" pill is a reference to paralysis, the loss of muscle function for one or more muscles.
- The "Pretty Fly" pill is a reference to the phrase "pretty fly".
- The "Pheromones" pill is a reference to pheromones, chemicals that trigger social responses in members of the same species.
- The "Puberty" pill is a reference to puberty, a process of physical change as a child's body matures into an adult body.
Voiceovers[edit | edit source]
|48 Hour Energy|
|Balls of Steel|
|Bombs Are Key|
|Feels like I'm walking on sunshine!|
|Friends Till the End!|
|I Can See Forever|
|I Found Pills|
|One Makes You Larger|
|One Makes You Small|
|R U a Wizard?|
|Achievements||Attributes||Bosses||Cards and Runes||Challenges||Chapters|