- +0.2 Speed up.
- Grants piercing tears.
- 8 Inch Nails+1.5 Damage Up. Replaces Isaac's tears with nails, which have increased knockback.: Overridden by Sagittarius.
- BlisterIncreases knockback of tears.: Overridden by Sagittarius.
- Cricket's HeadIncreases damage by 0.5, and multiplies it by 1.5x.: Overridden by Sagittarius.
- Flat WormIsaac's tears take on an oblong appearance. They also push enemies back.: Overridden by Sagittarius.
- Pisces-1 Tear Delay, adds knock-back shots and increases tear size.: Overridden by Sagittarius.
- Mysterious LiquidTears leave a small, short lasting pool of creep on impact or when their range is depleted.: Overridden by Sagittarius.
- Death's TouchIncreases Damage by 1.5, reduces Tears by 0.3 and increases tear size. Grants piercing tears. Tears are replaced by Death's scythes, which is a cosmetic effect only.: Death's scythes are replaced by Normal Tears, but retains the damage.
9NV4 7BBH (Treasure room adjacent to spawn)
2GRP SX84 (Treasure room adjacent to spawn)
73LS WMGB (First floor treasure room)
- Aries+0.25 Speed. Running into enemies while at a high speed will deal 18 points of damage. Does not prevent contact damage.
- TaurusSpeed down; gains speed while in a room with enemies until gaining My Little Unicorn effect for a few seconds.
- GeminiSuture becomes attached to Isaac, and does touch damage to enemies within its attacking range.
- CancerAdds 3 soul hearts. Grants The Wafer effect for the current room upon taking damage.
- LeoAllows you to crush rocks when you walk over them.
- VirgoGrants 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".
- LibraGives 6 coins, 6 bombs, and 6 keys and balances out all attributes.
- ScorpioGrants poison tears, which deal damage over time when inflicted.
- SagittariusIncreases speed by +0.2 and grants piercing tears.
- CapricornAll stats up.
- AquariusA trail of blue creep is left behind Isaac, which damages enemies.
- Pisces-1 Tear Delay, adds knock-back shots and increases tear size.
- ZodiacZodiac will give Isaac a random zodiac item effect that changes after every floor.