Special Item

Special items are items in the game that are considered stronger than normal by the developers. If the player sees a special item, even if the player has Curse of the Blind, subsequent special items have a chance of being re-rolled rather than being presented to Isaac, decreasing the likelihood of obtaining multiple special items on one run.

The list of special items is as follows:

• BrimstoneTears 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.
• D100Upon 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.
• The D6Allows Isaac to re-roll collectible items in the current room into other items, depending on the current room's Item Pool.
• Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.
• Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.
• GodheadIncreases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.
• Lil BrimstoneA Familiar that shoots a thin Brimstone beam. Must charge like Brimstone before shooting.
• The Ludovico TechniqueInstead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.
• Mom's KnifeIsaac'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.
• Mutant SpiderGrants quadruple shot but decreases tears.
• PolyphemusMakes Isaac shoot one huge tear. Also reduces Tears to minimum. Damage increased . If tear does more damage than an enemy's life, the tear continues to travel with the extra remaining damage.
• PyromaniacIsaac heals 1 heart instead of taking damage from an explosive source. Adds 5 bombs.
• Sacred HeartIncreases damage and range while reducing shot speed and grants homing tears. Grants a Heart Container and replenishes all Red Hearts.
• Soy MilkTears shrink and do much less damage, but fire in very rapid succession.
• Stop Watch Automatically inflicts slow to all enemies in every room.
  Upon taking damage, inflicts slow to all enemies for the current room.

Special Item Generation

When Isaac enters a room with an item in it, items are selected out of certain item pools depending upon the current room. Special items have a chance of being re-rolled depending on how many special items have been seen during the run:

Number of Special Items Seen	Re-roll Chance
0	0%
1	50%
2	90%
3	98%
4 or more	99%

Notes

• Isaac's The D6Allows Isaac to re-roll collectible items in the current room into other items, depending on the current room's Item Pool. doesn't count as a "seen" special item, as it is directly given to him when the run starts.
• Special items given by the D4Rerolls all of Isaac's items., the D100Upon 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., 1-pip Dice Rooms, and 6-pip Dice Rooms count as "seen" special items.
• Due to the nature of special items, it can sometimes require hundreds of The D6Allows Isaac to re-roll collectible items in the current room into other items, depending on the current room's Item Pool. rolls for special items that are not in the Treasure Room pool to appear. (Note that with infinite rolls, it is always possible to see a special item as long as it is not already removed from the pools.)