The Binding of Isaac: Afterbirth/Changes

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Player[edit | edit source]

Characters[edit | edit source]

Azazel
  • His mini-brimstone's range can be increased with range up items or pills.
The Lost

Items[edit | edit source]

Activated Collectibles[edit | edit source]

Bob's Rotten Head Bob's Rotten HeadBob's Rotten Head Icon.png3 roomsUpon use, Isaac holds a poison bomb which can be thrown towards any of the four cardinal points and explodes on impact.
  • The head deals 3 times Isaac's tear damage as poison over time instead of either 6 or 8 points.
The Book of Belial The Book of BelialThe Book of Belial Icon.png3 roomsUpon use increases damage by 2 for the current room and by a further +50% if the character also has the Blood of the Martyr.
Removed in Afterbirth Guarantees a Devil Room or Angel Room will be open after beating a boss while holding it, or Added in  Afterbirth increases the chance by 12.5%.
  • Increases the chance to open the Devil Room or Angel Room by 12.5% after killing a boss while holding it instead of guaranting it.
Book of Revelations Book of RevelationsBook of Revelations Icon.png6 roomsAdds 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).
  • Increases chance for a Devil/Angel Room Door to open by 17.5% instead of 35%.
Butter Bean Butter BeanButter Bean Icon.png3 secondsIsaac farts and pushes back nearby enemies.
  • Knocks back enemy shots.
Crack the Sky Crack the SkyCrack the Sky Icon.png4 roomsSummons multiple beams of light in random locations around the room, dealing a large amount of damage to any enemy that touches them.
  • The beams have a high chance to directly target enemies.
D4 D4D4 Icon.png6 roomsRerolls all of Isaac's items.
  • Previously held items are removed from the pause menu.
The D6 The D6The D6 Icon.png6 roomsAllows Isaac to re-roll collectible items in the current room into other items, depending on the current room's Item Pool.
  • Reroll an item after defeating The Fallen no longer replace the Devil Room item he drops to a random item from the normal boss item pool.
D10 D10D10 Icon.png1 roomsRerolls the enemies in a room. Only rerolls enemies that are still alive (does not spawn new enemies).
  • Fly enemies are only rerolled into other fly enemies.
  • Red flies can't be rerolled anymore (even though enemies can be rerolled into them).
Flush! Flush!Flush! Icon.png6 roomsChanges all enemies in the room into poop. Does not work on all enemies (Knights and bosses are immune). Instantly kills Dingle, Dangle, and Brownie.
  • Floods the whole room with water.
  • Flushes all poop-related enemies and bosses away.
  • The ladders are covered in water but the walls are not when used inside a crawl space.
Guppy's Paw Guppy's PawGuppy's Paw Icon.pngUnlimitedRemoves one red heart container in exchange for gaining 3 Soul Hearts.
  • Can no longer be used without red heart containers.
Head of Krampus Head of KrampusHead of Krampus Icon.png6 roomsFires 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, similar to Krampus' second Brimstone attack.
The Jar The JarThe Jar Rebirth Icon.pngUnlimitedWhen at full health, up to 4 extra hearts can be stored in the jar.
  • Sprite changed.
Monstro's Tooth Monstro's ToothMonstro's Tooth Icon.png3 roomsMonstro jumps onto a random enemy, doing area damage. Can damage/kill the player if summoned in an room without enemies.
  • Has no effect if Monstro is in the room the item is used in.
The Poop The PoopThe Poop Icon.png1 roomsSpawns a pile of poop where the character is standing and knocks nearby monsters back. May yield pickups like regular poop.
  • Knocks back enemy shots.
Scissors ScissorsScissors Icon.png6 roomsUpon use, turns Isaac's head into a stationary familiar for the current room which fires normal tears that deal 3.5 damage.
  • Its recharge time is 2 rooms instead of 6 rooms.
Undefined UndefinedUndefined Icon.png6 roomsTeleports Isaac to either the Secret Room, Super Secret Room, Treasure Room, or I AM ERROR.
  • Dark Room can no longer be cleared repeatedly.

Passive Collectibles[edit | edit source]

20/20 20/2020 20 Rebirth Icon.pngGrants double shot.
  • Sprite changed.
3 Dollar Bill 3 Dollar Bill3 Dollar Bill Icon.pngGives Isaac a random tear effect every room.
Removed in Afterbirth The effect given changes upon entering a room.
Added in Afterbirth The effect changes every 3 seconds.
  • The type of randomized tear changes every 2–3 seconds. The item appears to select two tear effects at once, perhaps staggering the times at which each of those effects change.
  • If a run is quit, and then continued, 3 Dollar Bill will keep tear effects for the current room.
Abel AbelAbel Icon.pngA familiar that mirrors the player's movements and shoots in the opposite direction.
  • Shoots tears towards Isaac regardless of which direction Isaac is shooting.
Ball of Bandages Ball of BandagesBall of Bandages Icon.pngOrbiting 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.
  • Blocks enemy shots.
Bob's Brain Bob's BrainBob's Brain Icon.pngSpawns 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 Brain is fired directly from where it is located in the chain of familiars behind Isaac, making aiming it slightly more difficult.
  • Each copy takes up its own spot on the familiar line, but only the first one launches out. Respawning brains may end up stacking on top of each other.
Bomb Bag Bomb BagBomb Bag Icon.pngIsaac is followed by a small bag that drops a Bomb, 1+1 Free, or a Troll Bomb every 3 rooms.
Box BoxBox Rebirth Icon.pngSpawns 1 of each (non-collectible) item: 1 coin, 1 key, 1 bomb, 1 heart, 1 card, 1 pill, 1 trinket.
Butt Bombs Butt BombsButt Bombs Icon.pngGives +5 bombs and makes all bombs Butt Bombs that fill the room with gas, damaging and confusing all enemies.
Cain's Other Eye Cain's Other EyeCain's Other Eye Icon.pngSpawns 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.
  • Each tear deals Isaac's base damage.
The Common Cold The Common ColdThe Common Cold Icon.pngAdds a chance to shoot poison tears, dealing damage over time when inflicted.
  • The poison hits twice, dealing a total of double Isaac's damage.
Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired.
  • Each bomb deals 5 times the character's normal tear damage instead of 3, plus a flat 30 damage. The flat 30 is not affected by damage multipliers.
Fire Mind Fire MindFire Mind Icon.pngGrants 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.
  • Isaac gives a wide glow lighting up dark areas, such as those under the effects of the Curse of Darkness or the Dark One's attacks.
Isaac's Heart Isaac's HeartIsaac's Heart Icon.pngIsaac himself is now immune to all damage, and a heart familiar appears and follows Isaac. If the heart is hurt, Isaac is hurt.
  • Brimstone shots damage the heart.
Leo LeoLeo Icon.pngAllows you to crush rocks when you walk over them.
  • Nullifies effects of One Makes You Small pills, One Makes You Larger pills, and other items which decrease size, such as Caffeine Pill.
Lost Contact Lost ContactLost Contact Icon.pngEvery tear has a small shield which will allow it to block one enemy projectile.
  • Gives a shield to familiar's tears.
Lord of the Pit Lord of the PitLord of the Pit Rebirth Icon.pngGrants flight and increases speed.
  • Speed boost is applied immediately.
Mom's Contacts Mom's ContactsMom's Contacts Rebirth Icon.pngAdds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.
  • Range and tears height buffs are applied immediately.
Mom's Knife Mom's KnifeMom's Knife Rebirth Icon.pngIsaac'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.
  • If picked up twice in the same run, two knives are fired at once.
Punching Bag Punching BagPunching Bag Icon.pngSpawns a Mulligan Familiar that will wander the room randomly. Enemies will attack the Mulligan if it's closer.
  • Dies after taking too much damage and then respawns after a long period of time. Exiting and continuing the run will cause it to reappear right away.
  • Dies instantly by enemies' beam-type attacks, such as Uriel's and Gabriel's beam. This also includes enemies' Technology lasers such as Eye and Camillo Jr..
  • Reappears instantly each time a familiar or orbital item is picked up.
Scorpio ScorpioScorpio Icon.pngGrants poison tears, which deal damage over time when inflicted.
  • The poison hits twice, dealing a total of double Isaac's damage.
Steam Sale Steam SaleSteam Sale Icon.pngReduces all Shop prices by 50%, rounded down to 7 coins for an item, rounded up to 2-3 coins for a pickup.
  • Having multiple Steam Sales reduces all shop prices to 0 coins.
  • Causes the Deals with the Devil not to convert the heart type automatically.
Stop Watch Stop WatchStop Watch Icon.pngRemoved in Afterbirth Automatically inflicts slow to all enemies in every room.
Added in  Afterbirth Upon taking damage, inflicts slow to all enemies for the current room.
  • The slow is only applied after the player is hit.
Strange Attractor Strange AttractorStrange Attractor Rebirth Icon.pngPickups, trinkets, and monsters are magnetically attracted to Isaac's tears.
  • Isaac's bombs are magnetically attracted to the player character's tears.
Tech.5 Tech.5Tech.5 Rebirth Icon.pngGrants a unlimited range piercing laser with random rate of fire that does not replace tears. The laser might occasionally fire with the effect of a random item or trinket, such as Hook Worm, Spoon Bender or Tiny Planet.
The Virus The VirusThe Virus Icon.pngInflicts poison to enemies who make contact with Isaac. Speed down.
  • Each poison hit deals damage equal to Isaac's tear damage instead of 4 or 6 damage.
  • Enemies killed after they have been inflicted with this type of poison have a 20% chance to drop black hearts.

Trinkets[edit | edit source]

Match Stick Match StickMatch Stick Icon.pngIncreases the chance of Bombs dropping after clearing a room, and the chance of finding Bombs when opening a Chest.
  • Can replace the Tick.
Missing Poster Missing PosterMissing Poster Icon.pngIf Isaac dies in a Sacrifice Room, a puzzle piece will appear on his last will (Added in  Afterbirth and unlocks The Lost). Added in  Afterbirth Revives Isaac as The Lost if unlocked. The Missing Poster then disappears.
  • No longer displays a particular puzzle piece on the last will screen if Isaac dies in a Sacrifice Room while holding it.
  • Dying in a Sacrifice Room while holding it unlock The Lost, regardless of current character.
    • If The Lost was already unlocked, Isaac will be revived as The Lost and Missing Poster will be consumed.
    • If the player's character is already The Lost, he will be revived in the previous room and Missing Poster will be consumed.
Mysterious Paper Mysterious PaperMysterious Paper Icon.pngHas a chance to replicate the effects of A Missing Page, The Polaroid, The Negative, or Missing Poster.
Tick TickTick Icon.pngDrain 15% health of each enemy with more than 60 HP (ie. most bosses). Also restores one red heart of Isaac whenever he enters an uncleared boss room. The Tick cannot be swapped out for another trinket.

Interactions[edit | edit source]

* 20/20 20/2020 20 Rebirth Icon.pngGrants double shot. + Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. - Two brimstone shots are fired, without an increase in charge time.
  • 20/20 20/2020 20 Rebirth Icon.pngGrants double shot. + Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. - Makes two missiles drop one after the other.
  • 20/20 20/2020 20 Rebirth Icon.pngGrants double shot. + The Inner Eye The Inner EyeThe Inner Eye Icon.pngGrants triple shot but decreases tears. - 5 shots are fired with the normal decrease in fire rate instead of 3.
  • 20/20 20/2020 20 Rebirth Icon.pngGrants double shot. + Mom's Knife Mom's KnifeMom's Knife Rebirth Icon.pngIsaac'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. - Two knives are now thrown instead of one.
  • 20/20 20/2020 20 Rebirth Icon.pngGrants double shot. + Mutant Spider Mutant SpiderMutant Spider Icon.pngGrants quadruple shot but decreases tears. - 6 shots are fired with the normal decrease in fire rate.
  • 20/20 20/2020 20 Rebirth Icon.pngGrants double shot. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Two technology shots are fired simultaneously.
  • Azazel + Monstro's Lung Monstro's LungMonstro's Lung Icon.pngIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro. - Gives several additional Brimstone beams around Azazel.
  • Azazel + My Reflection My ReflectionMy Reflection Icon.pngGives Isaac's tears a boomerang effect, and increases range and shot speed. - Greatly increases the Brimstone laser's range and makes the laser curve as Azazel moves around the room.
  • Azazel + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Technology laser wraps around the Brimstone beam, dealing extra damage, but not increasing Brimstone range.
  • BBF BBFBBF Icon.pngSpawns a familiar that flies around the room in a manner similar to the Boom Fly and explodes on contact with an enemy. Respawns after ten seconds. + Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. - BBF will fire Brimstone beams in all directions upon exploding.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. - Isaac continuously fires bombs while charging the Brimstone beams.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. - Fires 10 Brimstone beams in all directions upon impact of a missile.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Monstro's Lung Monstro's LungMonstro's Lung Icon.pngIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro. - 3-5 additional Brimstone beams fire in random directions. One beam always fire straight forward as normal.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + My Reflection My ReflectionMy Reflection Icon.pngGives Isaac's tears a boomerang effect, and increases range and shot speed. - Makes the beam curve when moving.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Mysterious Liquid Mysterious LiquidMysterious Liquid Icon.pngTears leave a small, short lasting pool of creep on impact or when their range is depleted. - When Brimstone hits enemies or walls it leaves creep based on how long it hits.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Proptosis ProptosisProptosis Rebirth Icon.pngTears start out massive with high damage, and then shrink down and become weaker over a short range. - Doubles damage but it rapidly decreases with distance, down to 0.1 from about 6 tiles away.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Rubber Cement Rubber CementRubber Cement Icon.pngTears bounce off walls, enemies, and environmental objects. - Brimstone beam bounces off walls, creating a second beam that does half damage. Azazel's Brimstone will continue to full length after bouncing, but will deal half of damage.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Sad Bombs Sad BombsSad Bombs Rebirth Icon.png+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. - Bombs explode into Brimstone beams in all directions.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Tech.5 Tech.5Tech.5 Rebirth Icon.pngGrants a unlimited range piercing laser with random rate of fire that does not replace tears. The laser might occasionally fire with the effect of a random item or trinket, such as Hook Worm, Spoon Bender or Tiny Planet. - Tech.5 fires at player's tear rate while Brimstone laser is charging.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - The Technology laser coils around the Brimstone beam, granting a 1.5x damage multiplier.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Technology 2 Technology 2Technology 2 Icon.pngDecreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously. - Laser fires while Brimstone is charging.
  • Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. + Tough Love Tough LoveTough Love Rebirth Icon.pngAdds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears. - Occasionally fires Brimstone beam with damage multiplier of Tough Love.
  • Broken Watch Broken WatchBroken Watch Icon.pngChance 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. + Stop Watch Stop WatchStop Watch Icon.pngRemoved in Afterbirth Automatically inflicts slow to all enemies in every room.
    Added in  Afterbirth Upon taking damage, inflicts slow to all enemies for the current room.
    - Both the slow effect and the rarer speed up can trigger at the start of a room. However, getting hit on a sped up room will trigger Stop Watch's slow down.
  • Cricket's Body Cricket's BodyCricket's Body Icon.pngGrants -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. + Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. - Bombs split outwards into 4 tiny bombs that are not affected by Isaac's bomb modifiers, which detonate almost immediately.
  • Death's Touch Death's TouchDeath's Touch Icon.pngIncreases 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. + Fire Mind Fire MindFire Mind Icon.pngGrants 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. - Scythes now properly explode.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Hot Bombs Hot BombsHot Bombs Icon.pngGrants 5 bombs. Isaac's bombs leave behind fire that damages enemies upon contact. - Bombs leave behind fire that damages enemies on contact after exploding.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Mom's Knife Mom's KnifeMom's Knife Rebirth Icon.pngIsaac'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. - Isaac continuously fires bombs while charging the knife.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Monstro's Lung Monstro's LungMonstro's Lung Icon.pngIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro. - Shoots 6 bombs which need to be fully charged before firing. The bombs detonate simultaneously.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Mysterious Liquid Mysterious LiquidMysterious Liquid Icon.pngTears leave a small, short lasting pool of creep on impact or when their range is depleted. - Exploding bombs leave behind a large pool of green creep.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + The Parasite The ParasiteThe Parasite Icon.pngIsaac's tears split in two when they hit something. - Bombs split into two bombs upon exploding.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Poison tears - No damage increase from poison.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Polyphemus PolyphemusPolyphemus Rebirth Icon.pngMakes 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. - Bombs become Mr. Mega bombs. After they explode, they leave behind a regular-sized bomb.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Sad Bombs Sad BombsSad Bombs Rebirth Icon.png+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. - Fires tears as normally placed Sad Bombs would. If this synergy is combined with Ipecac, the tears from the bomb become explosive, which Isaac is not immune to. Tears fired from previous Dr. Fetus bombs can collide with other Dr. Fetus bombs (can be negated with spectral tears).
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Spoon Bender Spoon BenderSpoon Bender Icon.pngGrants Isaac homing tears. - Bombs are purple and act as if Isaac had Bobby-Bomb.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Both bombs and lasers are fired.
  • Dr. Fetus Dr. FetusDr. Fetus Icon.pngTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired. + Tough Love Tough LoveTough Love Rebirth Icon.pngAdds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears. - Tears that would have fired a tooth shot instead become a bomb with the Mr. Mega, dealing more damage and shaking the screen.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Hot Bombs Hot BombsHot Bombs Icon.pngGrants 5 bombs. Isaac's bombs leave behind fire that damages enemies upon contact. - Creates a fire every time a shot lands.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Ipecac IpecacIpecac Icon.pngReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth. + Sad Bombs Sad BombsSad Bombs Rebirth Icon.png+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. - Tear Blast tears explode and can damage Isaac.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Mom's Knife Mom's KnifeMom's Knife Rebirth Icon.pngIsaac'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. - Each explosion shoots 10 knives in a circle from the point of impact.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Monstro's Lung Monstro's LungMonstro's Lung Icon.pngIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro. - Adds 2 to 4 more crosshairs that orbit the main crosshair and fires a missile onto each crosshair.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Mysterious Liquid Mysterious LiquidMysterious Liquid Icon.pngTears leave a small, short lasting pool of creep on impact or when their range is depleted. - Exploding bombs leave behind a large pool of green creep.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Sad Bombs Sad BombsSad Bombs Rebirth Icon.png+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. - Missiles fire a burst of tears where they land.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Spoon Bender Spoon BenderSpoon Bender Icon.pngGrants Isaac homing tears. - Cursor slides towards enemies.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Strange Attractor Strange AttractorStrange Attractor Rebirth Icon.pngPickups, trinkets, and monsters are magnetically attracted to Isaac's tears. - Enemies get drawn towards the crosshair.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Spoon Bender Spoon BenderSpoon Bender Icon.pngGrants Isaac homing tears. - Cursor slides towards enemies
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Explosion shoots Technology lasers in all directions. When firing/moving the cursor, Isaaac still shoot his Technology laser.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Technology 2 Technology 2Technology 2 Icon.pngDecreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously. - Both the Technology 2 laser, and the Epic Fetus missiles will be active.
  • Epic Fetus Epic FetusEpic Fetus Icon.pngIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote. + Telepathy for Dummies Telepathy for DummiesTelepathy for Dummies Icon.png2 roomsUpon activation, grants homing tears for the current room. - Cursor slides towards enemies.
  • Fire Mind Fire MindFire Mind Icon.pngGrants 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. + Mysterious Liquid Mysterious LiquidMysterious Liquid Icon.pngTears leave a small, short lasting pool of creep on impact or when their range is depleted. - When the Fire Mind tear explodes, a much larger pool of creep is left behind.
  • + - Ipecac shots now spawn blue flies on hit, both direct and indirect.
  • Holy Mantle Holy MantleHoly Mantle Icon.pngAutomatically negates first taken damage in every room. + Stop Watch Stop WatchStop Watch Icon.pngRemoved in Afterbirth Automatically inflicts slow to all enemies in every room.
    Added in  Afterbirth Upon taking damage, inflicts slow to all enemies for the current room.
    - Blocking damage with Holy Mantle triggers the Stop Watch effect.
  • The Inner Eye The Inner EyeThe Inner Eye Icon.pngGrants triple shot but decreases tears. + Mutant Spider Mutant SpiderMutant Spider Icon.pngGrants quadruple shot but decreases tears. - Shoots 7 tears instead of 3. No further decrease in fire rate.
  • Ipecac IpecacIpecac Icon.pngReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth. + Mysterious Liquid Mysterious LiquidMysterious Liquid Icon.pngTears leave a small, short lasting pool of creep on impact or when their range is depleted. - Explosions leave behind a large pool of green creep.
  • The Ludovico Technique The Ludovico TechniqueThe Ludovico Technique Icon.pngInstead 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 Knife Mom's KnifeMom's Knife Rebirth Icon.pngIsaac'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. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Creates an uncontrollable laser ring centered on Isaac. The knife becomes stuck under Isaac and cannot be fired.
  • The Ludovico Technique The Ludovico TechniqueThe Ludovico Technique Icon.pngInstead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy. + Monstro's Lung Monstro's LungMonstro's Lung Icon.pngIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro. - Tear becomes a cluster of variably sized tears spread over a small area. The tears move at the same speed when controlled but constantly move around each other.
  • The Ludovico Technique The Ludovico TechniqueThe Ludovico Technique Icon.pngInstead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy. + Mysterious Liquid Mysterious LiquidMysterious Liquid Icon.pngTears leave a small, short lasting pool of creep on impact or when their range is depleted. - Pools the size of the tear constantly form on the ground dealing large amounts of damage to any non-flying enemy inside the tear.
  • A Lump of Coal A Lump of CoalA Lump of Coal Icon.pngThe more distance tears travel, the more damage they will do. + Brimstone BrimstoneBrimstone Rebirth Icon.pngTears 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. - Beam will gradually increase in size and damage the farther it travels, on a multiplier that is roughly +20% per tile of distance.
  • A Lump of Coal A Lump of CoalA Lump of Coal Icon.pngThe more distance tears travel, the more damage they will do. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Damage increases the further away the enemy is, on a multiplier that is roughly +20% per tile of distance.
  • A Lump of Coal A Lump of CoalA Lump of Coal Icon.pngThe more distance tears travel, the more damage they will do. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. + Tiny Planet Tiny PlanetTiny Planet Icon.pngRange up and makes shot tears revolve around Isaac until they drop. - The extra distance covered by the laser more than doubles damage right in front of Isaac, and it increases as normal further away.
  • A Lump of Coal A Lump of CoalA Lump of Coal Icon.pngThe more distance tears travel, the more damage they will do. + Technology 2 Technology 2Technology 2 Icon.pngDecreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously. - Damage increases the further away the enemy is, on a multiplier that is roughly +20% per tile of distance.
  • Mom's Knife Mom's KnifeMom's Knife Rebirth Icon.pngIsaac'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. + Monstro's Lung Monstro's LungMonstro's Lung Icon.pngIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro. - Fires a cluster of 3-5 knives at maximum charge, each dealing 2x damage.
  • Mom's Knife Mom's KnifeMom's Knife Rebirth Icon.pngIsaac'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. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Both the knife and the laser fire normally.
  • My Reflection My ReflectionMy Reflection Icon.pngGives Isaac's tears a boomerang effect, and increases range and shot speed. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Makes the beam curve when moving. Has the same effect on Azazel's mini-brimstone and doubles the range.
  • My Reflection My ReflectionMy Reflection Icon.pngGives Isaac's tears a boomerang effect, and increases range and shot speed. + Technology 2 Technology 2Technology 2 Icon.pngDecreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously. - Laser is bent as Isaac moves, then gradually becomes straight as he stands still.
  • Mysterious Liquid Mysterious LiquidMysterious Liquid Icon.pngTears leave a small, short lasting pool of creep on impact or when their range is depleted. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - The laser spawns pools of liquid always when it hits obstacles and occasionally on enemies.
  • Proptosis ProptosisProptosis Rebirth Icon.pngTears start out massive with high damage, and then shrink down and become weaker over a short range. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - The beam decreases in damage and width the farther it travels. Tears become virtually powerless across large rooms like the Boss Rush and the Hush fight.
  • Proptosis ProptosisProptosis Rebirth Icon.pngTears start out massive with high damage, and then shrink down and become weaker over a short range. + Technology 2 Technology 2Technology 2 Icon.pngDecreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously. - The beam decreases in damage and width the farther it travels. Tears become virtually powerless across large rooms like the Boss Rush and the Hush fight.
  • Pisces PiscesPisces Icon.png-1 Tear Delay, adds knock-back shots and increases tear size. + Technology 2 Technology 2Technology 2 Icon.pngDecreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously. - Laser can knock back enemies well due to its high fire rate.
  • Rubber Cement Rubber CementRubber Cement Icon.pngTears bounce off walls, enemies, and environmental objects. + Technology TechnologyTechnology Icon.pngReplaces tears with a piercing laser with unlimited range. - Laser bounces off of walls, creating a second beam that does half damage.
  • Rubber Cement Rubber CementRubber Cement Icon.pngTears bounce off walls, enemies, and environmental objects. + Technology 2 Technology 2Technology 2 Icon.pngDecreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously. - Laser bounces off of walls, creating a second beam that does half damage.

Pickups[edit | edit source]

Bombs[edit | edit source]

Troll bomb
  • Troll Bombs are now given a random amount of time before exploding. Before that they always exploded at a fixed time. This means that if two Troll Bombs spawn at the exact same time right next to each other, there's a high chance one Troll Bomb will blow up before the other, sending that Troll Bomb sliding outwards a bit before exploding.

Entities[edit | edit source]

Monsters[edit | edit source]

Bony
  • Only leaves behind bones when killed.

Environment[edit | edit source]

Rooms[edit | edit source]

Boss Room
  • Double Trouble boss rooms can now contain 2 bosses of different types. Additionally, they can appear as early as Chapter 1.
Arcade

Arcade 12.pngArcade 13.pngArcade 14.pngArcade 15.png

Angel Room
  • Possible rewards found in the room include:
  • Urns might spawn in the room.
  • Killing Key key master and shell game beggar no longer applies the 25% bonus.
  • Donating to a normal beggar until it pays out with an item on the current floor applies a 10% bonus instead of 25%.
  • Donating to a Devil beggar until it pays out with an item on the current floor applies a 10% bonus instead of 25%.
    • If this coin flip succeeds, a Devil Room will be generated regardless of the above coin flips.
  • "You feel blessed!" fortune in the Sacrifice Room of the current floor applies a bonus:
    • If the "You feel blessed!" fortune appeared on the 3rd sacrifice, the chance will be 15%.
    • If the "You feel blessed!" fortune appeared on the 5th sacrifice, the chance will be 50%.
    • If both "You feel blessed!" fortunes appeared, the chance will be 65%.
  • Angel Rooms that spawn after Isaac defeats Mom's Heart or It Lives will be normal Angel Rooms with items or pickups.
  • A troll bomb can sometimes appear behind the Angel Statue, blowing it up. If the Angel fights have been unlocked, this will begin the boss fight if the player is not careful or quick enough to move the bomb.
Bedroom
  • The clean bedroom occasionally has two clean beds instead of one.
  • The trapdoor in a dirty bedroom has a chance to lead to a Crawl Space.
  • Occasionally, one Rag Man will spawn inside the dirty bedroom.
Boss Rush

Boss Rush 2.pngBoss Rush 3.pngBoss Rush 4.pngBoss Rush 5.png

  • If a sack spawns for whatever reason, picking it up will start the Boss Rush. The player can still pick up one of the pedestal items.
Black Market
  • Black Market can no longer be accessed in The Chest and The Dark Room, and therefore cannot be used to collect more items.
Curse Room
Challenge Room
  • The three waves appear in random orders rather than the original orders.
Sacrifice Room
  • The payouts only depend on the number of sacrifices made. The number of sacrifices is reset to 0 when the player goes to the next floor.
  • Rewards are reworked:
Number of sacrifices on Current Floor Possible Rewards
1st/2nd
  • 50% chance - Nothing
  • 50% chance - 1 Penny
3rd
  • 33% chance - Nothing
  • 67% chance - "You feel blessed!" (increased chance to receive an Angel Room over a Devil Room for the current floor; see Angel Room Generation Chance)
    • This does not increase the chance of receiving a Devil/Angel room after defeating a boss; it only increases the chance of getting an Angel Room over a Devil Room.
    • This can cause an Angel Room to spawn even if you have already taken a deal with the devil.
    • Note that this is less of a modifier than the "You feel blessed!" effect below.
4th
  • 50% chance - Nothing
  • 50% chance - 1 random chest
    • The type of chest is governed by the same mechanic as room drops. Thus, brown chests are more likely to spawn than any other kind of chest.
5th
  • 33% chance - 3 pennies
    • These coins do not have a chance to spawn as a nickel or a dime.
  • 67% chance - "You feel blessed!" (increased chance to receive an Angel Room over a Devil Room for the current floor; see Angel Room Generation Chance)
    • This does not increase the chance of receiving a Devil/Angel room after defeating a boss; it only increases the chance of getting an Angel Room over a Devil Room.
    • This can cause an Angel Room to spawn even if you have already taken a deal with the devil.
    • Note that this is more of a modifier than the "You feel blessed!" effect above.
6th
  • 33% chance - Teleport to the Devil/Angel Room.
    • If the Devil/Angel Room of the floor has not been entered yet, an Angel Room will be guaranteed to spawn (even if you have already taken a Devil Deal).
  • 67% chance - 1 random chest
    • The type of chest is governed by the same mechanic as room drops. Thus, brown chests are more likely to spawn than any other kind of chest.
7th
8th
9th
  • 100% chance - Uriel battle
10th
  • 50% chance - 7 soul hearts
  • 50% chance - 30 pennies
11th
12th and onwards
  • 50% chance - Nothing
  • 50% chance - Teleport directly to the Dark Room
  • Losing red hearts due to the spikes will reduce the chance for a Devil Room to appear.
  • The amount of luck that the player has does not affect the payout probabilities.
  • Angels are normally able to fly over spikes, but will take damage from sacrifice room spikes.
  • New layouts:

Sacrifice Room 2.pngSacrifice Room 3.pngSacrifice Room 4.pngSacrifice Room 5.png

Secret Room
Shop
  • There is a small chance when you bomb the Shopkeeper that they can turn into Greed and start attacking you.
Super Secret Room
Treasure Room
  • There's a rare chance that a treasure room might contains two items to choose from, only one of which can be taken.
  • Treasure rooms may also contain a restock box, allowing Isaac to re-roll offered items if he has coins or bombs.
  • New layouts:

Treasure Room 13.pngTreasure Room 14.pngTreasure Room 15.pngTreasure Room 16.pngTreasure Room 17.pngTreasure Room 18.pngTreasure Room 19.pngTreasure Room 20.pngTreasure Room 21.pngTreasure Room 22.pngTreasure Room 23.pngTreasure Room 26.pngTreasure Room 27.pngTreasure Room 28.pngTreasure Room 31.pngTreasure Room 32.pngTreasure Room 33.pngTreasure Room 34.pngTreasure Room 35.pngTreasure Room 36.pngTreasure Room 37.pngTreasure Room 38.pngTreasure Room 39.pngTreasure Room 24.pngTreasure Room 30.pngTreasure Room 25.pngTreasure Room 29.png

Other[edit | edit source]

  • When not having red hearts in Devil Room, the price of items switches to soul hearts.
  • Krampus has a new attack pattern.