The Binding of Isaac: Afterbirth/Changes/Synergies

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1st item 2nd item Description
Q Card Icon.png ? Card Blank Card Icon.png Blank Card Teleports you to the I AM ERROR room. This will consume both the Blank Card and the ? Card.
  • An exception is when they are used on Chest, Dark Room or Ultra Greed floors. Using them here consumes both the Blank Card and the ? Card and spawns an I AM ERROR Shopkeeper.
Blank Card Icon.png Blank Card Q Card Icon.png ? Card Teleports you to the I AM ERROR room. This will consume both the Blank Card and the ? Card.
  • An exception is when they are used on Chest, Dark Room or Ultra Greed floors. Using them here consumes both the Blank Card and the ? Card and spawns an I AM ERROR Shopkeeper.
1up! Icon.png 1up! Box of Friends Icon.png Box of Friends Familiars are multiplied but do not give Isaac additional lives.
Box of Friends Icon.png Box of Friends 1up! Icon.png 1up! Familiars are multiplied but do not give Isaac additional lives.
20 20 Icon.png 20/20 Brimstone Icon.png Brimstone Two brimstone shots are fired, without an increase in charge time.
Brimstone Icon.png Brimstone 20 20 Icon.png 20/20 Two brimstone shots are fired, without an increase in charge time.
20 20 Icon.png 20/20 Epic Fetus Icon.png Epic Fetus Makes two missiles drop one after the other.
Epic Fetus Icon.png Epic Fetus 20 20 Icon.png 20/20 Makes two missiles drop one after the other.
20 20 Icon.png 20/20 The Inner Eye Icon.png The Inner Eye 5 shots are fired with the normal decrease in fire rate.
The Inner Eye Icon.png The Inner Eye 20 20 Icon.png 20/20 5 shots are fired with the normal decrease in fire rate.
20 20 Icon.png 20/20 Mom's Knife Icon.png Mom's Knife Two knives are now thrown instead of one.
Mom's Knife Icon.png Mom's Knife 20 20 Icon.png 20/20 Two knives are now thrown instead of one.
20 20 Icon.png 20/20 Mutant Spider Icon.png Mutant Spider 6 shots are fired with the normal decrease in fire rate.
Mutant Spider Icon.png Mutant Spider 20 20 Icon.png 20/20 6 shots are fired with the normal decrease in fire rate.
20 20 Icon.png 20/20 Technology Icon.png Technology Two technology shots are fired simultaneously.
Technology Icon.png Technology 20 20 Icon.png 20/20 Two technology shots are fired simultaneously.
20 20 Icon.png 20/20 Tractor Beam Icon.png Tractor Beam Both tears are fired along the beam although due to a bug the second tear in each pair is invisible.
Tractor Beam Icon.png Tractor Beam 20 20 Icon.png 20/20 Both tears are fired along the beam although due to a bug the second tear in each pair is invisible.
20 20 Icon.png 20/20 The Wiz Icon.png The Wiz Two tears are fired each direction.
The Wiz Icon.png The Wiz 20 20 Icon.png 20/20 Two tears are fired each direction.
Collectible 9 Volt icon.png 9 Volt Wooden Nickel Icon.png Wooden Nickel Infinite coins (if you have the time).
Wooden Nickel Icon.png Wooden Nickel Collectible 9 Volt icon.png 9 Volt Infinite coins (if you have the time).
A Card Against Humanity Icon.png A Card Against Humanity Brown Cap Icon.png Brown Cap All the poop explodes in a chain reaction once one is destroyed.
Brown Cap Icon.png Brown Cap A Card Against Humanity Icon.png A Card Against Humanity All the poop explodes in a chain reaction once one is destroyed.
A Card Against Humanity Icon.png A Card Against Humanity BlueBlue.png Infested! Pill Every pile of poop spawns a blue spider.
BlueBlue.png Infested! Pill A Card Against Humanity Icon.png A Card Against Humanity Every pile of poop spawns a blue spider.
A Card Against Humanity Icon.png A Card Against Humanity Lil Larva Icon.png Lil Larva Every pile of poop spawns a blue Fly.
Lil Larva Icon.png Lil Larva A Card Against Humanity Icon.png A Card Against Humanity Every pile of poop spawns a blue Fly.
A Lump of Coal Icon.png A Lump of Coal Brimstone Icon.png Brimstone
No benefit though the beam color is darker.

Beam will gradually increase in size and damage the farther it travels, on a multiplier that is roughly +20% per tile of distance.
Brimstone Icon.png Brimstone A Lump of Coal Icon.png A Lump of Coal
No benefit though the beam color is darker.

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 Icon.png A Lump of Coal Mom's Knife Icon.png Mom's Knife Damage increases as the knife travels further.
Mom's Knife Icon.png Mom's Knife A Lump of Coal Icon.png A Lump of Coal Damage increases as the knife travels further.
A Lump of Coal Icon.png A Lump of Coal Technology Icon.png Technology Damage increases the further away the enemy is, on a multiplier that is roughly +20% per tile of distance.
Technology Icon.png Technology A Lump of Coal Icon.png A Lump of Coal Damage increases the further away the enemy is, on a multiplier that is roughly +20% per tile of distance.
A Lump of Coal Icon.png A Lump of Coal Tech X Icon.png Tech X Ring size and damage increases as ring travels further from Isaac.
Tech X Icon.png Tech X A Lump of Coal Icon.png A Lump of Coal Ring size and damage increases as ring travels further from Isaac.
Anarchist Cookbook Icon.png Anarchist Cookbook Blasting Cap Icon.png Blasting Cap The troll bombs have a chance to drop bomb pickups upon exploding.
Blasting Cap Icon.png Blasting Cap Anarchist Cookbook Icon.png Anarchist Cookbook The troll bombs have a chance to drop bomb pickups upon exploding.
Anarchist Cookbook Icon.png Anarchist Cookbook Bob's Bladder Icon.png Bob's Bladder The troll bombs will leave green creep.
Bob's Bladder Icon.png Bob's Bladder Anarchist Cookbook Icon.png Anarchist Cookbook The troll bombs will leave green creep.
Anarchist Cookbook Icon.png Anarchist Cookbook Bomber Boy Icon.png Bomber Boy The troll bombs will explode in a shape of a cross, making them very powerful but hard to dodge.
Bomber Boy Icon.png Bomber Boy Anarchist Cookbook Icon.png Anarchist Cookbook The troll bombs will explode in a shape of a cross, making them very powerful but hard to dodge.
Anarchist Cookbook Icon.png Anarchist Cookbook Glitter Bombs Icon.png Glitter Bombs Each troll bomb has a chance to drop a pickup.
Glitter Bombs Icon.png Glitter Bombs Anarchist Cookbook Icon.png Anarchist Cookbook Each troll bomb has a chance to drop a pickup.
Anarchist Cookbook Icon.png Anarchist Cookbook Safety Scissors Icon.png Safety Scissors The troll bombs will all be defused and turn into bomb pickups.
Safety Scissors Icon.png Safety Scissors Anarchist Cookbook Icon.png Anarchist Cookbook The troll bombs will all be defused and turn into bomb pickups.
Anarchist Cookbook Icon.png Anarchist Cookbook Scatter Bombs Icon.png Scatter Bombs Each troll bomb will spawn several smaller bombs upon exploding.
Scatter Bombs Icon.png Scatter Bombs Anarchist Cookbook Icon.png Anarchist Cookbook Each troll bomb will spawn several smaller bombs upon exploding.
Anarchist Cookbook Icon.png Anarchist Cookbook Sticky Bombs Icon.png Sticky Bombs If a troll bomb kills a enemy, it will spawn blue spiders.
Sticky Bombs Icon.png Sticky Bombs Anarchist Cookbook Icon.png Anarchist Cookbook If a troll bomb kills a enemy, it will spawn blue spiders.
Ball of Bandages Icon.png Ball of Bandages Box of Friends Icon.png Box of Friends Upgrades the cube/ball for the current room. This can be used to easily unlock the Super Meat Boy and Bandage Girl achievements.
Box of Friends Icon.png Box of Friends Ball of Bandages Icon.png Ball of Bandages Upgrades the cube/ball for the current room. This can be used to easily unlock the Super Meat Boy and Bandage Girl achievements.
BBF Icon.png BBF Brimstone Icon.png Brimstone BBF will fire brimstone beams in all directions upon exploding.
Brimstone Icon.png Brimstone BBF Icon.png BBF BBF will fire brimstone beams in all directions upon exploding.
Best Bud Icon.png Best Bud Box of Friends Icon.png Box of Friends If used before taking damage, the white fly will circle around Isaac. However, multiple white flies cannot be spawned, so using Box of Friends after taking damage or using it multiple times in a room has no effect.
Box of Friends Icon.png Box of Friends Best Bud Icon.png Best Bud If used before taking damage, the white fly will circle around Isaac. However, multiple white flies cannot be spawned, so using Box of Friends after taking damage or using it multiple times in a room has no effect.
BFFS! Icon.png BFFS! Farting Baby Icon.png Farting Baby The baby's increased size will make it easier to trigger the Baby's effect.
Farting Baby Icon.png Farting Baby BFFS! Icon.png BFFS! The baby's increased size will make it easier to trigger the Baby's effect.
BFFS! Icon.png BFFS! Incubus Icon.png Incubus Incubus deals double your damage instead of copying it. Effectively doubles Lilith's damage.
Incubus Icon.png Incubus BFFS! Icon.png BFFS! Incubus deals double your damage instead of copying it. Effectively doubles Lilith's damage.
Black Candle Icon.png Black Candle Cursed Eye Icon.png Cursed Eye Removes teleportation effect of Eye.
Cursed Eye Icon.png Cursed Eye Black Candle Icon.png Black Candle Removes teleportation effect of Eye.
Black Powder Icon.png Black Powder How to Jump Icon.png How to Jump Allows Isaac to quickly jump around the room and create large pentagrams.
How to Jump Icon.png How to Jump Black Powder Icon.png Black Powder Allows Isaac to quickly jump around the room and create large pentagrams.
Blank Card Icon.png Blank Card Dice Shard Icon.png Dice Shard Works as a 4-room recharge The D6 + D20.
Dice Shard Icon.png Dice Shard Blank Card Icon.png Blank Card Works as a 4-room recharge The D6 + D20.
Blind Rage Icon.png Blind Rage Holy Mantle Icon.png Holy Mantle Invincibility from Holy Mantle is extended.
Holy Mantle Icon.png Holy Mantle Blind Rage Icon.png Blind Rage Invincibility from Holy Mantle is extended.
Blind Rage Icon.png Blind Rage Mom's Box Icon.png Mom's Box Doubles the effect of Blind Rage, resulting in extremely long invincibility.
Mom's Box Icon.png Mom's Box Blind Rage Icon.png Blind Rage Doubles the effect of Blind Rage, resulting in extremely long invincibility.
Blind Rage Icon.png Blind Rage Swallowed Penny Icon.png Swallowed Penny Gives you more time to grab a penny with Keeper if you have Mom's Purse or Belly Button.
Swallowed Penny Icon.png Swallowed Penny Blind Rage Icon.png Blind Rage Gives you more time to grab a penny with Keeper if you have Mom's Purse or Belly Button.
Bob's Bladder Icon.png Bob's Bladder Bobby-Bomb Icon.png Bobby-Bomb The bombs will leave trails of green creep while homing in on enemies.
Bobby-Bomb Icon.png Bobby-Bomb Bob's Bladder Icon.png Bob's Bladder The bombs will leave trails of green creep while homing in on enemies.
Bob's Bladder Icon.png Bob's Bladder Dr. Fetus Icon.png Dr. Fetus Bombs from Dr. Fetus leave creep.
Dr. Fetus Icon.png Dr. Fetus Bob's Bladder Icon.png Bob's Bladder Bombs from Dr. Fetus leave creep.
Bob's Bladder Icon.png Bob's Bladder No. 2 Icon.png No. 2 Bombs from No. 2 leave creep.
No. 2 Icon.png No. 2 Bob's Bladder Icon.png Bob's Bladder Bombs from No. 2 leave creep.
Bob's Bladder Icon.png Bob's Bladder Remote Detonator Icon.png Remote Detonator Bombs will continue to leave creep until they are manually detonated, allowing lots of creep to be made by pushing bombs around.
Remote Detonator Icon.png Remote Detonator Bob's Bladder Icon.png Bob's Bladder Bombs will continue to leave creep until they are manually detonated, allowing lots of creep to be made by pushing bombs around.
Bob's Brain Icon.png Bob's Brain Box of Friends Icon.png Box of Friends Adds an additional brain. When used upon entering a room, Box of Friends eliminates the item delay, which allows Isaac to launch Bob's Brain immediately.
Box of Friends Icon.png Box of Friends Bob's Brain Icon.png Bob's Brain Adds an additional brain. When used upon entering a room, Box of Friends eliminates the item delay, which allows Isaac to launch Bob's Brain immediately.
Bob's Curse Icon.png Bob's Curse Bomber Boy Icon.png Bomber Boy The range for poisoning nearby enemies is much bigger.
Bomber Boy Icon.png Bomber Boy Bob's Curse Icon.png Bob's Curse The range for poisoning nearby enemies is much bigger.
Bob's Rotten Head Icon.png Bob's Rotten Head Continuum Icon.png Continuum Bob's Rotten Head can now travel through walls and appear out of the opposite wall, similar to a portal-type mechanic.
Continuum Icon.png Continuum Bob's Rotten Head Icon.png Bob's Rotten Head Bob's Rotten Head can now travel through walls and appear out of the opposite wall, similar to a portal-type mechanic.
Bobby-Bomb Icon.png Bobby-Bomb Bomber Boy Icon.png Bomber Boy The bombs will home in on enemies and explode in a cross shape, making them useful on groups of enemies.
Bomber Boy Icon.png Bomber Boy Bobby-Bomb Icon.png Bobby-Bomb The bombs will home in on enemies and explode in a cross shape, making them useful on groups of enemies.
Bobby-Bomb Icon.png Bobby-Bomb Curse of the Tower Icon.png Curse of the Tower When Isaac takes damage, 6 homing bombs will appear.
Curse of the Tower Icon.png Curse of the Tower Bobby-Bomb Icon.png Bobby-Bomb When Isaac takes damage, 6 homing bombs will appear.
Bobby-Bomb Icon.png Bobby-Bomb No. 2 Icon.png No. 2 Butt bombs dropped while firing tears will home in on enemies.
No. 2 Icon.png No. 2 Bobby-Bomb Icon.png Bobby-Bomb Butt bombs dropped while firing tears will home in on enemies.
Bomber Boy Icon.png Bomber Boy Butt Bombs Icon.png Butt Bombs Each explosion counts as an individual Butt Bomb, so this deals 90 damage per explosion to all enemies in the room.
Butt Bombs Icon.png Butt Bombs Bomber Boy Icon.png Bomber Boy Each explosion counts as an individual Butt Bomb, so this deals 90 damage per explosion to all enemies in the room.
Bomber Boy Icon.png Bomber Boy Curse of the Tower Icon.png Curse of the Tower The troll bombs spawned by the effect of this item will explode in a large cross pattern, making them more likely to damage both enemies and Isaac.
Curse of the Tower Icon.png Curse of the Tower Bomber Boy Icon.png Bomber Boy The troll bombs spawned by the effect of this item will explode in a large cross pattern, making them more likely to damage both enemies and Isaac.
Bomber Boy Icon.png Bomber Boy Dr. Fetus Icon.png Dr. Fetus Bomber Boy also affects the bombs fired by Dr. Fetus.
Dr. Fetus Icon.png Dr. Fetus Bomber Boy Icon.png Bomber Boy Bomber Boy also affects the bombs fired by Dr. Fetus.
Bomber Boy Icon.png Bomber Boy Glitter Bombs Icon.png Glitter Bombs Each explosion has a independent chance of generating a pickup to use.
Glitter Bombs Icon.png Glitter Bombs Bomber Boy Icon.png Bomber Boy Each explosion has a independent chance of generating a pickup to use.
Bomber Boy Icon.png Bomber Boy Hot Bombs Icon.png Hot Bombs Creates fire in a shape of a cross.
Hot Bombs Icon.png Hot Bombs Bomber Boy Icon.png Bomber Boy Creates fire in a shape of a cross.
Bomber Boy Icon.png Bomber Boy Mr. Mega Icon.png Mr. Mega All explosions have a larger radius and will overlap each other more, potentially vastly increasing damage.
Mr. Mega Icon.png Mr. Mega Bomber Boy Icon.png Bomber Boy All explosions have a larger radius and will overlap each other more, potentially vastly increasing damage.
Bomber Boy Icon.png Bomber Boy No. 2 Icon.png No. 2 Each explosion counts as an individual Butt Bomb, so this deals 90 damage per explosion to all enemies in the room.
No. 2 Icon.png No. 2 Bomber Boy Icon.png Bomber Boy Each explosion counts as an individual Butt Bomb, so this deals 90 damage per explosion to all enemies in the room.
Bomber Boy Icon.png Bomber Boy Pyromaniac Icon.png Pyromaniac Each bomb can restore multiple red hearts.
Pyromaniac Icon.png Pyromaniac Bomber Boy Icon.png Bomber Boy Each bomb can restore multiple red hearts.
Bomber Boy Icon.png Bomber Boy Sad Bombs Icon.png Sad Bombs Each of the nine explosions will have its own tear burst.
Sad Bombs Icon.png Sad Bombs Bomber Boy Icon.png Bomber Boy Each of the nine explosions will have its own tear burst.
Bomber Boy Icon.png Bomber Boy Scatter Bombs Icon.png Scatter Bombs Each of the smaller bombs explode in large cross-shaped blasts.
Scatter Bombs Icon.png Scatter Bombs Bomber Boy Icon.png Bomber Boy Each of the smaller bombs explode in large cross-shaped blasts.
Box of Friends Icon.png Box of Friends 20px ???'s Soul This familiar is not copied.
20px ???'s Soul Box of Friends Icon.png Box of Friends This familiar is not copied.
Box of Friends Icon.png Box of Friends Car Battery Icon.png Car Battery Adds two copies of each familiar.
Car Battery Icon.png Car Battery Box of Friends Icon.png Box of Friends Adds two copies of each familiar.
Box of Friends Icon.png Box of Friends Cube of Meat Icon.png Cube of Meat Upgrades the cube/ball for the current room. This can be used to easily unlock the Super Meat Boy and Bandage Girl achievements.
Cube of Meat Icon.png Cube of Meat Box of Friends Icon.png Box of Friends Upgrades the cube/ball for the current room. This can be used to easily unlock the Super Meat Boy and Bandage Girl achievements.
Box of Friends Icon.png Box of Friends Daddy Longlegs Icon.png Daddy Longlegs Familiar will be copied.
Daddy Longlegs Icon.png Daddy Longlegs Box of Friends Icon.png Box of Friends Familiar will be copied.
Box of Friends Icon.png Box of Friends 20px Pickup generating familiars The copied familiars will drop pickups independently.
20px Pickup generating familiars Box of Friends Icon.png Box of Friends The copied familiars will drop pickups independently.
Box of Friends Icon.png Box of Friends Guillotine Icon.png Guillotine Duplicates the Head circling around Isaac's body. Only one head will shoot tears.
Guillotine Icon.png Guillotine Box of Friends Icon.png Box of Friends Duplicates the Head circling around Isaac's body. Only one head will shoot tears.
Box of Friends Icon.png Box of Friends Incubus Icon.png Incubus Multiple Incubi which share the same tear modifiers as the player.
Incubus Icon.png Incubus Box of Friends Icon.png Box of Friends Multiple Incubi which share the same tear modifiers as the player.
Box of Friends Icon.png Box of Friends Isaac's Head Icon.png Isaac's Head This familiar is not copied.
Isaac's Head Icon.png Isaac's Head Box of Friends Icon.png Box of Friends This familiar is not copied.
Box of Friends Icon.png Box of Friends Isaac's Heart Icon.png Isaac's Heart This familiar is not copied.
Isaac's Heart Icon.png Isaac's Heart Box of Friends Icon.png Box of Friends This familiar is not copied.
Box of Friends Icon.png Box of Friends Key Piece 1 Icon.png Key Piece 1 Key pieces are multiplied, but do not complete the other half.
Key Piece 1 Icon.png Key Piece 1 Box of Friends Icon.png Box of Friends Key pieces are multiplied, but do not complete the other half.
Box of Friends Icon.png Box of Friends Key Piece 2 Icon.png Key Piece 2 Key pieces are multiplied, but do not complete the other half.
Key Piece 2 Icon.png Key Piece 2 Box of Friends Icon.png Box of Friends Key pieces are multiplied, but do not complete the other half.
Box of Friends Icon.png Box of Friends Milk! Icon.png Milk! The familiar itself doesn't appear but instead it decreases tear delay by 2 (effective tears up) when used, without needing to take damage.
Milk! Icon.png Milk! Box of Friends Icon.png Box of Friends The familiar itself doesn't appear but instead it decreases tear delay by 2 (effective tears up) when used, without needing to take damage.
Box of Friends Icon.png Box of Friends Multidimensional Baby Icon.png Multidimensional Baby This familiar is not copied.
Multidimensional Baby Icon.png Multidimensional Baby Box of Friends Icon.png Box of Friends This familiar is not copied.
Box of Friends Icon.png Box of Friends Smart Fly Icon.png Smart Fly Very useful on Greed mode as each usage will add an attacking fly, killing enemies and bosses very quick.
Smart Fly Icon.png Smart Fly Box of Friends Icon.png Box of Friends Very useful on Greed mode as each usage will add an attacking fly, killing enemies and bosses very quick.