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


Activated Collectibles

Collectible Bob's Rotten Head icon.png Bob's Rotten Head
  • The head deals 3 times Isaac's tear damage as poison over time instead of either 6 or 8 points.
Collectible The Book of Belial icon.png The Book of Belial
  • Increases the chance to open the Devil Room or Angel Room by 12.5% after killing a boss while holding it instead of guaranteeing it.
Collectible Book of Revelations icon.png Book of Revelations
  • Increases chance for a Devil/Angel Room Door to open by 17.5% instead of 35%.
Collectible Butter Bean icon.png Butter Bean
  • Knocks back enemy shots.
Collectible Crack the Sky icon.png Crack the Sky
  • The beams have a high chance to directly target enemies.
Collectible D4 icon.png D4
  • Previously held items are removed from the pause menu.
Collectible The D6 icon.png The D6
  • 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.
Collectible D10 icon.png D10
  • Fly enemies are only rerolled into other fly enemies.
  • Red flies can't be rerolled anymore (even though enemies can be rerolled into them).
Collectible Flush! icon.png Flush!
  • 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.
Collectible Guppy's Paw icon.png Guppy's Paw
  • Can no longer be used without red heart containers.
Collectible Head of Krampus icon.png Head of Krampus
  • Has a 50% chance to rotate all beams around the player 90 degrees, similar to Krampus' second Brimstone attack.
Collectible The Jar Afterbirth icon.png The Jar
  • Sprite changed.
Collectible Monstro's Tooth icon.png Monstro's Tooth
  • Does not affect if Monstro is in the room the item is used in.
Collectible The Poop icon.png The Poop
  • Knocks back enemy shots.
Collectible Scissors icon.png Scissors
  • Its recharge time is 2 rooms instead of 6 rooms.
Collectible Undefined icon.png Undefined
  • Dark Room can no longer be cleared repeatedly.

Passive Collectibles

Collectible 20 20 icon.png 20/20
  • Sprite changed.
Collectible 3 Dollar Bill icon.png 3 Dollar Bill
  • 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.
Collectible Abel icon.png Abel
  • Shoots tears towards Isaac regardless of which direction Isaac is shooting.
Collectible Ball of Bandages icon.png Ball of Bandages
  • Blocks enemy shots.
Collectible Bob's Brain icon.png Bob's Brain
  • 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.
Collectible Bomb Bag icon.png Bomb Bag
Collectible Box Rebirth icon.png Box
Collectible Butt Bombs icon.png Butt Bombs
Collectible Cain's Other Eye icon.png Cain's Other Eye
  • Each tear deals Isaac's tear damage.
Collectible The Common Cold icon.png The Common Cold
  • The poison hits twice, dealing a total of double Isaac's damage.
Collectible Dr. Fetus icon.png Dr. Fetus
  • 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.
Collectible Fire Mind icon.png Fire Mind
  • 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.
Collectible Isaac's Heart icon.png Isaac's Heart
  • Brimstone shots damage the heart.
Collectible Leo icon.png Leo
  • Nullifies effects of One Makes You Small pills, One Makes You Larger pills, and other items that decrease the size of Isaac, such as Caffeine Pill.
Collectible Lost Contact icon.png Lost Contact
  • Gives a shield to familiar's tears.
Collectible Lord of the Pit Rebirth icon.png Lord of the Pit
  • Speed boost is applied immediately.
Collectible Mom's Contacts Rebirth icon.png Mom's Contacts
  • Range and tears height buffs are applied immediately.
Collectible Mom's Knife Rebirth icon.png Mom's Knife
  • If picked up twice in the same run, two knives are fired at once.
Collectible Punching Bag icon.png Punching Bag
  • Dies after taking too much damage and then respawns after a long 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.
Collectible Scorpio icon.png Scorpio
  • The poison hits twice, dealing a total of double Isaac's damage.
Collectible Steam Sale icon.png Steam Sale
  • Having multiple Steam Sales reduces all shop prices to 0 coins.
  • Causes the Deals with the Devil not to convert the heart-type automatically.
Collectible Stop Watch icon.png Stop Watch
  • The slow is only applied after the player is hit.
Collectible Strange Attractor Rebirth icon.png Strange Attractor
  • Isaac's bombs are magnetically attracted to the player character's tears.
Collectible Tech.5 Rebirth icon.png Tech.5
Collectible The Virus icon.png The Virus
  • 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.


Trinket Match Stick icon.png Match Stick
  • Can replace the Tick.
Trinket Missing Poster icon.png Missing Poster
  • 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 the 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.
Trinket Mysterious Paper icon.png Mysterious Paper
Trinket Tick icon.png Tick


* Collectible 20 20 icon.png 20/20 + Collectible Brimstone Rebirth icon.png Brimstone - Two brimstone shots are fired, without an increase in charge time.



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 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.



  • Only leaves behind bones when killed.



Boss Room
  • Double Trouble boss rooms can now contain 2 bosses of different types. Additionally, they can appear as early as chapter 1.
Arcade 12.png
Arcade 13.png
Arcade 14.png
Arcade 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 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.
  • 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.png
Boss Rush 3.png
Boss Rush 4.png
Boss 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:
№ of sacrifices on Current Floor Chance Reward
1st/2nd 50% Nothing
50% 1 Penny
3rd 33% Nothing
67% "You feel blessed!" (increased chance to receive an Angel Room over a Devil Room for the current floor)
  • Does not increase the chance of a Devil/Angel room after defeating a boss, only the chance of getting an Angel Room over a Devil Room.
  • Can cause an Angel Room to spawn even if you already took a deal with the devil.
  • Less of a modifier than the "You feel blessed!" effect below.
4th 50% Nothing
50% 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% 3 Pennies (These coins do not have a chance to spawn as a nickel or a dime.)
67% You feel blessed!" (Same conditions as 3rd sacrifice but a stronger modifier.)
6th 33% Teleport to the Devil/Angel Room. (If the floor's Devil/Angel Room has not been entered yet, an Angel Room is guaranteed to spawn — even if you already took a Devil Deal.)
67% 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 33% 1 random Angel Room pedestal item.
67% 1 Soul Heart
8th 100% 6 Troll Bombs
9th 100% Uriel battle
10th 50% 7 Soul Hearts
50% 30 Pennies
11th 100% Gabriel battle
12th and onwards 50% Nothing
50% 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.png
Sacrifice Room 3.png
Sacrifice Room 4.png
Sacrifice Room 5.png
Secret Room
  • 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 Machine, allowing Isaac to re-roll offered items if he has coins or bombs.
  • New layouts:
Treasure Room 13.png
Treasure Room 14.png
Treasure Room 15.png
Treasure Room 16.png
Treasure Room 17.png
Treasure Room 18.png
Treasure Room 19.png
Treasure Room 20.png
Treasure Room 21.png
Treasure Room 22.png
Treasure Room 23.png
Treasure Room 26.png
Treasure Room 27.png
Treasure Room 28.png
Treasure Room 31.png
Treasure Room 32.png
Treasure Room 33.png
Treasure Room 34.png
Treasure Room 35.png
Treasure Room 36.png
Treasure Room 37.png
Treasure Room 38.png
Treasure Room 39.png
Treasure Room 24.png
Treasure Room 30.png
Treasure Room 25.png
Treasure Room 29.png


  • When not having red hearts in Devil Room, the price of items switches to soul hearts.
  • Krampus has a new attack pattern.
  • The floor icons on the stage transition sprites are updated; instead of being large rectangles with the unknown ones being grey, the sprites feature a much thinner and more detailed border with the unknown floors being represented by a closed trap door.
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