Treasure Room (Afterbirth+ Item Pool)

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Item Pool
Rebirth Treasure Room Shop Library Curse Room Boss Secret Room Devil Room Angel Room Golden Chest Red Chest Beggar Devil Beggar Key Master
DLC Indicator.png Afterbirth Treasure Room Shop Library Curse Room Boss Secret Room Devil Room Angel Room Golden Chest Red Chest Beggar Devil Beggar Key Master Bomb Bum
DLC Indicator.png Greed Mode Treasure Room Shop Library Curse Room Boss Secret Room Devil Room Angel Room Golden Chest
Afterbirth† Indicator.png Afterbirth † Treasure Room Shop Library Curse Room Boss Secret Room Devil Room Angel Room Golden Chest Red Chest Beggar Devil Beggar Key Master Bomb Bum
Afterbirth† Indicator.png Greed Mode Treasure Room Shop Library Curse Room Boss Secret Room Devil Room Angel Room Golden Chest

The Treasure Room item pool contains the majority of the game's items. All of the items in this pool are able to be found in the Treasure Room.

Activated Collectibles[edit | edit source]

Name ID Icon Quote Description Recharge
Anarchist Cookbook 65 Anarchist Cookbook Icon.png Summon bombs Spawns six troll bombs around the room. 3
The Bean 111 The Bean Icon.png Toot on command Isaac releases bad gas, poisoning any enemy in close vicinity. 1
Best Friend 136 Best Friend Icon.png Friends 'till the end Deploys a decoy Isaac that eventually explodes with an increased blast radius. 3
Black Hole Afterbirth† Indicator.png 512 Black Hole Icon.png Nothing can escape Throws a black hole on the ground which sucks in and damages enemies. 4
Blank Card 286 Blank Card Icon.png Card Mimic Has the same effect as the card or rune currently held by Isaac. 4
Blood Rights 186 Blood Rights Icon.png Mass enemy damage at a cost Damages all enemies in the room, but deals a heart of damage to Isaac with each use. 0
Bob's Rotten Head 42 Bob's Rotten Head Icon.png Reusable ranged bomb Upon use, Isaac holds a poison bomb which can be thrown towards any of the four cardinal points and explodes on impact. 3
Book of Revelations 78 Book of Revelations Icon.png Reusable soul protection Adds 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). 6
Book of Secrets 287 Book of Secrets Icon.png ?????? Upon use, gives the effect of Treasure Map, The Compass, or Blue Map for the duration of the current floor. 6
Book of Shadows 58 Book of Shadows Icon.png Temporary Invincibility Upon use, creates a protective shield nullifying all types of damage for 10 seconds. 3
The Book of Sin 97 The Book of Sin Icon.png Reusable Item Generator Spawns a random pickup, pill, card, or trinket. 4
Box of Spiders 288 Box of Spiders Icon.png It's a box of spiders Summons 2-4 blue spiders. 2
Brown Nugget Afterbirth† Indicator.png 504 Brown Nugget Icon.png Friendly fly Spawns a stationary fly familiar that fires tears at nearby enemies. 7 seconds
Butter Bean 294 Butter Bean Icon.png Reusable knock-back Isaac farts and pushes back nearby enemies. 3 seconds
Clicker Afterbirth† Indicator.png 482 Clicker Icon.png Change Transforms Isaac into another random character. 6
Crack the Sky 160 Crack the Sky Icon.png Holy white death Summons multiple beams of light in random locations around the room, dealing a large amount of damage to any enemy that touches them. 4
Crooked Penny Afterbirth† Indicator.png 485 Crooked Penny Icon.png 50/50 Spawns a penny and has a 50% chance to double all items and pickups in the room. If the effect fails, the items and pickups disappear. 4
Crystal Ball 158 Crystal Ball Icon.png I see my future Reveals the map (except the Super Secret Room) and drops a random Tarot Card or soul heart. 6
D100 283 D100 Icon.png REEROLLLLL! Upon 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. 6
D10 285 D10 Icon.png Rerolls enemies Rerolls the enemies in a room. Only rerolls enemies that are still alive (does not spawn new enemies). 1
D12 DLC Indicator.png 386 D12 Icon.png Rerolls rocks Re-rolls all rocks in the current room into other random objects, such as bomb rocks, metal blocks, TNT, or poops. 3
D1 Afterbirth† Indicator.png 476 D1 Icon.png What will it be? Duplicates a random pickup in the room. 4
D20 166 D20 Icon.png Reroll the basics Rerolls all pickups in the current room. 6
D4 284 D4 Icon.png Reroll into something else Rerolls all of Isaac's items. 6
The D6 105 The D6 Icon.png Reroll Your Destiny Allows Isaac to re-roll collectible items in the current room into other items, depending on the current room's Item Pool. 6
D7 DLC Indicator.png 437 D7 Icon.png Reroll rewards! Restarts the current room and brings back all enemies, allowing more rewards to be acquired by completing the room. 3
D8 DLC Indicator.png 406 D8 Icon.png Reroll stats Re-rolls Isaac's speed, range, tears, and damage. 4
D Infinity Afterbirth† Indicator.png 489 D Infinity Icon.png Reroll forever Grants a random dice item that changes each use. 2
Dad's Key 175 Dad's Key Icon.png Opens all doors... Opens all doors in the current room when activated, including doors which require a key to open and entrances to secret rooms. Opens the big doors in the first room of both The Chest and the Dark Room. 2
Dataminer Afterbirth† Indicator.png 481 Dataminer Icon.png 109 Displaces enemy sprites for the current room and increases or decreases a random stat. 4
Dead Sea Scrolls 124 Dead Sea Scrolls Icon.png It's a mystery Triggers the effect of a random activated item from a list of possible options (not every activated item is included). 2
Deck of Cards 85 Deck of Cards Icon.png Reusable Card Generator Gives Isaac a random Tarot Card. 6
Doctor's Remote 47 Doctor's Remote Icon.png Reusable Air Strike Sets a big red target on the ground (similar to the Epic Fetus item) which can be controlled with tear controls. After 6 seconds or by pressing space again, a huge explosive missile hits it, which damages all enemies caught in its blast radius. 2
Flush! 291 Flush! Icon.png ... Changes all enemies in the room into poop. Does not work on all enemies (Knights and bosses are immune). Instantly kills Dingle, Dangle, and Brownie. 6
Forget Me Now 127 Forget Me Now Icon.png I don't remember When activated, the level ends and is freshly regenerated with new rooms, monsters, and items. Disappears after use. One time use
Friendly Ball DLC Indicator.png 382 Friendly Ball Icon.png Gotta fetch 'em all! Throwing the ball at an enemy instantly kills it and captures it. The captured enemy can later be released and will be charmed until it dies, persisting between floors. 3
The Gamekid 93 The Gamekid Icon.png Temporary Man-Pac Upon use, turns the character into a into a Pac-Man-like creature for 5 seconds, granting invulnerability, inflicting fear on all enemies, and replenishing half a red heart container for every two enemies killed. 6
Glass Cannon DLC Indicator.png 352 Glass Cannon Icon.png Be gentle... When used, reduces Isaac's health to half a heart (including soul and black hearts) and fires one large piercing spectral tear that does a lot of damage. The damage done by Glass Cannon scales with Isaac's damage (at base damage it does 45 damage). 4 seconds
Glowing Hour Glass DLC Indicator.png 422 Glowing Hour Glass Icon.png Turn back time When used, this item will rewind time, put Isaac back in the previous room, and undo anything that happened in the current room. Any health, pickups, or items gained or lost will be reset back to the previous state. 2
The Hourglass 66 The Hourglass Icon.png Temporary enemy slowdown Upon activation, enemies and their projectiles are slowed down for a short duration. 2
How to Jump 282 How to Jump Icon.png It's about time you learned how Gives Isaac the ability to jump (over gaps, spikes, etc.). 0
Isaac's Tears 323 Isaac's Tears Icon.png Collected tears Shoots 8 tears around Isaac, which retain the damage, shot speed, and special effects of his tears. Each tear shot by Isaac increases item charge by one. 6
Kamikaze! 40 Kamikaze! Icon.png Become the bomb! Creates an explosion in the same area as Isaac, dealing half a heart of damage to him and also damaging all enemies caught in the blast radius. 0
Kidney Bean DLC Indicator.png 421 Kidney Bean Icon.png Love toots! Upon use, Isaac farts, charming all nearby enemies. 2
Lemon Mishap 56 Lemon Mishap Icon.png Oops Creates a small yellow pool of creep, which damages enemies that cross it. 2
Magic Fingers 295 Magic Fingers Icon.png Pay to play For 1 Coin, damages all enemies in the room. 0
Mega Bean DLC Indicator.png 351 Mega Bean Icon.png Giga fart! When used, the Mega Bean will freeze all enemies in the current room for a couple of seconds, deal 5 damage and poison any enemies near Isaac, and send a wave of spikes that deals 10 damage across the room in the direction Isaac is facing. 3
Metronome Afterbirth† Indicator.png 488 Metronome Icon.png Waggles a finger Grants a random item effect for the current room. 2
Mine Crafter DLC Indicator.png 427 Mine Crafter Icon.png Booom! When used, places an explosive TNT barrel that can be pushed and used to destroy rocks or damage enemies. If used a second time in the same room while the previous TNT barrel is still intact, it will remotely explode the TNT. 1
Mom's Bottle of Pills 102 Mom's Bottle of Pills Icon.png Reusable pill generator Gives Isaac a random pill, and will cause him to drop any held Q-slot item (If any). The player will only receive six different pill types in one playthrough. 6
Mom's Bra 39 Mom's Bra Icon.png Mass Fear Upon use, petrifies all enemies in the current room for approximately 4 seconds. 3
Mom's Pad 41 Mom's Pad Icon.png Gross... Upon use, inflicts fear to all enemies in the room for 5 seconds. 3
Monster Manual 123 Monster Manual Icon.png Temporary buddy generator Summons a random familiar for the current room. Can summon familiars not yet unlocked. 3
Monstro's Tooth 86 Monstro's Tooth Icon.png Summon Monstro Monstro jumps onto a random enemy, doing area damage. Can damage/kill the player if summoned in an room without enemies. 3
Mr. Boom 37 Mr. Boom Icon.png Reusable bomb buddy Drops a large bomb. 2
My Little Unicorn 77 My Little Unicorn Icon.png Temporary badass Upon use, grants invulnerability and increased speed for five seconds, removing the ability to shoot tears and replacing it with the ability to deal contact damage to enemies. 6
Notched Axe 147 Notched Axe Icon.png Rocks don't stand a chance Isaac holds the axe above his head for as long as the spacebar button is held (or until he leaves the room). While holding the axe, Isaac can break any rock he touches, but cannot attack or pick up other items. 3
Pause Afterbirth† Indicator.png 478 Pause Icon.png Stop! Freezes all enemies until a fire button is pressed. 2
The Pinking Shears 107 The Pinking Shears Icon.png Cut and Run Separates Isaac's head and body for the current room. Isaac's head, which now has flight, will be under the player's control, while his body will seek out enemies to attack by contact damage. 6
The Poop 36 The Poop Icon.png Plop! Spawns a pile of poop where the character is standing and knocks nearby monsters back. May yield pickups like regular poop. 1
Prayer Card 146 Prayer Card Icon.png Reusable eternity Grants an eternal heart per use. 6
Remote Detonator 137 Remote Detonator Icon.png Remote bomb detonation Bombs you place explode only when you use this item. Gives 5 bombs. 0
Satanic Bible 292 Satanic Bible Icon.png Reusable Evil Upon activation, Isaac gains a black heart. 6
Scissors 325 Scissors Icon.png Lose your head Upon use, turns Isaac's head into a stationary familiar for the current room which fires normal tears that deal 3.5 damage. NoDLC Indicator.png6
DLC Indicator.png2
Sharp Straw Afterbirth† Indicator.png 507 Sharp Straw Icon.png More blood! Damages all enemies in the room. 8 seconds
Shoop Da Whoop! 49 Shoop Da Whoop! Icon.png BLLLARRRRGGG! Fires a laser from Isaac's mouth. 2
Spider Butt 171 Spider Butt Icon.png Mass enemy slowdown + damage Damages all enemies in the room and slows them and their projectiles down. 2
Sprinkler Afterbirth† Indicator.png 516 Sprinkler Icon.png Sprinkles. Upon use, spawns a sprinkler that rotates and fires tears. 4
Telekinesis Afterbirth† Indicator.png 522 Telekinesis Icon.png The power of mind! Upon use, for the next two seconds, any enemy shots that come near Isaac are held in place. After the charge is depleted, they are fired back as tears. 3 seconds
Telepathy for Dummies 192 Telepathy for Dummies Icon.png Temporary psychic shot Upon activation, grants homing tears for the current room. 2
Teleport 44 Teleport Icon.png Teleport! Teleports you to a random room on the level. 2
Teleport 2.0 DLC Indicator.png 419 Teleport 2.0 Icon.png I-Teleport! When used, teleports Isaac to a random room that has not been explored yet. If all rooms are explored, including secret rooms, it will teleport Isaac to the Devil or Angel room. If all rooms are explored, including the Devil or Angel room, it will teleport Isaac to the I AM ERROR room. If used in a room with enemies, it will teleport Isaac out and back into the exact same room. 4
Undefined 324 Undefined Icon.png Undefined Teleports Isaac to either the Secret Room, Super Secret Room, Treasure Room, or I AM ERROR. 6
Unicorn Stump 298 Unicorn Stump Icon.png You feel stumped Upon use, grants invulnerability and increased speed for five seconds, but removes the ability to shoot tears. 1
Wait What? Afterbirth† Indicator.png 484 Wait What Icon.png I can't believe it's not Butter Bean! Isaac farts, sending out rock waves. 10 seconds
Yum Heart 45 Yum Heart Icon.png Reusable Regeneration Restores 1 whole red heart. 4

Passive Collectibles[edit | edit source]

Name ID Icon Quote Description
20/20 245 20 20 Afterbirth Icon.png Double shot Grants double shot.
3 Dollar Bill 191 3 Dollar Bill Icon.png Rainbow tears Gives Isaac a random tear effect every room.
NoDLC Indicator.png The effect given changes upon entering a room.
DLC Indicator.png The effect changes every 3 seconds.
8 Inch Nails DLC Indicator.png 359 8 Inch Nails Icon.png Stick it to 'em! +1.5 Damage Up. Replaces Isaac's tears with nails, which have increased knockback.
<3 15 Less Than Three Icon.png HP up Grants Isaac one red heart container and fully restores Isaac's health.
???'s Only Friend 320 Blue Baby's Only Friend Icon.png Controlled friend Summons a big attack fly that can be controlled with the shooting direction-keys.
A Quarter 74 A Quarter Icon.png +25 coins Adds 25 to Isaac's coin count, capping at 99.
Abel 188 Abel Icon.png Mirrored buddy A familiar that mirrors the player's movements and shoots in the opposite direction.
Acid Baby Afterbirth† Indicator.png 491 Acid Baby Icon.png Pills pills pills! Spawns a familiar that drops random pills every 2 rooms cleared. Upon using a pill, all enemies in the room are poisoned.
Adrenaline Afterbirth† Indicator.png 493 Adrenaline Icon.png Panic - power Increases damage based on how many empty heart containers Isaac has.
Analog Stick Afterbirth† Indicator.png 465 Analog Stick Icon.png 360 tears! Tears up. Allows Isaac to fire tears diagonally.
Anemic 214 Anemic Icon.png Toxic blood +5 range. After Isaac is damaged, a trail of red creep will be left behind Isaac until he leaves the current room.
Ankh 161 Ankh Icon.png Eternal life? Upon death, the player will respawn as ??? with 3 soul hearts.
Angry Fly Afterbirth† Indicator.png 511 Angry Fly Icon.png He's violent Spawns a fly familiar that orbits around a random enemy and deals 2 damage per tick to enemies it comes in contact with.
Anti-Gravity 222 Anti-Gravity Icon.png Antigravity tears + tears up -2 Tear Delay. Tears float in position until firing ceases, after which they will fly off in the direction they were shot in.
Apple! Afterbirth† Indicator.png 443 Apple! Icon.png Trick or treat? Increases tears. Adds a chance to fire a high-damage razor blade.
Aquarius 308 Aquarius Icon.png Trail of tears A trail of blue creep is left behind Isaac, which damages enemies.
Aries 300 Aries Icon.png Ramming speed +0.25 Speed. Running into enemies while at a high speed will deal 18 points of damage. Does not prevent contact damage.
BBF 272 BBF Icon.png Big Beautiful Fly Spawns 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.
Backstabber Afterbirth† Indicator.png 506 Backstabber Icon.png Watch your back! Has a chance to fire tears that inflict bleeding on enemies, causing them to slowly take damage over time.
Ball of Tar 231 Ball of Tar Icon.png Sticky feet... Adds a chance to shoot slowing tears and the character leaves a trail of slowing creep behind as he moves, impeding enemies' speed.
Best Bud 274 Best Bud Icon.png Sworn protector When hit, summons a white attack fly similar to Distant Admiration for the current room.
Betrayal DLC Indicator.png 391 Betrayal Icon.png Turn your enemy Every time Isaac takes damage, a charm effect is applied to every enemy in the room, causing them to attack each other rather than Isaac.
Big Chubby Afterbirth† Indicator.png 473 Big Chubby Icon.png Chub chub Spawns a familiar that slowly charges forward and damages enemies in its path.
Big Fan 279 Big Fan Icon.png Fat protector Spawns a large orbital familiar that blocks enemy projectiles and deals slight contact damage to enemies.
The Black Bean 180 The Black Bean Icon.png Toot on touch When taking damage, Isaac farts, causing poison damage to all enemies in range.
Blood of the Martyr 7 Blood of the Martyr Icon.png DMG up Increases Damage by 1, and turns Isaac's tears into blood tears.
Bloodshot Eye Afterbirth† Indicator.png 509 Bloodshot Eye Icon.png Bloody friend Spawns an orbiting eye familiar that fires tears every 2 seconds.
Bloody Lust 157 Bloody Lust Icon.png RAGE! Increases damage as Isaac receives damage. Damage increase stays for the whole floor.
Bob's Brain 273 Bob's Brain Icon.png Explosive thoughts Spawns a familiar that charges forward when shooting tears, explodes upon contact with an enemy and poisons them. Respawns after few seconds.
Bob's Curse 140 Bob's Curse Icon.png +5 poison bombs Gives 5 bombs and grants all bombs poison effect.
Bobby-Bomb 125 Bobby-Bomb Icon.png Homing bombs! Gives Isaac 5 Bombs, and causes all dropped bombs to home towards the closest enemy.
The Body 334 The Body Icon.png I feel all Adds 3 heart containers.
Bomb Bag 131 Bomb Bag Icon.png Gives bombs Isaac is followed by a small bag that drops a Bomb, 1+1 Free, or a Troll Bomb every 3 rooms.
Bomber Boy DLC Indicator.png 353 Bomber Boy Icon.png Explosive blast! +5 bombs. Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide). This also affects troll bombs.
Boom! 19 Boom! Icon.png 10 bombs Grants 10 bombs.
Bozo Afterbirth† Indicator.png 513 Bozo Icon.png Party time! Increases damage by a flat 0.1 and grants a soul heart. Enemies can randomly become briefly charmed or feared. Taking damage has a chance to spawn a rainbow poop.
Brother Bobby 8 Brother Bobby Icon.png Friends 'till the end Follows Isaac around shooting normal tears.
Bucket of Lard 129 Bucket of Lard Icon.png HP up Grants two empty heart containers and heals Isaac by half a heart, but decreases speed by 0.2.
Bum Friend 144 Bum Friend Icon.png He's greedy A portable beggar who follows Isaac, picks up coins for himself, and occasionally drops a pickup after collecting a coin. Does not spawn collectibles.
Bumbo DLC Indicator.png 385 Bumbo Icon.png Bumbo want coin! Spawns a beggar familiar which floats around the room and picks up any nearby coins, leveling up after collecting several coins. At level 2, Bumbo gains a body. At level 3, it begins to fire tears. At level 4, Bumbo chases enemies slowly, dealing contact damage.
Bursting Sack DLC Indicator.png 377 Bursting Sack Icon.png Spider love Spider enemies no longer target or deal contact damage to Isaac.
Butt Bombs 209 Butt Bombs Icon.png Toxic blast +5 bombs Gives +5 bombs and makes all bombs Butt Bombs that fill the room with gas, damaging and confusing all enemies.
Cain's Other Eye 319 Cain's Other Eye Icon.png Near sighted friend Spawns 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.
Camo Undies Afterbirth† Indicator.png 497 Camo Undies Icon.png Camo kid Isaac becomes camouflaged at the beginning of each room. Enemies will not attack Isaac until he starts firing tears.
Cancer 301 Cancer Icon.png HP up + you feel protected Adds 3 soul hearts. Grants The Wafer effect for the current room upon taking damage.
Capricorn 307 Capricorn Icon.png All stats up All stats up.
Celtic Cross 162 Celtic Cross Icon.png You feel blessed Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 7 seconds.
Charm of the Vampire 62 Charm of the Vampire Icon.png Kills heal Heals the character for half of a red heart for every 13 monsters killed.
Chemical Peel 154 Chemical Peel Icon.png DMG up Tears fired from left eye do increased damage.
Chocolate Milk 69 Chocolate Milk Icon.png Charge shots Grants charged tears that deal greater damage when fully charged.
The Common Cold 103 The Common Cold Icon.png Poison Damage Adds a chance to shoot poison tears, dealing damage over time when inflicted.
Compound Fracture Afterbirth† Indicator.png 453 Compound Fracture Icon.png Bone tears! Increases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
Cone Head Afterbirth† Indicator.png 457 Cone Head Icon.png Hard headed! Grants a soul heart. Adds a chance to block enemy shots.
Contagion Afterbirth† Indicator.png 466 Contagion Icon.png Outbreak! The first enemy killed in a room explodes and poisons nearby enemies. Poisoned enemies will also explode upon death.
Continuum DLC Indicator.png 369 Continuum Icon.png Transcendent tears +2.25 Range Up. +1.5 Tear Height. Isaac's tears travel through walls and appear out of the opposite wall. Isaac's tears also travel over rocks and objects.
Cricket's Body 224 Cricket's Body Icon.png Tears up + splash damage Grants -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.
Cricket's Head 4 Cricket's Head Icon.png DMG up Increases damage by 0.5, and multiplies it by 1.5x.
Cupid's Arrow 48 Cupid's Arrow Icon.png Piercing shots Grants Isaac piercing tears that travel through enemies (but not obstacles) instead of breaking on impact with them.
Curse of the Tower DLC Indicator.png 371 Curse of the Tower Icon.png You feel cursed... Causes Isaac to spawn 6 troll bombs on the floor every time he gets hit, similar to the Anarchist Cookbook mechanic.
Cursed Eye 316 Cursed Eye Icon.png Cursed charge shot Grants charged tears that can be fired in a tight burst of four. Getting hit while charging will teleport Isaac into another room.
Daddy Longlegs 170 Daddy Longlegs Icon.png Daddy's love Daddy Long Legs' shadow follows Isaac and stomps on enemies.
Dark Bum 278 Dark Bum Icon.png He wants to take your life Spawns a familiar that follows Isaac around and collects red hearts. For every one-and-a-half red hearts collected, Dark Bum will generate one soul heart, one hostile Spider or one friendly blue spider.
Dead Bird 117 Dead Bird Icon.png Protective buddy Spawns a flying familiar for the current room that chases enemies whenever Isaac takes damage.
Dead Eye DLC Indicator.png 373 Dead Eye Icon.png Accuracy brings power! Isaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.
Dead Onion 336 Dead Onion Icon.png Toxic aura tears Grants piercing and spectral tears. Increases tear size (without increasing damage) while greatly reducing range and shot speed.
Dead Tooth Afterbirth† Indicator.png 446 Dead Tooth Icon.png Halitosis While firing, Isaac gains a green aura that poisons nearby enemies.
Death's Touch 237 Death's Touch Icon.png Penetrative shot + damage up Increases 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.
Demon Baby 113 Demon Baby Icon.png Auto-turret friend Follows Isaac and automatically fires at enemies in its reach.
Depression Afterbirth† Indicator.png 469 Depression Icon.png :( Spawns a cloud familiar that leaves a trail of tears that damages enemies. Has a chance to spawn damaging beams of light onto enemies that touch the cloud.
Distant Admiration 57 Distant Admiration Icon.png Attack fly A red attack fly circles further out than the Halo of Flies / Pretty Flies, but closer than Forever Alone. Deals more damage than Forever Alone.
Dog Tooth Afterbirth† Indicator.png 445 Dog Tooth Icon.png Bark at the moon! Increases damage and speed. Upon entering a room adjacent to a secret room, a howl sound effect will play.
Dr. Fetus 52 Dr. Fetus Icon.png ??? Tears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.
Dry Baby 265 Dry Baby Icon.png Immortal Friend Spawns a familiar that follows Isaac around and blocks enemy projectiles. Upon blocking a shot, it has a chance of triggering The Necronomicon effect.
E Coli 236 E Coli Icon.png Turdy touch Gives "Turdy Touch" Effect. Enemies that touch Isaac are changed into poop.
Eden's Blessing DLC Indicator.png 381 Eden's Blessing Icon.png Your future shines brighter Tears up. Grants a random item at the start of the next run.
Epic Fetus 168 Epic Fetus Icon.png On-demand air strike Isaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.
Epiphora DLC Indicator.png 368 Epiphora Icon.png Intensifying tears Shooting in one direction increases Isaac's rate of fire until the cap is reached. As soon as Isaac changes direction or stops shooting, rate of fire is reset to its normal amount.
Euthanasia Afterbirth† Indicator.png 496 Euthanasia Icon.png Needle shot Adds a chance to fire needles. If a needle kills an enemy, it bursts into more needles.
Eve's Mascara 310 Eve's Mascara Icon.png Shot speed down + DMG up Doubles damage, halves tears stat, and greatly reduces shot speed.
Evil Eye DLC Indicator.png 410 Evil Eye Icon.png Eye shot! While firing tears, Isaac has a chance to fire an eye across the screen with a very slow shot speed, which will fire tears of its own in the same direction as Isaac. The eye will be destroyed if it comes into contact with an enemy or obstacle.
Experimental Treatment 240 Experimental Treatment Icon.png All stats up, then shuffled Randomly increases and decreases some of the character's stats. There will always be at least one stat increase and one decrease and the same stats can be increased/decreased multiple times.
Explosivo DLC Indicator.png 401 Explosivo Icon.png Sticky bomb shot! Isaac's tears have a chance to stick to enemies and explode.
Farting Baby DLC Indicator.png 404 Farting Baby Icon.png It farts! A familiar that follows Isaac and blocks tears. If a tear hits Farting Baby, there is a high chance for it to fart, which will either knock back, poison, or charm all nearby enemies.
Fast Bombs Afterbirth† Indicator.png 517 Fast Bombs Icon.png Faster bomb drops! Grants 7 bombs and allows bombs to be placed rapidly.
Fate's Reward DLC Indicator.png 361 Fate's Reward Icon.png Your fate beside you A blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.
Finger! Afterbirth† Indicator.png 467 Finger! Icon.png Watch where you point that! Spawns a finger familiar that points at enemies, dealing constant damage.
Fire Mind 257 Fire Mind Icon.png Flaming tears Grants 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.
Forever Alone 128 Forever Alone Icon.png Attack fly Spawns a blue attack fly that orbits a long distance from Isaac.
Friend Zone DLC Indicator.png 364 Friend Zone Icon.png Friendly fly A white orbiting fly which deals 3 contact damage per tick to enemies. This familiar orbits Isaac at a middle length distance somewhere between Distant Admiration and Forever Alone.
Fruit Cake DLC Indicator.png 418 Fruit Cake Icon.png Rainbow Effects! Isaac's tears gain a random effect that changes every shot.
GB Bug DLC Indicator.png 405 GB Bug Icon.png Game breaking bug, right away! A glitch familiar that bounces around the room and applies a random status effect to any enemies it comes into contact with and has a chance to re-roll pickups that it passes over.
Gemini 318 Gemini (Item) Icon.png Conjoined friend Suture becomes attached to Isaac, and does touch damage to enemies within its attacking range.
Ghost Baby 163 Ghost Baby Icon.png Spectral buddy Spawns a familiar that follows Isaac around and fires spectral tears.
Ghost Pepper Afterbirth† Indicator.png 495 Ghost Pepper Icon.png Flame tears Adds a chance to shoot a fire that damages enemies and remains in place until it deals enough damage or the room is left.
Gimpy 225 Gimpy Icon.png Sweet Suffering Has a chance of spawning a soul heart or black heart when taking damage. Enemies have a chance to drop a Half Red Heart after being killed.
Glitter Bombs DLC Indicator.png 432 Glitter Bombs Icon.png Prize Bombs! Gives Isaac 5 bombs, and makes Isaac's bombs have a chance to drop random pickups or charm enemies when they explode.
Glaucoma Afterbirth† Indicator.png 460 Glaucoma Icon.png Blind tears! Adds a chance to shoot concussive tears, causing enemies to walk around randomly.
Gnawed Leaf 210 Gnawed Leaf Icon.png Unbreakable After standing still and not shooting for a short time, Isaac turns invincible until he moves or shoots.
God's Flesh DLC Indicator.png 398 God's Flesh Icon.png Shrink shot Tears now have a random chance to apply a shrinking effect, causing enemies to shrink in size and also run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.
Guillotine 206 Guillotine Icon.png An out-of-body experience Isaac's head is removed from his body and floats around him. Increases Damage by 1 and grants -1 Tear Delay.
The Halo 101 The Halo Icon.png All stats up Grants one Heart Container, +0.3 Damage, +0.2 Tears, +0.25 Range, +0.3 Speed, and +0.5 Tear Height.
Haemolacria Afterbirth† Indicator.png 531 Haemolacria Icon.png I'm seeing red... Tears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.
Halo of Flies 10 Halo of Flies Icon.png Projectile protection Spawns two pretty fly familiars that block enemy shots and deal contact damage to enemies.
Harlequin Baby 167 Harlequin Baby Icon.png Double shot buddy Spawns a familiar that follows Isaac around and fires two tears at once in a V-pattern.
Headless Baby 269 Headless Baby Icon.png Bloody Friend Familiar that follows Isaac, leaving blood creep on the ground.
Holy Light DLC Indicator.png 374 Holy Light Icon.png Holy shot! Isaac has a random chance to fire a Holy tear, which when it hits an enemy, will spawn a Crack the Sky style light beam on the same enemy, dealing damage.
Holy Mantle 313 Holy Mantle Icon.png Holy shield Automatically negates first taken damage in every room.
Holy Water 178 Holy Water Icon.png Splash! When Isaac receives damage, the bottle breaks and a puddle of blue creep forms, which damages non-flying enemies, similar to Lemon Mishap. The bottle is reformed upon entering a different room.
Host Hat DLC Indicator.png 375 Host Hat Icon.png Nice hat! A host familiar that sits on Isaac's head and has a random chance to block enemy shots and retaliate with 3 tears. Grants immunity to explosions.
Hot Bombs 256 Hot Bombs Icon.png Burning blast +5 bombs Grants 5 bombs. Isaac's bombs leave behind fire that damages enemies upon contact.
Hushy Afterbirth† Indicator.png 470 Hushy Icon.png Lil hush! Spawns a Hush familiar that bounces around the room and deals contact damage. While firing tears, it stops moving.
Infamy 242 Infamy Icon.png Damage Reduction Chance to block projectiles coming from any direction.
Infestation 2 234 Infestation 2 Icon.png Infestation shot Spawns allied blue spiders from killed enemies.
Infestation 148 Infestation Icon.png They grow inside 1-3 Blue flies randomly spawn every time Isaac gets hit.
The Inner Eye 2 The Inner Eye Icon.png Triple shot Grants triple shot but decreases tears.
Ipecac 149 Ipecac Icon.png Explosive shots Replaces tears with explosive and poisoning projectiles fired in an arc from the mouth.
Iron Bar 201 Iron Bar Icon.png Concussive tears Increases damage by 0.3 and adds a chance to shoot concussive tears, causing enemies to walk around randomly.
Isaac's Heart 276 Isaac's Heart Icon.png Protect It Isaac himself is now immune to all damage, and a heart familiar appears and follows Isaac. If the heart is hurt, Isaac is hurt.
Jacob's Ladder Afterbirth† Indicator.png 494 Jacob's Ladder Icon.png Electric tears Tears fire sparks of electricity in random directions upon hitting an obstacle or enemy.
Judas' Shadow 311 Judas' Shadow Icon.png Sweet revenge Adds an extra life; upon death, it respawns Isaac as Black Judas with only two black hearts.
Juicy Sack 266 Juicy Sack Icon.png Sticky babies A familiar that follows behind Isaac. It drips a trail of creep, which slows enemies, and spawns 1-2 blue spiders after each room.
Key Bum DLC Indicator.png 388 Key Bum Icon.png He wants your keys! Spawns a portable key master that follows Isaac and collects keys, giving random chests in return.
Kidney Stone DLC Indicator.png 440 Kidney Stone Icon.png Matt's kidney stone Randomly while firing tears, Isaac will stop firing and turn red, where he will charge and release a lot of 'tears' in one go. In the burst of tears is a kidney stone which deals a lot of damage.
Lachryphagy Afterbirth† Indicator.png 532 Lachryphagy Icon.png Feed them! Isaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.
Large Zit Afterbirth† Indicator.png 502 Large Zit Icon.png Creep shots Adds a chance to fire a creep shot that deals double damage and leaves a trail of slowing white creep.
Lazarus' Rags 332 Lazarus' Rags Icon.png Eternal Life? Upon dying, resurrect as Revived Lazarus with one heart container and Anemic item.
Lead Pencil Afterbirth† Indicator.png 444 Lead Pencil Icon.png He's a bleeder! After every 15 tears fired, Isaac will fire a high-damage cluster of tears.
Leech 270 Leech Icon.png Blood sucker Spawns a friendly familiar leech on the ground that hunts down enemies and heals you for half a heart each time it eats one.
Leo 302 Leo Icon.png Stompy Allows you to crush rocks when you walk over them.
Leprosy Afterbirth† Indicator.png 525 Leprosy Icon.png You're tearing me apart! Upon taking damage, grants a body part as an orbital, which blocks enemy shots and deals 7 damage per tick to enemies it comes in contact with. The orbitals will be destroyed if they take enough damage from enemies or enemy shots.
Libra 304 Libra Icon.png You Feel Balanced Gives 6 coins, 6 bombs, and 6 keys and balances out all attributes.
Lil Gurdy DLC Indicator.png 384 Lil Gurdy Icon.png A gurd of your own! Gives Isaac a Gurdy familiar that will charge around the room dealing contact damage to enemies. Lil Gurdy is charged by holding down a fire button and letting go. The longer the button is held, the faster Lil Gurdy will fling itself across the screen. Lil Gurdy can pass over objects and obstacles in the room.
Lil' Loki DLC Indicator.png 435 Lil' Loki Icon.png 4-way buddy! A Loki familiar that follows Isaac and shoots 4 tears in a cross pattern.
Lil Monstro Afterbirth† Indicator.png 471 Lil Monstro Icon.png Ain't he cute? Spawns a familiar that fires clusters of tears. Must be charged before shooting.
Lil Brimstone 275 Lil Brimstone Icon.png Evil Friend A Familiar that shoots a small Brimstone beam. Must charge like the Brimstone Item before shooting.
Lil Haunt 277 Lil Haunt Icon.png Fear him A familiar that damages enemies by chasing them as well as inducing the fear effect.
Linger Bean Afterbirth† Indicator.png 447 Linger Bean Icon.png Crying makes me toot Adds a chance to fire a gas cloud that damages nearby enemies.
Little C.H.A.D. 96 Little C.H.A.D. Icon.png Gives kisses A familiar who will drop a half red heart every 2 rooms.
Little Chubby 88 Little Chubby Icon.png Attack Buddy A familiar that charges forward and deals touch damage to any enemies in its path.
Little Gish 99 Little Gish Icon.png Sticky friend Spawns a familiar that follows Isaac around and fires slowing tears, impeding enemies' speed.
Little Steven 100 Little Steven Icon.png Psychic friend Spawns a familiar that follows Isaac around and fires homing tears.
Loki's Horns 87 Loki's Horns Icon.png Cross Tears Gives a random chance for projectiles to fire in all 4 cardinal directions.
Lost Contact 213 Lost Contact Icon.png Shielded tears Every tear has a small shield which will allow it to block one enemy projectile.
Lost Fly DLC Indicator.png 365 Lost Fly Icon.png Lost protector A familiar fly that moves in a straight line and attaches itself to the first obstacle or wall it comes into contact with in each room. If any enemies walk into its path, it will deal 7 contact damage per tick. If the obstacle it is attached to is destroyed then it will continue rolling in the direction it was previously travelling until it meets another wall or obstacle.
Lucky Foot 46 Lucky Foot Icon.png Luck up +1 Luck. Increases chance of winning Shell Game Beggar. (Independent of luck stat)
The Ludovico Technique 329 The Ludovico Technique Icon.png Controlled Tears Instead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.
Lusty Blood DLC Indicator.png 411 Lusty Blood Icon.png Their blood brings rage! Each time Isaac kills an enemy, Isaac's damage increases for the current room.
Maggy's Bow 312 Maggy's Bow Icon.png HP up + you feel healthy Gives one heart container and doubles the healing provided by red hearts.
Magic Mushroom 12 Magic Mushroom Icon.png All Stats Up! Increases all stats and enlargens Isaac.
Magneto 53 Magneto Icon.png Item snatcher Pulls pickups towards Isaac.
Marked DLC Indicator.png 394 Marked Icon.png Directed tears Isaac will now fire tears automatically directed at a red target on the ground which is controlled by the player. This allows for a full 360 degree tear firing radius. Can be overridden by other tear modifiers such as Mom's Knife or Brimstone.
Metal Plate Afterbirth† Indicator.png 449 Metal Plate Icon.png It itches... Adds a chance to reflect enemy shots. Grants one soul heart.
Midas' Touch 202 Midas' Touch Icon.png Golden touch Enemies that touch you are stunned and turn gold. Any enemy killed while in this state will drop a coin.
Milk! DLC Indicator.png 436 Milk! Icon.png Don't cry over it... A glass of milk follows Isaac and spills on the floor upon taking damage. After the milk spills, Isaac's tear delay is decreased by 2 for the rest of the room.
The Mind 333 The Mind Icon.png I know all Grants the combined effects of the Blue Map, Treasure Map, and The Compass, revealing the floor layout and all special rooms, including Secret Rooms and Super Secret Rooms.
Mini Mush 71 Mini Mush Icon.png Speed + range up Increases Speed and Shot Height and decreases Isaac's size, but lowers Range.
Mitre 173 Mitre Icon.png You Feel Blessed Grants a chance of converting any red hearts pickups into soul hearts instead.
Mom's Contacts 110 Mom's Contacts Icon.png Freeze effect Adds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.
Mom's Eyeshadow 200 Mom's Eyeshadow Icon.png Charm tears Tears have a chance to charm enemies.
Mom's Eye 55 Mom's Eye Icon.png Eye in the back of your head Allows Isaac to fire tears from the back of his head.
Mom's Knife 114 Mom's Knife Icon.png Stab stab stab Isaac'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.
Mom's Perfume 228 Mom's Perfume Icon.png Fear shot Adds a chance to shoot fear tears and decreases tear delay by 1.
Mom's Razor Afterbirth† Indicator.png 508 Mom's Razor Icon.png It's sharp! Spawns an orbiting razor that damages enemies it touches and inflicts bleeding on enemies, causing them to slowly take damage over time.
Mom's Wig 217 Mom's Wig Icon.png You feel itchy... Adds a chance to spawn blue spiders when firing tears. Restores 1 red heart.
Money = Power 109 Money = Power Icon.png $$$ = DMG Increases damage by 0.04 for every coin Isaac has, up to +3.96 damage at 99 coins.
Mongo Baby 322 Mongo Baby Icon.png Mongo Friend Summons a familiar that copies the tears of Isaac's other familiars.
Monstro's Lung 229 Monstro's Lung Icon.png Charged attack Increases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.
Mr. Mega 106 Mr. Mega Icon.png Blast damage Gives Isaac 5 bombs, and makes all dropped bombs larger, which have an increased blast radius and increased damage.
The Mulligan 151 The Mulligan Icon.png They grow inside Tears have a 1/6 chance of spawning allied blue flies when they hit an enemy.
Multidimensional Baby DLC Indicator.png 431 Multidimensional Baby Icon.png ydduB Buddy Spawns a familiar that will follow Isaac's movements on a 2.5 second delay. Tears that pass through the baby will be doubled and increase in speed.
Mutant Spider 153 Mutant Spider Icon.png Quad shot Grants quadruple shot but decreases tears.
My Reflection 5 My Reflection Icon.png Boomerang tears Gives Isaac's tears a boomerang effect, and increases range and shot speed.
Mysterious Liquid 317 Mysterious Liquid Icon.png Toxic Splash Damage Tears leave a small, short lasting pool of creep on impact or when their range is depleted.
Mystery Sack 271 Mystery Sack Icon.png ? Spawns a familiar that follows Isaac around and has a chance to drop a heart, coin, bomb, or key after clearing a room.
No. 2 DLC Indicator.png 378 No. 2 Icon.png Uh oh... Continuously firing tears for several seconds causes Isaac to drop a Butt Bomb. Butt Bombs explode for 50 damage like normal bombs, but also deal 10 damage to all enemies in the room and daze them for a short period of time.
Number One 6 Number One Icon.png Tears up Tears range is heavily decreased, but the fire rate is greatly increased.
Obsessed Fan DLC Indicator.png 426 Obsessed Fan Icon.png Follows my every move... A purple fly familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.
Odd Mushroom 121 Odd Mushroom (Large) Icon.png DMG up Grants an empty heart container. Increases damage, range and shot height while reducing speed.
Odd Mushroom 120 Odd Mushroom (Thin) Icon.png Fire rate up Increases Tears and Speed while reducing Damage.
Ouija Board 115 Ouija Board Icon.png Spectral tears Grants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them.
PHD 75 PHD Icon.png Better pills Converts all bad pills into good pills, spawns one pill pickup and restores health. Identifies all pills upon pickup.
Papa Fly DLC Indicator.png 430 Papa Fly Icon.png Turret follower A blue fly familiar follows Isaac's movements on a 3 second delay. Papa Fly will fire tears at nearby enemies.
The Parasite 104 The Parasite Icon.png Split Shot Isaac's tears split in two when they hit something.
Parasitoid Afterbirth† Indicator.png 461 Parasitoid Icon.png Egg tears! Adds a chance to fire an egg sack which spawns slowing creep and spawns a blue fly or spider upon hitting an enemy.
The Peeper 155 The Peeper Icon.png Plop! Spawns a familiar that floats slowly around the room on a zig-zag pattern similar to Boom Flies damaging enemies it passes through.
Piggy Bank 227 Piggy Bank Icon.png My life savings Gives 3 pennies on pick-up. Every time Isaac is damaged, he will drop one additional penny.
Pisces 309 Pisces Icon.png Tears up + knock-back shots -1 Tear Delay, adds knock-back shots and increases tear size.
Polyphemus 169 Polyphemus Icon.png Mega Tears Makes 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.
Pop! Afterbirth† Indicator.png 529 Pop! Icon.png Eyeball tears! Replaces Isaac's tears with eyeballs that can bounce off of each other. The eyeballs are not limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle.
Proptosis 261 Proptosis Icon.png Short range mega tears Tears start out massive with high damage, and then shrink down and become weaker over a short range.
Punching Bag 281 Punching Bag Icon.png Scape Goat Spawns a Mulligan Familiar that will wander the room randomly. Enemies will attack the Mulligan if it's closer.
Pupula Duplex DLC Indicator.png 379 Pupula Duplex Icon.png Wide shot Transforms Isaac's tears into a wide arc shape which gives them a much larger hitbox. Gives Isaac spectral tears which allows them to travel through objects in the environment (i.e. rocks).
Purity DLC Indicator.png 407 Purity Icon.png Aura stat boost This item will boost one of Isaac's stats depending on the color of the aura around him. The aura will disappear upon taking damage and will reappear with a random color upon entering a new room. A red aura boosts damage, a blue aura boosts rate of fire, a yellow aura boosts speed, and an orange aura boosts range.
Pyromaniac 223 Pyromaniac Icon.png It hurts so good +5 Bombs Isaac heals 1 heart instead of taking damage from an explosive source. Adds 5 bombs.
Pyro 190 Pyro Icon.png 99 bombs Adds 99 bombs.
Rainbow Baby 174 Rainbow Baby Icon.png Random buddy Spawns a familiar that follows Isaac around and fires tears with random effects.
The Relic 98 The Relic Icon.png Soul generator Isaac is followed by a small blue cross that will drop a Soul Heart every 4 rooms.
Robo-Baby 2.0 267 Robo-Baby 2.0 Icon.png We worked out all the kinks Fires lasers at any enemy in its line of sight and moves based on the direction Isaac is firing tears.
Robo-Baby 95 Robo-Baby Icon.png Friends 'till the bbbbzzzt Follows Isaac around, shooting enemies with an eye laser similar to Technology.
Roid Rage 14 Roid Rage Icon.png Speed and range up Increases speed by 0.6, range by 5.25, and tear height by 0.5.
Rosary 72 Rosary Icon.png Faith up Adds 3 Soul Hearts and increases the chance for The Bible to appear in any item pool.
Rotten Baby 268 Rotten Baby Icon.png Infested friend A familiar that spawns blue flies.
Rubber Cement 221 Rubber Cement Icon.png Bouncing tears Tears bounce off walls, enemies, and environmental objects.
Rune Bag DLC Indicator.png 389 Rune Bag Icon.png Rune generator A bag that follows Isaac and drops a random rune every 3 rooms.
Sack of Pennies 94 Sack of Pennies Icon.png Gives money Isaac is followed by a small bag that drops a coin every 2 rooms.
Sacrificial Dagger 172 Sacrificial Dagger Icon.png My fate protects me Dagger orbits Isaac, dealing very high damage.
Sad Bombs 220 Sad Bombs Icon.png Tear blast +5 bombs +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.
The Sad Onion 1 The Sad Onion Icon.png Tears up Increases Tears by 0.7.
Sagittarius 306 Sagittarius Icon.png Penetrative shot + speed up Increases speed by +0.2 and grants piercing tears.
Samson's Chains 321 Samson's Chains Icon.png The ol' ball and chain Pull a chain and ball behind you that will damage enemies on contact and is able to break stones.
Scapular 142 Scapular Icon.png You have been blessed Once per room, when Isaac is reduced to his last half red Heart, the aura around his head temporarily vanishes and he is granted one Soul Heart.
Scatter Bombs DLC Indicator.png 366 Scatter Bombs Icon.png 'We put bombs in your bombs!' Adds 5 bombs. Isaac's bombs explode into 2-4 tiny bombs
Scorpio 305 Scorpio Icon.png Poison tears Grants poison tears, which deal damage over time when inflicted.
Seraphim DLC Indicator.png 390 Seraphim Icon.png Sworn friend An angel familiar which follows Isaac and fires homing tears which deal 10 damage at -25% shot speed and a reduced fire rate.
Serpent's Kiss DLC Indicator.png 393 Serpent's Kiss Icon.png The kiss of death Tears now have a random chance to apply a poison effect, causing 4 or 6 damage per tick to enemies (Similar to The Common Cold item). Isaac now deals poison damage on contact with enemies similar to The Virus item (Damage over time 4 or 6 per tick). Enemies that were poisoned have a chance to drop a black heart when killed.
Shard of Glass Afterbirth† Indicator.png 448 Shard of Glass Icon.png Blood and guts! Upon taking damage, Isaac has a chance to drop a full red heart, gain 5 range, and leave a trail of damaging red creep for the current room.
Sinus Infection Afterbirth† Indicator.png 459 Sinus Infection Icon.png Booger tears! Adds a chance to fire a booger which sticks to enemies and poisons them.
Sissy Longlegs 280 Sissy Longlegs Icon.png She loves you Wanders about the room, occasionally spawning blue spiders.
Sister Maggy 67 Sister Maggy Icon.png Friends 'till the end A familiar that follows Isaac around shooting blood tears.
Smart Fly 264 Smart Fly Icon.png Revenge fly After Isaac takes damage, this fly will deal continuous touch damage to whatever enemy caused the damage until it is dead. The fly will then systematically attack 1 enemy at a time until the room is cleared.
The Soul 335 The Soul Icon.png I am all Grants two soul hearts. Isaac now repels enemy projectiles.
Soy Milk 330 Soy Milk Icon.png DMG Down + Tears Way Up Tears shrink and do much less damage, but fire in very rapid succession.
Speed Ball 143 Speed Ball Icon.png Speed + shot speed up Increases speed by 0.3 and shot speed by 20%.
Spelunker Hat 91 Spelunker Hat Icon.png See-through doors Reveals type of adjacent rooms, including location for secret rooms and super secret rooms.
Spider Bite 89 Spider Bite Icon.png Slow effect Adds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them.
Spider Baby 211 Spider Baby Icon.png Spider revenge When hit, spawns up to 2 blue spiders.
Spoon Bender 3 Spoon Bender Icon.png Homing shots Grants Isaac homing tears.
Stem Cells 176 Stem Cells Icon.png HP up Adds one filled heart container and increases Shot Speed.
Sticky Bombs DLC Indicator.png 367 Sticky Bombs Icon.png Egg sack bombs! +5 bombs. Bombs stick to enemies and spawn 2-4 blue spiders if they kill an enemy.
Stigmata 138 Stigmata Icon.png DMG + HP up Increases damage, and adds 1 heart container.
Strange Attractor 315 Strange Attractor Icon.png Magnetic tears Pickups, trinkets, and monsters are magnetically attracted to Isaac's tears.
Sulfuric Acid Afterbirth† Indicator.png 463 Sulfuric Acid Icon.png Acid tears! Increases damage. Adds a chance to fire acidic tears which can destroy obstacles.
Super Bandage 92 Super Bandage Icon.png +2 hearts Grants one Heart Container and gives 2 Soul Hearts.
Taurus 299 Taurus Icon.png Speed down + rage is building Speed down; gains speed while in a room with enemies until gaining My Little Unicorn effect for a few seconds.
Tech X DLC Indicator.png 395 Tech X Icon.png Laser ring tears Tears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.
Tech.5 244 Tech.5 Icon.png It's still being tested... Grants 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.
Technology 2 152 Technology 2 Icon.png Laser Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously.
Technology 68 Technology Icon.png Laser tears Replaces tears with a piercing laser with unlimited range.
Technology Zero Afterbirth† Indicator.png 524 Technology Zero Icon.png Static tears! Connects Isaac's tears with electricity that can damage enemies.
Thunder Thighs 314 Thunder Thighs Icon.png HP up + speed down + you feel stompy Destroys rocks upon contact with Isaac. Adds one heart container, and lowers Speed.
Tiny Planet 233 Tiny Planet Icon.png Orbiting tears + range up Range up and makes shot tears revolve around Isaac until they drop.
Tough Love 150 Tough Love Icon.png Tooth shot Adds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears.
Toxic Shock DLC Indicator.png 350 Toxic Shock Icon.png Mass poison Upon entering a room, poisons all enemies, dealing double Isaac's tear damage. Killing enemies leaves a small, short lasting pool of green creep on the ground.
Tractor Beam DLC Indicator.png 397 Tractor Beam Icon.png Control your tears Isaac emits a beam from his face. Isaac's tears travel in the path of the beam.
Varicose Veins Afterbirth† Indicator.png 452 Varicose Veins Icon.png I'm leaking... Taking damage releases a ring of 10 high damage tears.
Virgo 303 Virgo Icon.png You feel refreshed and protected Grants 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".
The Virus 13 The Virus Icon.png Poison touch Inflicts poison to enemies who make contact with Isaac. Speed down.
The Wafer 108 The Wafer Icon.png Damage resistance All sources of damage that would cause more than one half heart of damage are reduced to one half heart instead.
The Wiz DLC Indicator.png 358 The Wiz Icon.png Double wiz shot! Tears simultaneously fire out of both eyes diagonally, similar to the effect of the R U A Wizard? pill. Isaac's tears also travel above all obstacles.
X-Ray Vision 76 X-Ray Vision Icon.png I've seen everything Reveals and opens all Secret Room and Super Secret Room entrances.
YO LISTEN! Afterbirth† Indicator.png 492 YO LISTEN! Icon.png Yo listen! Increases luck. Spawns a fairy familiar that points out secret room entrances and tinted rocks.
Zodiac DLC Indicator.png 392 Zodiac Icon.png The heavens will change you Zodiac will give Isaac a random zodiac item effect that changes after every floor.