Pills

Pickups

Hearts

Coins

Bombs

Keys

Batteries

Pills

Cards/Runes

Chests

Sacks

Pills are pickups that can provide useful or inhibiting effects. They take up the same slot as cards and runes.

At the start of each run, an effect is randomly assigned to each color of pill. The pill effect for that color will remain constant throughout the run. (However, it is possible for PHD or Virgo to reassign some of the effects, such that 2 different colored pills will have the same effect.) The set of pill effects for any given run is usually known as the pill pool.

• Template:Afterbirth The pill pool for each run has increased from 9 to 13.

Pill Effects

Pill	Effect
48 Hour Energy	Drops one to two Little Batteries and fully charges the spacebar item. Template:Afterbirth Can be used with the Placebo to generate infinite batteries.
Amnesia	Replaces the floor map with a ? for the rest of the floor. If no other curses are active for the floor, the Curse of the Lost will appear under the level name when TAB is held. This effect cannot be negated by Black Candle. Template:Afterbirth Also the only pill to have its flavour text appear on a piece of paper, like curses do.
Bad Gas	Isaac farts, poisoning enemies around him.
Bad Trip	Injures Isaac by a full heart. If a Bad Trip pill is used while Isaac only has a single heart left or less, the pill will turn into a Full Health pill instead. (This damage counts as red heart damage for the purposes of getting a Devil Deal.)
Balls of Steel	Grants Isaac two soul hearts.
Bombs Are Key	Switches number of bombs and keys.
Explosive Diarrhea	Spawns five active bombs behind Isaac over a period of five seconds, at one a second.
Full Health	Restores all health.
Health Down	Removes one red heart container upon use. While Isaac has one or fewer red heart containers, it will act as a Health Up pill instead.
Health Up	Adds one empty red heart container upon use.
Hematemesis	Empties all but one red heart container and spawns 1-4 full red heart pickups. If Isaac only has half of a heart left, it will heal him to one heart. If used without any red heart containers, no health will be deducted, but red hearts will still spawn. If used in a Black Heart or Eternal Heart-containing Super Secret Room, it will spawn those types of hearts instead.
I Can See Forever	Opens all entrances to the Secret Room and Super Secret Room for the current floor.
I Found Pills	Changes the appearance of Isaac's face. This pill is cosmetic only, Template:NoDLC and the effect disappears when you leave the room.
Lemon Party	Spawns a large yellow pool (similar to Lemon Mishap) around your character. Greatly damages any enemy that steps on it.
Luck Down	Decreases Isaac's luck by 1.
Luck Up	Increases Isaac's luck by 1.
Paralysis	Prevents Isaac from moving for a short duration.
Pheromones	Charms all enemies in the room for a short period of time.
Puberty	Causes Isaac to grow four hairs from the top of his head and zits on his face. This pill is cosmetic only, and will stay for the rest of the run. Template:Afterbirth+ Consuming three puberty pills will grant the Adult transformation.
Pretty Fly	Grants 1 fly orbital that circles the player, blocking projectiles and damaging fly-type enemies on touch.
Range Down	Decreases Isaac's range by 2.
Range Up	Increases Isaac's range by 2.5.
R U a Wizard?	Tears are shot diagonally outwards for about one minute. This effect does not reset upon exiting the room.
Speed Down	Decreases Isaac's movement speed by 0.12.
Speed Up	Increases Isaac's movement speed by 0.15.
Tears Down	Decreases Isaac's tears by 0.28.
Tears Up	Increases Isaac's tears by 0.35.
Telepills	Isaac gets teleported to a random room. Has a small chance to teleport Isaac to the I AM ERROR room, and an extremely small chance to teleport him to the Black Market, like Undefined.
Template:Afterbirth Afterbirth
Addicted	Makes Isaac take a full heart of damage from all sources for the current room. Unlocked by completing Challenge #24: PAY TO PLAY.
Friends Till The End!	Spawns three Blue Flies.
Infested!	Destroys all poop in the room and spawns a single Blue Spider under Isaac and on each destroyed poop.
Infested?	Spawns Blue Spiders equal to the number of enemies in the room. If there are no enemies in the room, spawns 1-3 Blue Spiders.
One Makes You Small	Decreases Isaac's size and increases the pitch of his voice. This effect decreases the size of Isaac's hitbox.
One Makes You Larger	Increases Isaac's size and decreases the pitch of his voice. This effect does not increase the size of Isaac's hitbox. Template:Afterbirth+ These pills contribute to the Stompy transformation.
Percs	Gives The Wafer effect while in the room. Unlocked by completing Challenge #24: PAY TO PLAY.
Power Pill	Activates an effect similar to The Gamekid.
Re-Lax	For a short time, poop spawns wherever Isaac moves, like Explosive Diarrhea but with poop. A higher move speed means you can touch more tiles in the same time. A pun on laxatives. Unlocked by completing Challenge #25: Have a Heart.
Retro Vision	Briefly pixelates the screen 3 times over 30 seconds.
???	Gives the Curse of the Maze effect for the remainder of the floor. The effect can stack with other curses. If no other curses are active for the floor, Curse of the Maze will appear under the level name when TAB is held. This effect cannot be negated by Black Candle. Unlocked by completing Challenge #25: Have a Heart.
Template:Afterbirth+ Afterbirth †
Feels Like I'm Walking on Sunshine!	Temporarily makes Isaac invincible, similar to Unicorn Stump. Unlocked by acquiring the Sin Collector achievement.
Gulp!	Upon use, any trinkets that the player is holding are destroyed, and their effects are permanently applied to the player. Unlocked by acquiring the Once More With Feeling! achievement.
Horf!	Upon use, Isaac shoots an explosive tear with the Ipecac effect. Unlocked by acquiring the Dedication achievement.
I'm Drowsy...	Upon use, slows all enemies for the duration of the room.
I'm Excited!!!	Upon use, increases the speed of all enemies for the duration of the room. The effect triggers again 30 seconds after use and 60 seconds after use.
Something's Wrong...	Creates a pool of black creep beneath Isaac.
Vurp!	Throws up the last pill you used. Will spawn itself if no other pills were taken beforehand. Unlocked by acquiring the U Broke It! achievement.
X-Lax	Creates a pool of slippery brown creep underneath Isaac.

Pill Appearances

Template:Afterbirth

Notes

• Among the attribute modifying pill effects, only five of the seven visible attributes are covered: health, range, tears, speed, and luck. Both shot speed and damage can't be altered by pills.
• Template:Afterbirth Pill effects have a chance to be narrated upon use, as are cards and runes.
• Template:Afterbirth Currently, the "Retro Vision" pill effect can crash the game on some machines, resulting in restarting the current floor when the game is continued.
• Template:Afterbirth The "Addicted!" pill will have no effect if Isaac has The Wafer.
• Having Midas' Touch and using a "Re-Lax" pill has a chance to spawn golden poop.
• Template:Afterbirth+ Having Meconium and using a "Re-Lax" pill has a chance to spawn black poop.
• Template:Afterbirth Using an "Infested!" pill on red poop will spawn blue spiders and the red poop will regenerate.

Strategy

• Use of unidentified pills is recommended for outside of combat as Hematemesis, R U a Wizard, Paralysis, Template:Afterbirth Addicted!, and Template:Afterbirth+ I'm Excited!!! can be detrimental mid-fight. However, Template:Afterbirth+ I'm Drowsy..., Template:Afterbirth Percs, Template:Afterbirth Power Pill, Lemon Party, Bad Gas, and Pheromones are nearly useless outside of combat.
• Template:Afterbirth The invincibility effect from Power Pill and Template:Afterbirth+ Feels like I'm walking on sunshine! can be utilized to get into Curse Rooms or play Blood Donation machines without taking any damage.

Trivia

• Hematemesis is the vomiting of blood.
• Lemon Party is an internet shock site featuring a group of elderly men performing oral sex.
• Template:Afterbirth+ The Vurp! pill is a portmanteau of the words vomit and burp.
• Template:Afterbirth Power Pills activating the Gamekid effect is a reference to Pacman in which the "Super-Pac" powerup is obtained by eating a Power Pellet.
• I Found Pills (and Ate Them), R U a Wizard? and I can see Forever are all image macro memes.
• The Feels like I'm walking on sunshine! pill is a reference to the 80s song Walking on Sunshine.
• Balls of Steel is a reference to Duke Nukem; it is one of Duke's more famous quotes.
• Despite being called I Can See Forever, the effects only last for the rest of that floor.
• Explosive Diarrhea is extremely loud and forceful diarrhea. In the original game, the message that displayed when the pill was activated was "Oh No!"
• Even though it plays a negative "buzzer" sound effect when used, Explosive Diarrhea could potentially be useful. The same goes for Puberty, which is completely neutral and has a positive effect in Afterbirth+.
• In the original game, Wrath of the Lamb, there was another positive pill effect called "Friends Til The End", which summoned 3 blue attack flies. This effect was improved and given to the Rune Berkano in Rebirth.
  • Template:Afterbirth The pill effect was re-added.
  • Template:Afterbirth Note that the "Infested?" and "Infested!" pill effects are similar to the original "Friends Til The End" effect, but instead of spawning three flies, a variable number of spiders spawn.
• Template:Afterbirth The Friends Till The End! pill is the only non-narrated pill.
  • Template:Afterbirth+ The Friends till the End! pill now has narration.
• 48 Hour Energy is a reference to the drink 5 Hour Energy.
• Template:Afterbirth "One makes you larger" and "One makes you small" are references to Alice in Wonderland.
• Template:Afterbirth "Percs" is a reference to a street name for the prescription drug Percocet, which is more generically known as Oxycodone. This drug is meant to be used to treat pain, but often abused for recreational purposes.
  • It may also be be a play on the word "perk".
• Template:Afterbirth The "Re-Lax" and Template:Afterbirth+ "X-Lax" pill effects are references to laxatives.
• Template:Afterbirth The "???" is the only pill which has 3 different narrated voice lines.
• The "Amnesia" pill is a reference to amnesia, the loss of memory.
• The "Bad Gas" pill is a reference to farts.

Voiceovers

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