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The Lost (Strategy)

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The Lost has no health, dying by any damage taken. Therefore, he needs to be played with extreme care. Although possible, it is extremely difficult to finish a full playthrough without getting hit at all. Powerful item combinations are often necessary for a successful run.

General Tips[edit | edit source]

  • Before attempting runs with The Lost, unlock any items that may be helpful for The Lost.
  • It is recommended to have advanced knowledge of all types of rooms, champions, and enemies.
  • The Lost's ability to fly can be used to hide safely above obstacles and pits, avoiding enemies and projectile contact.
  • Always play on hard mode, as hard mode is required to unlock Godhead Godhead. If the player manages to get good item combinations, the difficulty will not matter much.
  • Bombs can be used to escape rooms you think you cannot handle.
  • The Lost will absorb soul, black, and Eternal Hearts by picking them up, but will not gain any health from them. It is recommended to avoid picking them up in case the D20, a Dice Room (with 3 pips, 2 if the hearts spawn in the Dice Room), or a Added in Afterbirth Dice Shard is found later on.
    • The same applies to useless items (except while holding the D4, that can reroll the passive items). If an option to reroll items is found, they can be changed if not yet picked up.
  • Three orbitals of any kind absorb nearly all projectiles. It is recommended to use Slot Machines as much as possible to obtain Pretty Flies.
  • The Lost does not receive Bad Trip or Health Down pills. This makes pills more useful since they are more likely to have positive effects.
  • Added in Afterbirth With the Missing Poster, a run may be taken to the end with an easier character and finished as The Lost by dying on purpose, granting the unlock for The Lost without doing a full run.
  • Added in Afterbirth Since The Lost does not take damage from the Greed Mode button, you can dramatically limit the number of enemies you have to face at a given time by stepping back onto the button after activating it.

"The Still Statue"[edit | edit source]

This strategy is very safe and easily played. It combines Gnawed Leaf Gnawed Leaf with any automatically damaging Familiar. This allows The Lost to enter a room, become invulnerable, and let his familiar clear the room. There are almost no rooms where The Lost gets hit before he enters statue form. This strategy requires a lot of patience.

Although many familiars are not able to clear all types of enemies or rooms, it is still recommended to get any type of familiar the player finds. Some examples are:

  • Added in Afterbirth †7 Seals 7 Seals: Extremely powerful, as the harbingers will travel anywhere across a room that spawns locusts and leaving trails of creep. The War and Death harbingers will also chase enemies.
  • Daddy Longlegs Daddy Longlegs: Extremely powerful, because it reaches any enemy and will eventually clear the room against any type of hostiles.
  • Demon Baby Demon Baby and Gemini Gemini - Reliably take out enemies nearby, but will not target foes far away.
  • Orbitals provide decent damage against chasing enemies, but are useless against enemies that stay on distance.
  • Leech Leech: Can chase after enemies like Lil Haunt, but due to its poor programming, it often gets stuck, causing you to have to move to kill an enemy. It is also unable to pass over pits.
  • Lil Haunt Lil Haunt: While not as powerful as Daddy Longlegs, it's one of the few familiars that chase enemies (and don't require you to take damage to summon).
  • Midas' Touch Midas' Touch: Still dealing damages when Gnawed Leaf Gnawed Leaf is active, maybe useless against bosses who stay away from The Lost.
  • The Peeper The Peeper: It reaches any spot of a room and will be able to take out most enemies. A lot of time is required, though.
  • Robo-Baby 2.0 Robo-Baby 2.0: Shoots only horizontal and vertical, not reaching enemies that stay diagonally. Robo-Baby 2.0 will still clear most rooms. If Robo-Baby 2.0 is moved, a statue form will be exited.
  • Rotten Baby Rotten Baby and Sissy Longlegs Sissy Longlegs: Blue Flies and Spiders target most enemies inside a room. The flies may not attack foes far away, the spiders are unable to pass over pits.
  • Added in AfterbirthSuccubus Succubus: Similar to The Peeper, but with a much larger area of effect. Still has trouble with large rooms, however.
  • The Virus The Virus: Similar to Midas' Touch, enemies that touch The Lost when Gnawed Leaf Gnawed Leaf is active will be poisoned, but is useless against foes and bosses who stay away from The Lost.

Issues[edit | edit source]

Although the strategy is quite safe, game-ending issues likely occur. Some example scenarios are:

  • The Lost fights Loki with a Poky inside the room. The boss will always stay at distance, making familiars like Distant Admiration Distant Admiration useless. Poky pushes constantly against The Lost, forcing him not to move.
  • The Lost fights a room full of Mask + Heart, the Hearts being behind a pit. Familiars like Leech are useless, while The Lost is constantly attacked by a Mask.
  • The Lost fights Globins, while his follower is not doing enough damage to finish them off after they fell into goo. One Globin is always alive at a time and attacking The Lost.

It is required to have an emergency option if a room cannot be cleared as intended in such scenarios. Spacebar items, cards and pills can be safely activated, even if The Lost in statue form currently has enemy contact.[citation needed] Another option is to exit the run and reenter it by pressing the continue button. This will place the player at the start of the room but all monsters killed would have to be killed again if the player did not clear the room first.

Boss Rush[edit | edit source]

The method may be perfect for the Boss Rush fight itself, however, as the player will probably be progressing too slow, not finishing Mom in time. Therefore this method is not recommended to attain the Boss Rush.

Execution[edit | edit source]

The game is restarted until Gnawed Leaf Gnawed Leaf is found in a treasure room adjacent to spawn. Then, the player has to rely on finding proper familiars later on.

"Getting Carried"[edit | edit source]

This strategy is very general, though leading often to success. The goal is to gain a massive offensive potential, killing enemies before they can hurt The Lost. To survive game-ending mistakes, The Lost also tries to find shielding, invulnerability or reviving items. The strategy bases a lot on item luck because some of the most powerful items in the game need to be found early on.

Key Items[edit | edit source]


  • Brimstone Brimstone: Grants massive power, is piercing and spectral, can be charged in the preceding room and instantly fired.
  • Added in AfterbirthGlass Cannon Glass Cannon: Shoots a giant damaging tear with no downside.
  • Mom's Knife Mom's Knife: Offers massive damage, is piercing and spectral.
  • Polyphemus Polyphemus Increases tear damage more than most other items. If combined with other damage increasing items, it makes most enemies in the first chapters one-shot and shortens boss fights significantly.
  • The Guppy transformation increases the Lost's offensive potential significantly, and several of the items required for it are useful to the Lost in their rights.


  • Dead Cat Dead Cat: Gives The Lost nine lives.
  • Holy Mantle Holy Mantle: Absorbs the first hit in each room, nullifying a game-ending mistake once per room. It also allows the Lost to enter Curse Rooms and open Spiked Chests and Mimics.
    • Care must still be taken when making use of curse rooms, as any damage taken inside of it will nullify the Holy Mantle charge, trapping the Lost inside unless he has some way to generate a shield, teleport out, or extra lives.
    • Added in AfterbirthThe Holy Mantle as a starting item can be unlocked by donating 879 coins to the Greed Machine.
  • Added in AfterbirthHost Hat Host Hat, Infamy Infamy, and Added in Afterbirth †Metal Plate Metal Plate: Have a chance of deflecting projectiles that come into contact with the Lost.
    • Also, Added in AfterbirthHost Hat Host Hat will also make the Lost immune to explosions and stomp attacks, increasing his survivability further and allowing safer use of items like Ipecac Ipecac and Dr. Fetus Dr. Fetus.
  • Lost Contact Lost Contact Destroys bullets upon contact with tears. It makes "bullet-hell" boss fights like It Lives significantly easier.

The goal is to obtain at least one offensive and one defensive item early in the run, additional ones later on. If they are combined with further helpful items, a run becomes very promising.

Note: Godhead Godhead and Sacred Heart Sacred Heart are also major offensive key items. However, it is assumed the player has not yet unlocked Godhead. Sacred Heart can earliest be found on the third floor with very low chances, is therefore not mentioned.

Issues[edit | edit source]

  • Although you can restart a game until you find a key item in the first treasure room, you are still dependent on item luck later in the run.
  • Many key items are special items, lowering the chances of finding such combinations.
  • Running only with key items may not be enough, therefore additional damage ups or emergency options may be necessary.

Boss Rush[edit | edit source]

This method is well suited for the Boss Rush because The Lost can progress quite fast with his massive damage output. The Boss Rush fight itself shall be done with extreme care because many defensive Items lose most of their value in a long fight:

  • Dead Cat Dead Cat would revive you outside, ruining the attempt.
  • Holy Mantle Holy Mantle will still trigger once in the Boss Rush fight, but that may not be enough for the whole duration of the fight.

Execution[edit | edit source]

The game is restarted until one of the key items is found in a Treasure Room adjacent to spawn. Afterward, the player has to rely on finding additional key items and synergies later on.
Note that Brimstone can only be found in Devil Rooms, and Dead Cat only in Curse Rooms, Devil Rooms and Red Chests. The player may decide if they want to check on these opportunities or rather restart instantly.
Some players enter a Curse Room if it is located adjacent to the start. Removed in Afterbirth This will usually be fatal. Rarely, though, a Dead Cat can be found in it. This behavior can make sense, as the run would anyway have gotten restarted without a Treasure Room next to the spawn.

"Remote Control"[edit | edit source]

This method bases around any remotely controlled damage source, such as The Ludovico Technique The Ludovico Technique, ???'s Only Friend ???'s Only Friend, or Robo-Baby 2.0 Robo-Baby 2.0. After entering a room, The Lost tries to find a safe hiding spot as soon as possible, like above an obstacle. After being safe, he uses his remote damage source to finish the room. Acquiring both The Ludovico Technique The Ludovico Technique and Lost Contact Lost Contact can help immensely, especially during the fights against Isaac and ???, as the tear can easily block all enemy shots. Acquiring The Ludovico Technique and Strange Attractor Strange Attractor can also be very helpful as enemies can be pulled away from The Lost.

Issues[edit | edit source]

  • Many rooms do not contain any safe spot, quickly making the method counterproductive.
  • Flying enemies can reach any spot in the room. Jumping enemies like Hoppers can also jump over obstacles if they find a landing spot behind.
  • The Ludovico Technique The Ludovico Technique prevents The Lost from firing normal tears, which may be fatal in rooms without hiding places.
  • The player may focus on their controlled tear/familiar, rather than watching The Lost, overlooking a deadly danger.

Boss Rush[edit | edit source]

If the player manages to reach the Boss Rush room, their odds are quite good. The Boss Rush room offers some rocks as hiding spots, and many bosses stay quite calm. This allows for a nice damage output with the remotely controlled familiars. Flying, fast or mobile bosses, like Fistula, may still become problematic, and therefore treated with extreme care. Also, the variety of Brimstone and explosive attacks are very dangerous. There is a bug who will give the player the "Boss rush completed" achievement and will unlock the D100 without actually completing the boss rush. To make this, the player needs some bombs before entering the boss rush. Once the player is inside, he should place bombs in all the skulls he can find, until an enemy spawns from one of them. If the player kills the enemy (Without picking up any of the boss rush items) the game will think the room is "cleared" and give the player the achievement.

Execution[edit | edit source]

The game is restarted until one of the above items is found in a Treasure Room adjacent to spawn.

Emergency options[edit | edit source]

The Lost should always be prepared for the unexpected by having an emergency option.
Note: 9 Volt 9 Volt and The Battery The Battery allow a much more flexible use of spacebar items and are generally recommended.

Shield and invulnerability[edit | edit source]

Becoming invulnerable is often avoiding deadly situations, therefore having such a card or spacebar item is highly recommended.

  • Algiz offers a shield for 30 seconds. Combined with the Blank Card Blank Card, it forms one of the best defensive item combinations.
  • Book of Shadows Book of Shadows offers a shield for 10 seconds.
  • The Gamekid The Gamekid fears all enemies, deals contact damage and offers invulnerability for five seconds.
  • My Little Unicorn My Little Unicorn and VII - The Chariot grant invulnerability and contact damage for five seconds. Taurus has a similar effect, but is not completely controllable.
  • Unicorn Stump Unicorn Stump grants a 5-second invulnerability, letting The Lost reposition himself safely. It comes with only one charge, thus can be used often.

Teleport[edit | edit source]

Teleportation can be used to avoid run-ending situations by just leaving the room on demand. However, depending on the method used and on the floor the item is used, the player may end up in a random, more dangerous room. Teleporting into a Curse Room can potentially end a run, as under normal conditions they cannot be exited without taking damage. There is also a chance of landing in the I AM ERROR room, which forces the player to leave items and pickups behind and potentially forces the player to skip an unlock.

Hard Removal[edit | edit source]

Hard Removal describes the option to clear a dangerous room instantaneously on demand. Items offering hard removal are:

  • Chaos Card kills any enemy in its path, including bosses, in one hit. It is very useful for single-targets but doesn't have the area of effect for massive enemy horde rooms.
  • Flush! Flush! clears a room instantly, but doesn't work against bosses, except Added in Afterbirth Brownie, Dingle and Added in AfterbirthDangle.
  • Head of Krampus Head of Krampus deals massive damage in a cross-pattern, killing all non-boss enemies in its path, and severely damaging bosses.
  • Magic Fingers Magic Fingers can clear a whole room extremely fast if the item is spammed, the damage is high enough and if enough coins are available.
  • The Necronomicon The Necronomicon and XIII - Death XIII - DeathPickup XIII - Death icon.pngDeals 40 damage to all enemies in the room (same effect as The Necronomicon). kill most non-boss enemies in a room.

Resurrection items[edit | edit source]

These items do still work with The Lost, although the life number does not appear on the HUD. They give the player another chance if a fatal mistake was made.

  • 1up! 1up! offers one life.
  • Dead Cat Dead Cat offers nine lives.
  • Guppy's Collar Guppy's Collar has a 50% chance of reviving The Lost.
    • When combined with Dead Cat, Guppy's Collar takes priority over it, potentially granting more lives.

Angel & Devil Rooms[edit | edit source]

Devil and Angel Rooms appear quite frequently to The Lost because he is not allowed to take damage. The Lost can take Devil deals for free. However, Angel Rooms offer some of the most helpful items for The Lost.
It is generally recommended to go for Devil deals, and thus hinder Angel Rooms to appear, though the player is free to pursue Angel Rooms if they find them more attractive. Goat Head Goat Head is a strong item to obtain early as it will ensure that The Lost can visit a Devil or Angel Room on every floor except for Basement/Cellar I and everything past The Womb/Utero II. Removed in Afterbirth The Book of Belial The Book of Belial fulfills a similar effect, however, another spacebar item may be preferred.

Devil Room[edit | edit source]

Although the Devil Room may only contain Black Hearts or Red Chests that only contain Soul Hearts, Troll Bombs or enemy spiders, it usually has helpful items, though some such as Dark Bum Dark Bum or Razor Blade Razor Blade can be either useless or dangerous. Some of the most valuable are:

For a full list of Devil Room items see Devil Room Item Pool.

Angel Room[edit | edit source]

The Angel Room often contains Soul or Eternal Hearts, being useless for the Lost. Many items that can be obtained are of no use, too, such as Prayer Card Prayer Card or Celtic Cross Celtic Cross, and some such as Dead Sea Scrolls Dead Sea Scrolls or Breath of Life Breath of Life can actually be dangerous. However, with luck, one may find a very valuable item, such as:

For all Angel Room items see Angel Room Item Pool.

Items[edit | edit source]

Positive Items[edit | edit source]

Aside from the already mentioned items, the following are of great use:

  • Any item increasing damage in some way and/or any other of The Lost's stats.
  • The Stop Watch Stop Watch, unlocked by donating 999 coins to the Donation Machine slows down all enemies in the room, all projectiles, and makes enemies that charge for an attack charge forward very slowly.
    • Added in Afterbirth The Stopwatch was nerfed to only work upon taking damage, although, in a recent update, it now works when the Holy Mantle's shield is depleted.
  • Lil Brimstone Lil Brimstone is similarly beneficial like Brimstone itself.
  • Items that inflict crowd control status effects such as fear, slow or petrification can be useful. On the other hand, some players dislike these items because they can make enemies move in unpredictable ways.
  • Black Candle Black Candle removes curses.
  • The Red Candle Red Candle's properties make it one of the most useful items for defeating the waves of mobs and bosses in Greed Mode. Filling the room with flames before pushing the button to start a new wave, although very time consuming, virtually guarantees a swift victory with very little risk.
  • D4 D4, , or Rune of Perthro can reroll negative or useless items into something useful, while D20 can do the same with pickups. D100 acts like the three combined.
    • The D4 and the D100 D100 can deactivate very important items you obtained earlier.
      • Added in Afterbirth As the Lost starts with the Holy Mantle after giving the Greed Machine enough coins, the D4 can potentially be deprecated from the start.
    • After multiple re-rolls, the D4 and D100 can be counterproductive. If the item pools are depleted, they will only give The Lost Breakfast.
  • There's Options There's Options and Added in AfterbirthMore Options More Options increase the chances of the Lost finding useful items.
  • Pyromaniac Pyromaniac grants immunity to explosions, making it especially useful should the player have explosive items such as Ipecac Ipecac or Epic Fetus Epic Fetus. It will also nullify stomp attacks.
  • Items revealing the map are very useful to avoid unnecessary rooms.
  • Whore of Babylon Whore of Babylon is always active.
  • Added in AfterbirthCrown of Light Crown of Light is essentially a permanent double damage as it cannot be deactivated.
  • Added in AfterbirthGlass Cannon Glass Cannon can greatly increase The Lost's damage output without any negative effects.
  • Missing Poster Missing PosterTrinket Missing Poster icon.pngIf Isaac dies in a Sacrifice Room, a puzzle piece will appear on his last will (Added in Afterbirth and unlocks The Lost). Added in Afterbirth Revives Isaac as The Lost if unlocked. The Missing Poster then disappears. effectively acts as a 1-Up on The Lost.
  • Added in AfterbirthEmpty Vessel Empty Vessel is always active for The Lost. The Lost will not benefit from the flight given but will benefit from the periodic invincibility it grants.
  • Added in AfterbirthSafety Scissors Safety ScissorsTrinket Safety Scissors icon.pngTroll bombs turn into Bomb pickups before they explode. Mega troll bombs turn into 1+1 free bombs before they explode. neutralizes the threat of Troll Bombs and grants additional bomb pickups.
  • Added in Afterbirth †Void Void can convert health ups or otherwise useless items into stat boosts.

Useless items[edit | edit source]

The following list includes items and trinkets that only affect health, only grant flight, only grant spectral tears, use damage as a trigger or contain a combination of what's listed with no other positive effect. It's advised to pick them after a floor has been explored in case a D4 D4, D100 D100, or a Dice Room (with 1 or 6 dots) are found later on during the run.

Name ID Icon Quote Description
Converter 296
Convert your soul When used, converts two soul hearts into a heart container.
Prayer Card 146
Prayer Card
6 rooms
Reusable eternity Grants an eternal heart per use.
Satanic Bible 292
Satanic Bible
6 rooms
Reusable Evil Upon activation, Isaac gains a black heart.
The Jar 290
The Jar
Save your life When at full health, up to 4 extra hearts can be stored in the jar.
Yum Heart 45
Yum Heart
4 rooms
Reusable Regeneration Restores 1 whole red heart.
Name ID Icon Quote Description
A Snack 346 A Snack HP up Grants one full red heart container.
Black Lotus 226 Black Lotus HP up x3! Grants the player one red heart container, one soul heart, and one black heart.
Bloody Lust 157 Bloody Lust RAGE! Increases damage as Isaac receives damage. Damage increase stays for the whole floor.
Breakfast 25 Breakfast HP up Grants Isaac one full red heart container.
Cancer 301 Cancer HP up + you feel protected Adds 3 soul hearts. Grants The Wafer effect for the current room upon taking damage.
Celtic Cross 162 Celtic Cross 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 Kills heal Heals the character for half of a red heart for every 13 monsters killed.
Dead Bird 117 Dead Bird Protective buddy Spawns a flying familiar for the current room that chases enemies whenever Isaac takes damage.
Dead Dove 185 Dead Dove Flight + spectral tears Grants spectral tears and flight.
Dessert 24 Dessert HP Up Grants Isaac one full red heart container.
Dinner 23 Dinner HP Up Adds 1 heart container.
Fanny Pack 204 Fanny Pack It's filled with goodies! Has a chance to drop a random pickup when Isaac takes damage.
Fate 179 Fate Flight eternal Grants flight and one eternal heart.
Gimpy 225 Gimpy 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.
Habit 156 Habit Item Martyr When Isaac is hit, 1 point of an item's charge is filled.
Holy Grail 184 Holy Grail Flight + HP up Grants flight and one heart container.
Holy Water 178 Holy Water 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.
Little C.H.A.D. 96 Little C.H.A.D. Gives kisses A familiar who will drop a half red heart every 3 rooms.
Lunch 22 Lunch HP Up Adds 1 heart container.
Maggy's Bow 312 Maggy's Bow HP up + you feel healthy Gives one heart container and doubles the healing provided by red hearts.
Missing Page 2 262 Missing Page 2 Evil up. Your enemies will pay! Gives 1 black heart. Upon taking damage that reduces Isaac's health to one heart or less, activates The Necronomicon effect, dealing 40 damage to all enemies in the room.
Mitre 173 Mitre You Feel Blessed Grants a chance of converting any red hearts pickups into soul hearts instead.
Old Bandage 219 Old Bandage HP up Adds one empty heart container. Whenever Isaac takes damage there's a chance that a Red Heart may drop.
Ouija Board 115 Ouija Board Spectral tears Grants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them.
Placenta 218 Placenta HP up + regen Grants a full heart container, and a chance to regenerate a half-heart of health every minute of gameplay.
Raw Liver 16 Raw Liver HP up Grants 2 Heart Containers and completely restores health.
Rotten Meat 26 Rotten Meat HP up Adds one heart container.
Scapular 142 Scapular 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.
Sharp Plug 205 Sharp Plug Charge with blood Using an activated item while it's not charged will charge it and Sharp Plug does 2 full heart damage to Isaac.
Spider Baby 211 Spider Baby Spider revenge When hit, spawns up to 2 blue spiders.
Spirit of the Night 159 Spirit of the Night Scary Grants spectral tears and flight.
Super Bandage 92 Super Bandage +2 hearts Grants one Heart Container and gives 2 Soul Hearts.
The Body 334 The Body I feel all Adds 3 heart containers.
The Ladder 60 The Ladder Building bridges Allows Isaac to walk across gaps one square across by automatically placing a ladder between the two walkable sections.
The Relic 98 The Relic Soul generator Isaac is followed by a small blue cross that will drop a Soul Heart every 5-6 rooms.
The Wafer 108 The Wafer Damage resistance All sources of damage that would cause more than one-half heart of damage are reduced to one-half heart instead.
Transcendence 20 Transcendence We all float down here... Grants flight.
Added in Afterbirth Athame 408 Athame Call to the void Whenever Isaac takes damage, a black ring briefly appears around Isaac, dealing damage to all nearby enemies.
Added in Afterbirth Cambion Conception 412 Cambion Conception Feed them hate After taking damage a certain amount of times, a permanent demonic familiar spawns.
Added in Afterbirth Curse of the Tower 371 Curse of the Tower You feel cursed... Causes Isaac to spawn 6 troll bombs on the floor every time he gets hit, similar to the Anarchist Cookbook mechanic.
Added in Afterbirth Milk! 436 Milk! 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.
Added in Afterbirth My Shadow 433 My Shadow Me! And my shaaaadow! Each time Isaac takes damage, inflicts fear on all enemies in the room and spawns a black friendly Charger that will attack enemies. The Charger will be killed if it is damaged too much.
Added in Afterbirth PJs 428 PJs You feel cozy Grants four soul hearts and fully restores Isaac's red health.
Name ID Icon Quote Description
A Missing Page 48 A Missing Page It glows with power 5% chance to induce The Necronomicon's effect upon taking damage.
Added in Afterbirth Blind Rage 81 Blind Rage Blind to damage Increases invincibility time after getting hit.
Bloody Penny 49 Bloody Penny Wealth of health Gives a 50% chance to drop a half heart when money is collected.
Callus 14 Callus Your feet feel stronger Prevents damage from creep and spikes.
Child's Heart 34 Child's Heart It calls out to its brothers. Increases the chance of a heart pickup dropping after clearing a room, and the chance of finding a heart when opening a Chest.
Added in Afterbirth Cracked Dice 67 Cracked Dice You feel cursed... kinda. Whenever Isaac gets hit, there is a chance that the effect of The D6, D8, D12, or D20 gets activated.
Cursed Skull 43 Cursed Skull Cursed? If Isaac has less than one full red heart after taking damage, he will be immediately teleported to the last cleared room he was in.
Fish Head 29 Fish Head It stinks Spawns a blue fly every time Isaac takes damage.
Isaac's Fork 46 Isaac's Fork Consume thy enemy A chance to heal Isaac for 1/2 a red heart upon clearing a room.
Judas' Tongue 56 Judas' Tongue Payment Received Items in the Devil Room only cost 1 heart. Soul heart trades still cost 3 soul hearts.
Maggy's Faith 55 Maggy's Faith Faith's reward Gives an eternal heart at the start of every floor.
Added in Afterbirth Mom's Locket 87 Mom's Locket You feel her love Grants half a red heart each time a key is used. Converts half red heart pickups into full red hearts.
Mom's Pearl 38 Mom's Pearl It emanates purity Grants a secondary 10% chance of any non-specific heart drop turning into a soul heart.
Monkey Paw 20 Monkey Paw Wish granted If the character has half a heart after taking damage, it drops a black heart. The effect can trigger up to three times, after which the trinket will disappear.
Mysterious Paper 21 Mysterious Paper ??? Has a chance to replicate the effects of A Missing Page, The Polaroid, The Negative, or Missing Poster.
Red Patch 40 Red Patch Your rage grows Grants a chance of increasing damage by 1.8 for the current room upon taking damage.
Swallowed Penny 1 Swallowed Penny Gulp! Upon taking damage, Isaac drops a penny.
Umbilical Cord 33 Umbilical Cord Fetal Protection When Isaac's health is brought to half a red heart and no soul hearts, a Little Steven familiar spawns for the current room.

Notes on item selection

  • Best Bud Best Bud, Guppy's Paw Guppy's Paw, and Infestation Infestation are not included because while they do not provide any passive benefit, they do count for transformations.
  • Listed items that generate heart pickups of any kind are useless in most scenarios, but can be converted to other types of pickups if The Lost is holding the D20 or D100.
  • Bloody Lust Bloody Lust will increase damage if The Lost has multiple lives.
  • Items that activate a Necronomicon-like effect upon getting hit have a very limited use, as they can deal the last bit of damage needed to kill a boss, or clear a room if The Lost has multiple lives.
  • Rosary Rosary is mostly useless, but not completely, as it raises the chance of finding The Bible.
  • Missing Poster Missing PosterTrinket Missing Poster icon.pngIf Isaac dies in a Sacrifice Room, a puzzle piece will appear on his last will (Added in Afterbirth and unlocks The Lost). Added in Afterbirth Revives Isaac as The Lost if unlocked. The Missing Poster then disappears. is no longer useless for the Lost.
  • Added in Afterbirth Ouija Board, Dead Dove and Spirit of the Night are useless in Afterbirth because The Lost now starts with spectral tears. They are still useful items in Rebirth.
  • Added in Afterbirth Blind Rage is only useless if the player has not unlocked Holy Mantle as The Lost's starting item.
  • Added in Afterbirth Items that increase your chances of finding Soul Hearts or Black Hearts gain some use when combined with Immaculate Conception.

Negative items[edit | edit source]

  • Ankh Ankh, Broken Ankh Broken AnkhTrinket Broken Ankh icon.pngWhen held, Isaac has a chance to be revived as ???. Can occur multiple times in the same run., Judas' Shadow Judas' Shadow and Lazarus' Rags Lazarus' Rags grant extra lives but respawn The Lost as ???, Black Judas, or Lazarus respectively, which will cause the game to treat them as these characters instead of The Lost. It is suggested to avoid these three items altogether if the player is interested in gaining The Lost exclusive achievements and/or completion marks.
  • Dark Bum Dark Bum no longer maintains its main benefit of providing Soul Hearts as Soul Hearts are now useless. While it may spawn a friendly spider, it is also likely to spawn an enemy spider, which can instantly kill The Lost if the player is not careful.
    • With Added in AfterbirthImmaculate Conception Immaculate Conception, Dark Bum will be useful to convert useless Red Hearts to useful Soul Hearts. However, the player must still be careful of Spiders.
  • Isaac's Heart Isaac's Heart, while having many useful synergies as well as the added benefit of immunity to Brimstone lasers, makes dodging more difficult in many scenarios, leading many players to take damage when they otherwise would not have. It is also very difficult to avoid a stray laser from an Eye, as The Lost cannot block this shot and protect Isaac's Heart from it. Also, there is a chance it can spawn atop an Eye in the It Lives fight, leading to a very cheap and unavoidable death.
  • Any explosive items, such as Anarchist Cookbook Anarchist Cookbook, Added in AfterbirthCurse of the Tower Curse of the Tower, or Ipecac Ipecac should be used with extreme care.
    • If the player chooses to pick up Ipecac Ipecac, they should not pick up Loki's Horns Loki's Horns or Mom's Eye Mom's Eye, as an unexpected shot against a wall will lead to instant death. Lost Contact Lost Contact is also problematic as it can cause explosions to happen in closer proximity to the player than desired.
  • Items that work by causing self-damage, such as the IV Bag IV Bag, Blood Rights Blood Rights or Razor Blade Razor Blade will end the run if used and must be avoided. Dead Sea Scrolls Dead Sea Scrolls also has the potential to prematurely end a run if a self-damaging item is triggered. Isaac's Heart Isaac's Heart will allow The Lost to use these items without taking damage.
  • Bucket of Lard Bucket of Lard reduces speed by 0.2 and does not provide any benefit.
  • Leo Leo and Thunder Thighs Thunder Thighs are not great as they remove The Lost's ability to use obstacles to his advantage, as they can break these obstacles. Also, stepping on a poisonous mushroom, or carelessly stepping on a Bomb Rock can end a run. The only benefit is the small chance of finding a trapdoor or items like Dry Baby Dry Baby or The Small Rock The Small Rock when breaking said obstacles.
  • Strange Attractor Strange Attractor: Unpredictably pulls enemies towards The Lost, especially floating enemies like Boom Flies. It's advised to avoid this item unless The Lost has The Ludovico Technique The Ludovico Technique, as both items combined may create a powerful synergy.

Seeds[edit | edit source]

Note that seeded runs do not count towards achievements or unlocks.

 PC  4BGT 79XL (Hard) ("Getting Carried" Strategy: Brimstone in the first Devil Room. After obtaining it, Forget Me Now shall be used to get Holy Mantle in the Treasure Room in Basement I. Infamy is found in Necropolis II. Lost Contact will be in the Secret Room in Utero I, Dead Cat in the Super Secret Room and Goat Head in the Dice Room.)

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