Game Guide

Everything in the game: rooms, drop pools, items, pickups, pills, enemies, champions and bosses, generated from the game's own definitions.

Overview

The Basement is a top-down dungeon crawler for 1–4 players (online co-op). You descend through procedurally generated floors, clearing rooms, collecting items and fighting a boss at the end of every floor. Runs are seedable: the same run seed rebuilds the same floors, encounters, champions, item offers and rewards.

Floors are grouped into chapters, each with its own look: The Basement / The Cellar / Burning Basement → The Caves / The Catacombs / Flooded Caves → The Depths / The Necropolis / Dank Depths → The Womb / Utero → Sheol / The Cathedral. Rooms are wide 16:9 spaces, and the start room of every floor is empty (no enemies, no obstacles, just decals).

Characters

CharacterStarting active itemWhat it does
JamieSpare HeartHeals 1 HP.
HollowPhantom WailNearby enemies freeze in fear and take damage.
SporelingPuffballPoisons enemies in a wide circle. Slowly recharges over time.
Little KingRoyal DecreeFires a ring of tears. +3.5 damage for the room.

Rooms

Every floor is a grid of connected rooms. Doors open when a room is cleared. Special rooms hang off the grid as dead ends or hidden rooms.

Start Room

Where you spawn. Always empty, with its doors open from the start.

Normal Rooms

Filled with obstacles (rocks, pots, crates, poop, mushrooms, barrels, spikes, skull piles…) and a group of enemies chosen by floor depth (see Enemies). Wide rooms hold about 1.5× the enemies of the old square rooms. Clearing the room opens the doors, recharges active items and rolls the room-clear reward.

Treasure Room

One per floor. Choose one item from the pedestals (one per living player). From floor 2 the door is locked and costs one key; on floor 1 it is open and the door shows no keyhole. Each locked room guarantees one key somewhere reachable without opening a locked door.

Shop

One per floor, never locked. Sells 2 items plus 3 consumables: a Red Heart, a Pill, and a Soul, Eternal or Black Heart. Item prices by tier: Tier 1 = 8 coins, Tier 2 = 15, Tier 3 = 25; each offer has a 25% chance of being half price.

Boss Room

One boss (see Bosses), possibly a champion boss. Defeating it opens the level exit and drops 2 item pedestals (3 for a champion boss), claimable once per player. There is a 50% chance a glowing hatch to a Devil or Angel room appears too.

Devil & Angel Rooms

Reached only through the Boss Room hatch. Angel odds start at 50% and rise with the Sacrifice Room's “Heavens Stir” bonus. Angel Rooms offer 0–4 free items (5% none, 35% one, 35% two, 20% three, 5% four) and may hold an Angel guardian that rewards Bible tokens. Devil Rooms sell items for heart capacity (Tier 1 = 2, Tier 2 = 3, Tier 3 = 4 half-hearts).

Boss Challenge Room

On eligible even floors, this room has a free item from the Boss pool. Every living player must have at most one full heart of total red, soul and black health to enter. Taking the item starts two boss waves. Entering alone does not start the fight. Each defeated wave charges the active item once.

Sacrifice Room

Base generation chance 1/7, or 5/14 when total health covers red-heart capacity, before Dice Room replacement rolls. Twelve enabled native layouts use a central spike pad; layout 8 is disabled. See the sacrifice table for payouts and saved counters.

Secret Rooms

Hidden beside a normal room; bomb the wall to open it. Four kinds: treasure (a pedestal item), ambush (5–7 enemies; pays out bombs, a heart and a coin), stash (a hoard of 3–5 coins, bombs and hearts) or sacrifice. A Super Secret Room holds treasure or sacrifice rewards.

Trapdoor Cellar

Each floor hides a cellar. Bomb-only obstacles (rocks, tinted rocks, super rocks, skull piles) have a 2% chance when destroyed to uncover a floor hatch down to it.

Dark Room and Golden Gate

Reached by a successful twelfth-or-later sacrifice. The starting room has four red chests containing Devil-pool deals. Other chests yield Treasure-pool items. Prices use native one- or two-container costs; without red or bone containers, a deal costs three Soul Hearts. A two-container deal with one container costs that container plus two Soul Hearts. These starting-room deals do not block Angel Rooms.

The floor uses our authored enemy and degraded-boss counterparts, with Ossuary Lamb as its final encounter. Its ending chest finishes the run. Both angel key pieces open the north Golden Gate to a separate lower-half arena containing our Obsidian Patriarch counterpart; this is not a recreation of Mega Satan’s attack script. The ending chest there also finishes the run.

Dice Room

Replaces a successfully rolled Sacrifice Room: 1/50, or 27/125 with at least two keys when entering the floor. It costs two keys to enter, once for the party. Only one use per room. All 21 native standard layouts are included, with our authored counterparts for the fixed enemies. The die face is chosen separately from the layout.

FaceEffect
1Reroll held collectibles using their acquisition pools; passive items remain passive.
2Reroll this room’s ground pickups and closed chests. Open chest shells and pedestals stay.
3Reroll floor pickups, including Shop consumables. Excludes Devil/Angel Rooms, Black Markets and Crawl Spaces.
4Reroll floor pedestals. Excludes the same rooms as face 3 and also Libraries.
5Restart the current floor with a new seed; keep items and the current floor branch.
6Combine faces 1, 3 and 4.

Only implemented items can be selected. Closed-chest and pickup variants use the game’s supported reroll mix; the probability of a Shop consumable becoming an item is an estimate. Repentance Dice Room reference.

Key blocks, golden poop and reward plates

A key block consumes one key when a grounded player pushes against it, then disappears. Golden poop uses the same 12 HP tear-damage breakpoints requested for our ordinary breakables. It pays either 5–7 pennies or Counterfeit Penny (one-third chance when unlocked). Counterfeit Penny grants at most one extra cent per coin pickup: chance = 1 − 0.5coin value, capped at 99 coins.

Reward plates can be pressed once. Half give enemies, closing the doors; half give a reward. Rewards include pickups, chest variants, machines, poop, an item or a next-floor hatch. The wiki’s listed reward percentages total 110%; this build normalizes their relative weights. Enemies use authored counterparts for the native floor families.

Donation machines preserve their bank between runs, accept one coin per play and can jam. The first coin on a floor has a 0.15% jam chance, rising by 0.15% per donated coin; a jam lasts for the run. Donations have a 2% chance to add one Luck. Ten donations on the current floor add a separate 50% Angel replacement roll if no Devil deal was purchased. Bombing an unjammed machine pays 6–14 pennies, limited by its bank, and prevents future Donation Machines that run; the bank loses that payout plus one when the next run starts. A 1,000th donation resets the bank and pays twelve dimes. Unlocks are not used to withhold already implemented items.

References: Buttons, Poops, Counterfeit Penny, Donation Machine.

More special rooms

These rooms appear in newly started runs. Placement needs an available dead end. Repentance base generation odds are used without guaranteed rotation. Unsupported Dice Room and Vault replacement rolls are reserved, so they do not increase Sacrifice Room or Arcade frequency. Floor eligibility is recorded when entering the floor; reducing your health later does not create a missing challenge room.

RoomWhen it appearsEntranceContents and rules
Normal ChallengeOdd floors after floor 1, through floor 10, if every player's total health covers their red-heart capacity when entering the floor.The same health requirement applies at the door.A chest waits inside. Opening it starts three waves of floor-appropriate enemies. Each cleared wave adds one active-item charge. You can leave before opening the chest.
Boss ChallengeEven floors through floor 10, with the same floor-entry health eligibility. Floor 2 has a 50% generation roll.Every living player needs one full heart or less, counting soul and black hearts.A Boss-pool item waits inside. Taking it starts two boss waves; each cleared wave adds one active-item charge. No extra collectible is awarded after the fight.
ArcadeEven floors through floor 8 when at least one player entered with five coins. After the Vault replacement roll, Arcade probability is 90% with fewer than two keys, or 60% with at least two keys, before placement availability.Pay one coin once to unlock it for the party.Slot machine and shell game cost one coin per play. The blood machine takes half a heart, or a full heart from floor 7, for coins and a chance at Blood Bag. Invulnerable players cannot donate for free. Approach a machine and press Enter, L3 or the interaction button. Bombs destroy machines. Current payouts use supported pickups and items; special machine variants and Vault replacements are unavailable.
Curse Room25% generation roll through floor 10.Spiked doors hurt on entry and exit. Flight avoids entry damage, but not exit damage. Existing protection can block a hit.New version 34+ runs use only the 31 standard layouts below, plus ten Voodoo Head layouts when eligible. Mobs appear only in layouts that specify them; there are no additional ambush or ordinary-enemy rolls. Red-chest enemy outcomes are replaced with coins so enemy-free layouts remain enemy-free.
Library5% generation roll through floor 10; placed in the Repentance special-room order among available dead ends.Pay one key once to unlock it for the party.One to three distinct supported books, sometimes a battery. All books can be taken independently. Active items swap on the pedestal and remain there on return. Book counts and bonus-battery odds are game-specific.
Sacrifice RoomThrough floor 10: 1/7 base chance, or 5/14 if total health covers red-heart capacity. A successful roll is replaced by an unavailable Dice Room 2% of the time, or 21.6% with at least two keys; those outcomes currently spawn neither type.Free entrance. Stepping on its central spikes costs health.Existing sacrifice reward sequence. The old 70% generation chance is removed. Shops and Treasure Rooms stop after Chapter 3 unless a future implemented effect explicitly enables them.

References: Isaac level generation, Challenge rooms, Arcades, Curse rooms, Libraries.

Drop pools & rewards

Enemies in this game do not drop loot when they die. Everything comes from clearing rooms, breaking obstacles, opening chests and the special rooms.

Room-clear reward (normal rooms)

6% of the time the reward is a chest instead. Otherwise one roll per line, in this order, first success wins:

DropChance
Pill6%
Card (world 32+)4%
Black Heart2%
Rotten Heart1.2%
Bone Heart1%
Blended Heart1.2%
Half Soul Heart1.2%
Golden Heart0.6%
Soul Heart3.5%
Eternal Heart0.8%
Key7%
Bomb10%
Red Heart8%
Coin20%

Chests

Touch to open (locked chests need a key). A chest throws out 2–4 pickups, each picked by weight:

PickupWeight
Coin5
Red Heart2.5
Bomb2.5
Key2
Pill2
Card (world 32+)1.5
Soul Heart1
Black Heart0.65
Half Soul Heart0.5
Rotten Heart0.3
Blended Heart0.3
Bone Heart0.25
Eternal Heart0.25
Golden Heart0.12

Rock loot

Plain rocks drop nothing. Tinted rocks (about 6.5% of rocks) drop one of: Soul Heart 48%, Bomb 22%, Key 17%, Chest 10%, Small Rock item 3% (if you do not already own it). Super rocks (rarer; two blasts) drop a combo: 2 Soul Hearts 35%, Soul Heart + Bomb 25%, Bomb + Key 20%, Chest + Soul Heart 15%, Small Rock + Soul Heart 5%.

Ambush room clear

A Bomb, a second Bomb (60%) or a Red Heart, and a Coin.

Boss rewards

2 item pedestals (3 for a champion boss), the level exit and a possible Devil/Angel hatch.

Obstacle drop tables

ObstacleHPSolidHow it breaksDrops
Rockindestructible (bomb)YesBomb only—
Tinted Rockindestructible (bomb)YesBomb only—
Super Rockindestructible (bomb)YesBomb only—
Pot2YesBreak with tearsHeart 20%, Bomb 12%, Coin 30%
Poop3YesBreak with tearsHeart 8%, Bomb 8%, Coin 15%
Mushroom2YesBreak with tearsHeart 15%, Coin 15%, Bomb 8%
Barrel2YesExplodes when destroyedCoin 15%, Bomb 10%
Spikesindestructible (bomb)NoDamages on touch—
Skullsindestructible (bomb)YesBomb onlyCoin 12%, Bomb 6%
Crate2YesBreak with tearsBomb 30%, Heart 12%, Coin 35%
Bone Urn2YesBreak with tearsCoin 20%, Bomb 10%, Heart 8%
Wax Effigy3YesBreak with tearsHeart 14%, Coin 12%, Bomb 7%
Rotted Sack2YesBreak with tearsBomb 16%, Coin 24%, Heart 8%

Sacrifice table

Only actual health lost on the central spikes counts. A normal hit costs one full heart. Invulnerability and shields do not pay; flight still activates the spikes. Filled bone shells and a final half soul heart retain their damage protection. Each room has a deterministic counter and rewards saved with the run.

ActivationReward
1–250%: one penny; otherwise nothing. On floor one, a boss defeated within one minute and no bombs guarantees one bomb.
32/3: the weaker current-floor Angel blessing; otherwise nothing.
450%: one chest; otherwise nothing.
51/3: exactly three pennies; otherwise the stronger current-floor Angel blessing.
61/3: teleport to this floor’s Angel Room, or its already-opened Devil Room; otherwise one chest. The return hatch leads back here.
71/3: an Angel-pool item; otherwise one Soul Heart. Redemption replaces the Soul Heart only when its ability is implemented and unlocked.
8Seven Troll Bombs.
9Ivory Annunciant (Uriel counterpart). Defeat it for Key Piece 1.
1050%: seven Soul Hearts; otherwise thirty pennies.
11Scarlet Cantor (Gabriel counterpart). Defeat it for Key Piece 2.
12+50%: teleport to the Dark Room; otherwise nothing. Reusing this teleport while already there returns to its starting room.

Blessings last only for the current floor. The weak and strong blessings add 15% and 50% replacement rolls (65% together), after the ordinary Angel roll fails; they do not increase the chance that a deal spawns. Before any deal has been encountered, a blessing guarantees that floor’s first deal is an Angel Room. Item rewards use the implemented portion of the native Repentance item pools and their weights.

References: Sacrifice Room rules; Dark Room rules.

Items

335 playable collectibles; 718 catalogued. This table and the developer playground are checked against this release’s actual item definitions. Unfinished items cannot enter random drops. Missing art uses the shared black silhouette.

Stats and runtime modifiers use this build’s values. Effect descriptions give the complete reference mechanics; unfinished rows are planned behavior. Custom-world distances and familiar tick timing are documented where estimated. One heart equals two half-heart health units.

Item & spriteStatsEffectsModifiers & conditions
The Sad OnionID 1 · Quality 3 · PassivePlayable
Drop poolsItem Room
  • +0.7 Tears per second
  • +0.7 Tears Up
  • This build: +0.7 Tears Up.
The Inner EyeID 2 · Quality 2 · Passive, Tear ModifierPlayable
Drop poolsItem Room
  • Tears per second ×0.51
  • Tears now shoot three at a time (Triple Shot)
  • Tears Down significantly - Tears fired per second * 0.51
  • Triple
  • This build: tears x0.51. Three tears per shot.
Spoon BenderID 3 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Gives Isaac's tears a homing effect
  • Homing
  • This build: Homing tears.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Cricket's HeadID 4 · Quality 4 · PassivePlayable
Drop poolsItem Room
  • +0.5 Damage
  • +0.5 Damage Up
  • x1.5 times Damage Multiplier (Does not stack with the Magic Mushroom multiplier)
  • Can be found in golden chests
  • Cricket's Head used to be known as Max's Head in the original game and was renamed for Rebirth
  • Damage Group: 1.5
  • This build: +0.5 damage. Shared damage multiplier x1.5.
My ReflectionID 5 · Quality 2 · Passive, Tear ModifierPlayable
Drop poolsItem Room
  • +1.5 Damage
  • -1 Luck
  • Tears curve back toward the moving player.
  • +1.5 damage and -1 luck per copy.
  • Range becomes 2× range +1.5; shot speed is multiplied by 1.6. These two bonuses apply once, regardless of copies.
  • This build: Returning tears pulled toward the moving owner; +1.5 damage and -1 luck per copy; range 2x +1.5 and shot speed x1.6 once; piercing tears cannot hit the same enemy twice.
  • Turnaround distance scales with range; custom-world flight physics use pixel estimates.
  • Piercing tears cannot hit the same enemy again on their return, including after a Rubber Cement bounce.
  • Split tears return independently. Haemolacria primary tears return with extended airtime; its burst tears keep their native arc. Lachryphagy burst tears return; Pop! tears swarm until the shared eight-second projectile limit.
  • A Lump of Coal gains damage with traveled distance. Nearby homing targets take priority over returning. Pupula Duplex spins cosmetically; Trisagion uses a growing thin loop shared by drawing and collision.
  • Removing the last copy restores ordinary firing and removes the stat bonuses. Other unfinished weapon abilities and their dependent synergies remain unavailable.
Number OneID 6 · Quality 2 · PassivePlayable
Drop poolsItem Room
  • +1.5 Tears per second
  • -2.5 Range
  • Gives you a very high tear rate in exchange for a big range down
  • +1.5 Tears Up
  • -2.5 Range Down
  • This build: +1.5 tears/s. -2.5 range.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Blood of the MartyrID 7 · Quality 3 · PassivePlayable
Drop poolsItem Room, Angel Room
  • +1 Damage
  • +1.0 Damage Up
  • x1.5 times Damage Multiplier if you also have Book of Belial (Does not stack with Magic Mushroom or Cricket's Head multipliers)
  • This build: +1 damage. Shared multiplier with Book of Belial.
Brother BobbyID 8 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room, Devil Room
No direct change.
  • A familiar which follows Isaac and shoots normal tears which do 3.5 damage
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • This build: A familiar which follows Isaac and shoots normal tears which do 3.5 damage.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 3.5
  • Familiar Cd: 0.4
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
SkatoleID 9 · Quality 0 · PassivePlayable
Drop poolsSpecial reward only
No direct change.
  • A lot of fly enemies are no longer aggressive towards Isaac
  • Attack Fly, Dart Fly, Eternal Fly, and Ring Fly are transformed into a neutral black fly
  • Boom Fly, Red Boom Fly, Drowned Boom Fly move slower, but still deal contact damage
  • Moter, Level 2 Fly, Full Fly, Pooter, and Super Pooter move slower and deal no contact damage
  • Can only be obtained from the shell game in the arcade
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation.
  • Not in random drops: Only obtainable from the arcade shell game, which this game does not have.
  • This build: Aggressive flies calm down into harmless Flies after a moment and Moters stop hurting or splitting. Counts toward both Beelzebub and Oh Crap.
  • Reference transformation families: Beelzebub, Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
Halo of FliesID 10 · Quality 2 · Passive, OrbitalPlayable
Drop poolsItem Room, Key Beggar
No direct change.
  • Gives Isaac 2 orbital flies which block enemy shots
  • Picking up this item as well as 2 other fly-type items will allow you to transform into Lord of the Flies
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: Gives Isaac 2 orbital flies which block enemy shots.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 0
  • Familiar Radius: 46
  • Familiar Speed: 2.6
  • Familiar Block: true
  • Familiar Copies: 2
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
1UPID 11 · Quality 2 · PassivePlayable
Drop poolsSecret Room
No direct change.
  • Gives the player an extra life
  • When revived, the green mushroom that follows Isaac will disappear and he will respawn with the same amount of red heart containers at full health
  • Resurrection takes place before all other items which give you an extra life
  • This build: One full-health revival.
Magic MushroomID 12 · Quality 4 · PassivePlayable
Drop poolsItem Room, Mushrooms
  • +1 Red heart containers
  • +0.3 Damage
  • +1.5 Range
  • +0.3 Movement speed
  • +1 HP Up
  • +0.3 Damage Up
  • x1.5 times Damage Multiplier (Does not stack with the multipliers from Cricket's Head / Blood of The Martyr + Book of Belial)
  • +1.5 Range Up
  • +0.3 Speed Up
  • Increases the size of your player sprite, but doesn't increase the hitbox
  • Fully restores all red heart containers
  • Counts as 1 of 3 mushroom items needed towards the Fun Guy transformation
  • Counts as 1 of 3 size-increasing items needed towards the Stompy transformation
  • Visual Size: 1.25
  • Damage Group: 1.5
  • Heal: full
  • This build: +1 heart containers. +0.3 damage. +1.5 range. +0.3 speed. Shared damage multiplier x1.5. Refills red health. Larger sprite; same collision size.
  • Reference transformation families: Fun Guy, Stompy. Set bonuses and costumes remain a separate unfinished overhaul.
The VirusID 13 · Quality 2 · PassivePlayable
Drop poolsItem Room, Demon Beggar, Lust Miniboss
  • +0.2 Movement speed
  • Enemies touching you take 12 damage, then a poison effect is applied for 6-7 ticks, dealing damage equal to the amount of red hearts you have (up to 30.8 at 12 full red hearts)
  • +0.2 Speed Up
  • Has a chance to drop from the Lust miniboss fight
  • Counts as 1 of 3 syringe items needed towards the Spun transformation
  • This build: +0.2 speed. virus.
  • Reference transformation families: Spun. Set bonuses and costumes remain a separate unfinished overhaul.
Roid RageID 14 · Quality 2 · PassivePlayable
Drop poolsItem Room, Boss Room, Demon Beggar
  • +0.3 Movement speed
  • +1.5 Range
  • -0.5 Tear height
  • +0.3 Speed Up
  • +1.5 Range Up
  • +0.5 Shot Height
  • Counts as 1 of 3 syringe items needed towards the Spun transformation
  • This build: +0.3 speed. +1.5 range. -0.5 tear height.
  • Reference transformation families: Spun. Set bonuses and costumes remain a separate unfinished overhaul.
<3ID 15 · Quality 2 · PassivePlayable
Drop poolsItem Room, Gluttony Miniboss
  • +1 Red heart containers
  • +1 HP Up
  • Fully restores all red heart containers
  • Has a chance to drop from the Gluttony miniboss fight
  • Heal: full
  • This build: +1 heart containers. Refills red health.
Raw LiverID 16 · Quality 2 · PassivePlayable
Drop poolsSecret Room
  • +2 Red heart containers
  • +2 Health Up
  • Full red heart heal
  • Heal: full
  • This build: +2 heart containers. Refills red health.
Skeleton KeyID 17 · Quality 3 · PassivePlayable
Drop poolsItem Room, Secret Room
  • Keys set to 99
  • Gives Isaac 99 Keys
  • This build: Gives Isaac 99 Keys.
A DollarID 18 · Quality 3 · PassivePlayable
Drop poolsNone (Arcade machine only), Item Room
  • +100 Coins
  • Gives Isaac 100 coins
  • Can drop from an exploding slot machine while playing it
  • This build: Gives Isaac 100 coins. Can drop from an exploding slot machine while playing it.
Boom!ID 19 · Quality 0 · PassivePlayable
Drop poolsItem Room
  • +10 Bombs
  • +10 Bombs
  • This build: +10 Bombs.
TranscendenceID 20 · Quality 3 · PassivePlayable
Drop poolsSecret Room
No direct change.
  • Gives Isaac the ability to fly
  • Flying
  • This build: Gives Isaac the ability to fly.
The CompassID 21 · Quality 2 · PassivePlayable
Drop poolsShop, Beggar
No direct change.
  • Shows most icons on the map (Shops, Item Rooms, Boss Rooms etc.)
  • Does not show the layout of the map
  • Doesn't show the location of Secret or Super Secret rooms
  • Room icons will not show if a Curse of the Lost is in effect on the current floor
  • This build: mapCompass.
LunchID 22 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Challenge Room, Beggar
  • +1 Red heart containers
  • +1 HP Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts.
DinnerID 23 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Beggar, Challenge Room
  • +1 Red heart containers
  • +1 HP Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts.
DessertID 24 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Beggar, Challenge Room
  • +1 Red heart containers
  • +1 HP Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts.
BreakfastID 25 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Challenge Room, Beggar
  • +1 Red heart containers
  • +1 HP Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts.
Rotten MeatID 26 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Beggar, Challenge Room
  • +1 Red heart containers
  • +1 HP Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts.
Wooden SpoonID 27 · Quality 1 · PassivePlayable
Drop poolsBoss Room
  • +0.3 Movement speed
  • +0.3 Speed Up
  • This build: +0.3 Speed Up.
The BeltID 28 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +0.3 Movement speed
  • +0.3 Speed Up
  • This build: +0.3 Speed Up.
Mom's UnderwearID 29 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Challenge Room, Gold/Stone Chest, Mom's Chest
  • +1.5 Range
  • +1.5 Range Up
  • Gives 3-6 blue attack flies when picked up
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • This build: +1.5 range. momsUnderwear.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Mom's HeelsID 30 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Challenge Room, Mom's Chest
  • +1.5 Range
  • +1.5 Range Up
  • Makes Isaac deal 12 contact damage per tick (24 damage per second)
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • This build: +1.5 range. momsHeels.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Mom's LipstickID 31 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Challenge Room, Mom's Chest
  • +2.25 Range
  • +2.25 Range Up
  • Drops a random heart on the floor when picked up
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • This build: +2.25 range. momsLipstick.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Wire Coat HangerID 32 · Quality 3 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +0.7 Tears per second
  • +0.7 Tears Up
  • This build: +0.7 Tears Up.
The BibleID 33 · Quality 1 · ActivePlayable
Drop poolsShop, Library, Angel Room
No direct change.
  • Gives Isaac angel wings for the current room, allowing him to fly
  • Instantly kills the Mom's Foot, Mom's Heart and It Lives boss fights
  • If used during the Satan fight, The Bible will instantly kill Isaac
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Bible
  • This build: Gives Isaac angel wings for the current room, allowing him to fly. Instantly kills the Mom's Foot, Mom's Heart and It Lives boss fights.
  • Reference transformation families: Bookworm, Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
The Book of BelialID 34 · Quality 2 · ActivePlayable
Drop poolsLibrary, Devil Room
No direct change.
  • Upon use, gives +2 damage up which lasts for the current room
  • x1.5 times Damage Multiplier if you also have Blood of the Martyr (Does not stack with Magic Mushroom or Cricket's Head multipliers)
  • Increases your chances of getting a devil/angel room by +12.5%
  • Judas starts with this item
  • Additional uses in the same room or combined with The Devil XV give +1 damage per use
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: 3 rooms
  • Deal Chance: 0.125
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Book of Belial
  • This build: +2 damage this room; repeated uses add +1.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
The NecronomiconID 35 · Quality 1 · ActivePlayable
Drop poolsLibrary, Secret Room, Devil Room
No direct change.
  • Deals 40 damage to everything in the room when used
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Necronomicon
  • This build: 40 damage to every enemy.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
The PoopID 36 · Quality 0 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Drops a poop on the floor
  • Blue Baby starts with this item
  • Can be placed next to a pit and exploded to make a bridge
  • Can be placed over a broken red poop to overwrite it, causing it to no longer regenerate
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation
  • Recharge Time: 1 room
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Poop
  • This build: Drops a poop on the floor. Can be placed next to a pit and exploded to make a bridge. Can be placed over a broken red poop to overwrite it, causing it to no longer regenerate.
  • Reference transformation families: Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
Mr. BoomID 37 · Quality 1 · ActivePlayable
Drop poolsItem Room, Wrath Miniboss, Bomb Beggar
No direct change.
  • Drops a large bomb below the player which does 185 damage
  • Compatible with bomb modifiers, such as Glitter Bombs, Sticky Bombs etc
  • Has a chance to drop from the Wrath miniboss fight
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mr. Boom
  • This build: Drops a large bomb below the player which does 185 damage. Compatible with bomb modifiers, such as Glitter Bombs, Sticky Bombs etc. Has a chance to drop from the Wrath miniboss fight.
Tammy's HeadID 38 · Quality 2 · ActivePlayable
Drop poolsItem Room, Gold Chest
No direct change.
  • Fires 10 tears in a circle around Isaac
  • Each tear is equal to your damage stat + 25 flat damage
  • The tears spawned from Tammy's Head retain tear effects of Isaac's tears, such as poison or homing
  • Recharge Time: 1 room
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Tammy's Head
  • This build: Ten tears in a ring, each with +25 damage.
Mom's BraID 39 · Quality 1 · ActivePlayable
Drop poolsItem Room, Challenge Room, Mom's Chest
No direct change.
  • When used, freezes all enemies in the current room for about 4 seconds
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mom's Bra
  • This build: When used, freezes all enemies in the current room for about 4 seconds.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
KamikazeID 40 · Quality 0 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Causes an explosion near Isaac which takes away half a heart and does 40 damage all enemies in close proximity
  • Does not reduce your devil/angel room chances when used
  • Recharge Time: Instant
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Kamikaze
  • This build: Causes an explosion near Isaac which takes away half a heart and does 40 damage all enemies in close proximity. Does not reduce your devil/angel room chances when used.
Mom's PadID 41 · Quality 0 · ActivePlayable
Drop poolsItem Room, Challenge Room, Mom's Chest
No direct change.
  • When used, causes all enemies in the current room to run away from Isaac in fear for 5 seconds
  • Spawns 1 blue attack fly per use
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mom's Pad
  • This build: When used, causes all enemies in the current room to run away from Isaac in fear for 5 seconds. Spawns 1 blue attack fly per use.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Bob's Rotten HeadID 42 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Sloth Miniboss
No direct change.
  • A poison bomb which can be thrown and leaves a poison effect on any enemies within the blast radius. It also leaves a gas cloud at the place where it exploded
  • The bomb deals 185 damage + your tear damage on hit and leaves a damage over time poison effect that does 3 times your tear damage per tick
  • Synergizes with tear modifying items such as My Reflection or Tiny Planet
  • Has a chance to drop from the Sloth miniboss fight
  • Counts as 1 of 3 poison items needed towards the Bob transformation
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 15
  • Name: Bob's Rotten Head
  • This build: A poison bomb which can be thrown and leaves a poison effect on any enemies within the blast radius. It also leaves a gas cloud at the place where it exploded.
  • Reference transformation families: Bob. Set bonuses and costumes remain a separate unfinished overhaul.
TeleportID 44 · Quality 0 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Teleports Isaac to a random location on the map
  • Can't be used to teleport to the I AM ERROR room
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Teleport
  • This build: Teleports Isaac to a random location on the map. Can't be used to teleport to the I AM ERROR room.
Yum HeartID 45 · Quality 1 · ActivePlayable
Drop poolsItem Room, Super Lust Miniboss
No direct change.
  • Heals Isaac for one whole red heart
  • Maggy starts with this item
  • When used as the Keeper, one coin HP is restored
  • Has a chance to drop from the Super Lust miniboss fight
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Yum Heart
  • This build: Heals one red heart.
Lucky FootID 46 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Beggar
No direct change.
  • +1.0 Luck Up
  • Better chance to win while gambling at the Shell Game and Fortune Telling Machine
  • Higher chance to get a random drop after clearing a room
  • Converts all negative pills into their positive counterparts. Doesn't affect neutral ones and pills remain unidentified
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1.0 Luck Up. Better chance to win while gambling at the Shell Game and Fortune Telling Machine. Higher chance to get a random drop after clearing a room.
Doctor's RemoteID 47 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A target is placed on the floor which can be controlled. After a few seconds a huge missile hits the target and deals 20x your tear damage to anything nearby
  • Essentially a one-time use of the Epic Fetus item
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 2.5
  • Name: Doctor's Remote
  • This build: A target is placed on the floor which can be controlled. After a few seconds a huge missile hits the target and deals 20x your tear damage to anything nearby.
Cupid's ArrowID 48 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Isaac's tears now have a piercing effect which allows them to travel through enemies instead of breaking on hit
  • Piercing
  • This build: Tears pass through enemies.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Shoop Da Whoop!ID 49 · Quality 2 · ActivePlayable
Drop poolsItem Room, Envy Miniboss, Super Envy Miniboss
No direct change.
  • When used, fires a high damage laser in a straight line across the room in a similar way to Brimstone
  • The laser deals damage equal to double your tear damage. The laser hits up to 13 times if an enemy stays inside it for the duration
  • Has a chance to drop from the Envy and Super Envy miniboss fights
  • Recharge Time: 2 rooms
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 15
  • Name: Shoop Da Whoop!
  • This build: When used, fires a high damage laser in a straight line across the room in a similar way to Brimstone.
StevenID 50 · Quality 3 · PassivePlayable
Drop poolsSteven Boss, Item Room
  • +1 Damage
  • +1 Damage Up
  • Can only be dropped by the Steven boss
  • This build: +1 Damage Up.
PentagramID 51 · Quality 3 · PassivePlayable
Drop poolsBoss Room, Curse Room, Devil Room, Demon Beggar, Crane Game
  • +1 Damage
  • +1.0 Damage Up
  • +10% chance of a devil/angel room opening while held
  • A second Pentagram will give an extra +5% chance
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation
  • Deal Chance: 0.1
  • This build: +1.0 Damage Up. +10% chance of a devil/angel room opening while held. A second Pentagram will give an extra +5% chance.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
Dr. FetusID 52 · Quality 4 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Instead of tears, Isaac now shoots bombs from his eyes, which explode dealing damage to anything nearby
  • Bomb damage = damage * 10
  • Tears Down (Tear delay * 2.5)
  • Bombs will also synergize with other bomb items and tear modifiers, including Sad Bombs, Mr. Mega and many more
  • Bombs grow larger or smaller with tear size modifiers and are immune to knockback from their own explosions
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Instead of tears, Isaac now shoots bombs from his eyes, which explode dealing damage to anything nearby. Bomb damage = damage * 10. Tears Down (Tear delay * 2.5).
MagnetoID 53 · Quality 1 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Causes pickups on the floor move towards the player
  • Works across pits, but not through Key blocks
  • Chests up to 2 tiles away from Isaac open automatically. Spiked chests are opened without damaging Isaac. Locked chests and stone chests are not opened and still require a key/bomb
  • This build: Causes pickups on the floor move towards the player. Works across pits, but not through Key blocks.
Treasure MapID 54 · Quality 2 · PassivePlayable
Drop poolsShop, Beggar
No direct change.
  • Reveals the entire map for every floor except the secret room locations
  • Does not show the icons for any unexplored rooms
  • Can still help you to guess which direction the boss room is in, due to the fact that the Boss Room is usually in the room furthest away from the first room
  • This build: mapTreasure.
Mom's EyeID 55 · Quality 1 · Passive, Tear ModifierPlayable
Drop poolsItem Room, Challenge Room, Mom's Chest
No direct change.
  • Isaac has a random chance to fire another tear out the back of his head
  • The chance to fire the second tear can improve based on your luck stat and will always activate at +5 Luck
  • At +0 luck theres a ~50% chance for this effect to activate
  • Synergizes very well with a lot of items. If used with Brimstone you have a 100% chance to fire a laser out the back of your head
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • This build: Chance to fire an extra tear backward; 50% at zero luck and guaranteed at five luck.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Lemon MishapID 56 · Quality 0 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, drops a pool of 'lemonade' on the floor which damages any enemies that come into contact with it for 8 damage per tick
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Lemon Mishap
  • This build: When used, drops a pool of 'lemonade' on the floor which damages any enemies that come into contact with it for 8 damage per tick.
Distant AdmirationID 57 · Quality 2 · Passive, OrbitalPlayable
Drop poolsItem Room, Key Beggar
No direct change.
  • Gives Isaac an orbiting fly which deals 5 contact damage to enemies per tick
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: Gives Isaac an orbiting fly which deals 5 contact damage to enemies per tick.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 5
  • Familiar Radius: 64
  • Familiar Speed: 2.2
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Book of ShadowsID 58 · Quality 3 · ActivePlayable
Drop poolsItem Room, Library
No direct change.
  • Gives the player an invulnerability effect which lasts for a 10 seconds
  • Can be used to get free hits on the Blood Donation machines and Devil Beggars
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Book of Shadows
  • This build: Invulnerable for 10 seconds.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
The LadderID 60 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Allows Isaac to walk over gaps with a width of one tile
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Allows Isaac to walk over gaps with a width of one tile.
Charm of the VampireID 62 · Quality 1 · PassivePlayable
Drop poolsItem Room
  • +0.3 Damage
  • +0.3 Damage Up
  • Heals half a heart after every 13 enemies killed
  • Works with the Keeper for restoring coin HP
  • This build: +0.3 damage. Heals half a heart every 13 kills.
The BatteryID 63 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • All spacebar items can now be 'overcharged', allowing them to be charged up twice instead of once
  • The extra charges appear in yellow on top of the normal green bars
  • This item works with self-recharging items
  • Not in random drops: Its original ability is not implemented yet.
  • This build: All spacebar items can now be 'overcharged', allowing them to be charged up twice instead of once. The extra charges appear in yellow on top of the normal green bars.
Steam SaleID 64 · Quality 2 · PassivePlayable
Drop poolsShop, Greed Miniboss, Shopkeeper
No direct change.
  • Items in the shop are now -50% off
  • 15c items are reduced to 7c. 5c pickups become 3c. 3c pickups become 2c
  • Taking more than 1 steam sale reduces the price of all items even further
  • This item is called Steamy Sale on PS4, PS Vita, Xbox One and Switch versions, probably due to copyright reasons
  • This build: Shop prices are reduced by 50%; additional copies reduce them further.
Anarchist CookbookID 65 · Quality 1 · ActivePlayable
Drop poolsItem Room, Library, Pride Miniboss
No direct change.
  • Spawns 6 troll bombs at random locations around the room
  • Bombs are effected by other passive bomb items
  • Has a chance to drop from the Pride miniboss fight
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Anarchist Cookbook
  • This build: Spawns 6 troll bombs at random locations around the room. Bombs are effected by other passive bomb items. Has a chance to drop from the Pride miniboss fight.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
The HourglassID 66 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, slows down all enemies in the current room and their projectiles for about 8 seconds
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Hourglass
  • This build: Slows enemies for 8 seconds.
Sister MaggyID 67 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room, Devil Room
No direct change.
  • A familiar which follows Isaac around and shoots blood tears that deal 5 damage
  • The tears appear red but have no additional damage
  • Sister Maggy fires tears at a rate of 1 tear per second
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • This build: A familiar which follows Isaac around and shoots blood tears that deal 5 damage. The tears appear red but have no additional damage. Sister Maggy fires tears at a rate of 1 tear per second.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 5
  • Familiar Cd: 0.4
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
TechnologyID 68 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac's tears are replaced with a laser that has unlimited range and can only fire at right angles
  • Lasers travel through enemies but not obstacles in the room
  • Synergizes with most items that affect how many tears you fire (20/20, Mutant Spider etc.) or the path they take (My Reflection, Tiny Planet etc.)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's tears are replaced with a laser that has unlimited range and can only fire at right angles. Lasers travel through enemies but not obstacles in the room.
Chocolate MilkID 69 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac can now charge shots for more damage by holding down the fire button
  • At full charge, your tears do 4 times more damage
  • Tears fired at the minimum possible charge do roughly 1/3 of your normal damage
  • You can spam the fire button to rapid fire, however the overall damage per second will be low
  • Tears down: Delay * 2.5
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac can now charge shots for more damage by holding down the fire button. At full charge, your tears do 4 times more damage.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Growth HormonesID 70 · Quality 3 · PassivePlayable
Drop poolsBoss Room, Demon Beggar
  • +1 Damage
  • +0.2 Movement speed
  • +1.0 Damage Up
  • +0.2 Speed Up
  • Counts as 1 of 3 syringe items needed towards the Spun transformation
  • This build: +1 damage. +0.2 speed.
  • Reference transformation families: Spun. Set bonuses and costumes remain a separate unfinished overhaul.
Mini MushID 71 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
  • +0.3 Movement speed
  • +1.5 Range
  • +0.3 Speed Up
  • +1.5 Range Up
  • Causes Isaac to shrink in size (including hitbox slightly)
  • Can be dropped when exploding mushrooms in the environment that are usually found in the Caves/Catacombs and in secret rooms
  • Counts as 1 of 3 mushroom items needed towards the Fun Guy transformation
  • Not in random drops: Player/hitbox shrinking is not implemented.
  • This build: +0.3 speed. +1.5 range. miniMush.
  • Reference transformation families: Fun Guy. Set bonuses and costumes remain a separate unfinished overhaul.
RosaryID 72 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Angel Room
  • +3 Soul hearts
  • +0.5 Tears per second
  • +3 Soul Hearts
  • +0.5 Tears Up
  • Adds several instances of The Bible item into all item pools
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • Not in random drops: Extra Bible copies in item pools are not implemented.
  • This build: +3 soul hearts. +0.5 tears/s. rosary.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Cube of MeatID 73 · Quality 2 · PassivePlayable
Drop poolsNone (Horsemen boss only), Item Room
No direct change.
  • An orbital which blocks shots and damages enemies it comes into contact with for 7 damage per tick
  • Exclusively drops from one of the horsemen bosses
  • 2 cubes of meat transform the orbital into a meat head which fires blood tears which deal 3.5 damage each
  • 3 cubes of meat transform it into a meat boy familiar that walks around and deals 3.5 contact damage per tick to enemies
  • 4 cubes of meat cause the meat boy familiar to grow in size and do 5.5 damage per tick instead
  • Any further cubes of meat past 4 will start the cycle again
  • This build: An orbital which blocks shots and damages enemies it comes into contact with for 7 damage per tick. Exclusively drops from one of the horsemen bosses.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 7
  • Familiar Radius: 54
  • Familiar Speed: 2
  • Familiar Block: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
A QuarterID 74 · Quality 0 · PassivePlayable
Drop poolsDevil Room, Gold Chest, Super Greed Miniboss
  • +25 Coins
  • +25 Coins
  • Has a very small chance to drop after destroying one of the pots that appear in the Basement and Cellar floors
  • Has a chance to drop from the Super Greed miniboss fight
  • This build: +25 Coins. Has a very small chance to drop after destroying one of the pots that appear in the Basement and Cellar floors. Has a chance to drop from the Super Greed miniboss fight.
PhDID 75 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Shop
No direct change.
  • Converts most negative pills into their positive counterparts, e.g. Stat Down becomes Stat Up. Bad Trip becomes Balls of Steel. Amnesia becomes I Can See Forever etc
  • Pills are identified before using them
  • Drops one pill on pickup
  • Heals for 2 full red hearts
  • Adds 0-2 coins to the payout when you use a Blood Donation machine or IV Bag
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Converts most negative pills into their positive counterparts, e.g. Stat Down becomes Stat Up. Bad Trip becomes Balls of Steel. Amnesia becomes I Can See Forever etc.
X-Ray VisionID 76 · Quality 2 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Reveals the entrance to secret rooms and automatically opens the hole, removing the need for bombs to enter
  • This build: xRayVision.
My Little UnicornID 77 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Gives Isaac invincibility and +0.28 Speed for 6 seconds
  • While active you cannot fire tears, but running into enemies will deal 40 contact damage per second
  • Allows free hits on the Blood Donation machines and devil beggars
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: My Little Unicorn
  • This build: Gives Isaac invincibility and +0.28 Speed for 6 seconds. While active you cannot fire tears, but running into enemies will deal 40 contact damage per second.
Book of RevelationsID 78 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Library
No direct change.
  • Upon use, gives Isaac an extra Soul heart
  • Using this item gives you a higher chance of finding a horsemen boss at the end of the floor
  • +17.5% chance of a Devil Deal opening after the boss fight
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Book of Revelations
  • This build: Upon use, gives Isaac an extra Soul heart. Using this item gives you a higher chance of finding a horsemen boss at the end of the floor. +17.5% chance of a Devil Deal opening after the boss fight.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
The MarkID 79 · Quality 3 · PassivePlayable
Drop poolsCurse Room, Devil Room, Demon Beggar
  • +1 Damage
  • +0.2 Movement speed
  • +1 Soul hearts
  • +1.0 Damage Up
  • +0.2 Speed Up
  • +1 Soul Heart
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation
  • This build: +1 damage. +0.2 speed. +1 soul hearts.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
The PactID 80 · Quality 3 · PassivePlayable
Drop poolsDevil Room, Curse Room, Demon Beggar
  • +0.5 Damage
  • +0.7 Tears per second
  • +2 Black hearts
  • +0.5 Damage Up
  • +0.7 Tears Up
  • +2 Black Hearts
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation
  • This build: +0.5 damage. +0.7 tears/s. +2 black hearts.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
Dead CatID 81 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room, Red Chest, Super Pride Miniboss
No direct change.
  • Isaac's health is set to 1 and he also gains 9 extra lives
  • Each time Isaac dies, he will respawn with 1 Health
  • Has a chance to drop from the Super Pride mini boss
  • The floating Dead Cat head that follows you will disappear when you are on your last life (Very useful for The Lost)
  • Counts as 1 of 3 cat items needed towards the Guppy transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's health is set to 1 and he also gains 9 extra lives. Each time Isaac dies, he will respawn with 1 Health. Has a chance to drop from the Super Pride mini boss.
  • Reference transformation families: Guppy. Set bonuses and costumes remain a separate unfinished overhaul.
Lord of the PitID 82 · Quality 3 · PassivePlayable
Drop poolsDevil Room, Demon Beggar
  • +0.3 Movement speed
  • Gives Isaac demon wings and the ability to fly
  • +0.3 Speed Up
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation.
  • Flying
  • This build: +0.3 speed. Flight.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
The NailID 83 · Quality 2 · ActivePlayable
Drop poolsDevil Room, Demon Beggar
No direct change.
  • Each use of this item gives +0.7 Damage Up, -0.18 Speed Down and the ability to destroy most obstacles for the current room.
  • Each use also gives half a black heart, however this is stays between rooms unlike the other effects
  • Allows Isaac to deal 40 contact damage to enemies for the current room. Does not prevent Isaac from taking contact damage
  • All the above effects are only active when the item is used for the current room
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Nail
  • This build: Each use of this item gives +0.7 Damage Up, -0.18 Speed Down and the ability to destroy most obstacles for the current room.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
We Need To Go DeeperID 84 · Quality 2 · ActivePlayable
Drop poolsSecret Room, Devil Room
No direct change.
  • Spawns a trapdoor at Isaac's feet which allows him to travel to the next floor
  • Digging in certain spots with objects or markings on the floor will guarantee a crawlspace once per floor
  • In Sheol, Cathedral, Chest and Dark Room this item either opens a Crawl Space, or does nothing
  • Cannot spawn a trapdoor directly infront of a secret room entrance
  • Can destroy rocks if used when Isaac is flying over a rock
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: We Need To Go Deeper
  • This build: Spawns a trapdoor at Isaac's feet which allows him to travel to the next floor. Digging in certain spots with objects or markings on the floor will guarantee a crawlspace once per floor.
Deck of CardsID 85 · Quality 2 · ActivePlayable
Drop poolsItem Room, Shop
No direct change.
  • Gives Isaac a random tarot card on use
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Deck of Cards
  • This build: Gives Isaac a random tarot card on use.
Monstro's ToothID 86 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, spawns a Monstro which will jump on a random enemy in the room, dealing 120 damage and destroying nearby obstacles
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Monstro's Tooth
  • This build: When used, spawns a Monstro which will jump on a random enemy in the room, dealing 120 damage and destroying nearby obstacles.
Loki's HornsID 87 · Quality 1 · Passive, Tear ModifierPlayable
Drop poolsItem Room, Demon Beggar
No direct change.
  • Everytime you fire a tear, there is a chance that you will also fire three more tears in all cardinal directions
  • The chance to fire 4-way tears is affected by your luck stat and at +15 Luck it will activate every time
  • At +0 luck the effect has a 30% chance to activate
  • This build: Chance to fire in four directions; 30% at zero luck and guaranteed at fifteen luck.
Little ChubbyID 88 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familiar that follows Isaac and charges forwards, dealing 3.5 damage per tick to any enemies it comes into contact with
  • This build: A familiar that follows Isaac and charges forwards, dealing 3.5 damage per tick to any enemies it comes into contact with.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: charger
  • Familiar Dmg: 3.5
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Spider BiteID 89 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Adds a 25% chance to shoot slowing tears, reducing enemy movement speed and the speed of any projectile they fire.
  • The slow lasts 2.5 seconds.
  • Chance follows 1 / (4 - floor(Luck / 5)): 25% at 0 Luck and 100% at 15 Luck. Increases occur at each 5 Luck threshold.
  • Outside Rebirth and Afterbirth, Spider Bite belongs to the Spider Baby set; collecting three set items transforms Isaac into a humanoid spider.
  • In Repentance+, defeating Triachnid has a 1% chance to drop Spider Bite.
  • Finger! can also apply the slow. Technology, Technology 2, Tech.5, Tech X (except in Rebirth), and Brimstone lasers turn light pink and can slow enemies.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears now have a chance of slowing enemies and their projectiles for 2.5 seconds. The chance to slow enemies is affected by your luck stat and at +15 Luck it will activate every time.
The Small RockID 90 · Quality 3 · PassivePlayable
Drop poolsNone (Tinted rock only), Item Room
  • +1 Damage
  • +0.2 Tears per second
  • -0.2 Movement speed
  • +1.0 Damage Up
  • +0.2 Tears Up
  • -0.2 Speed Down
  • Has a chance to drop when exploding a tinted rock
  • This build: +1 damage. +0.2 tears/s. -0.2 speed.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Spelunker HatID 91 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Reveals adjacent rooms up to 2 rooms away, this includes revealing if you're next to a Secret Room or Super Secret Rooms
  • Gives Isaac a slight glow when Curse of Darkness is active
  • Blocks damage from projectiles falling from above
  • Not in random drops: Falling-projectile protection is not implemented.
  • This build: spelunkerHat.
Super BandageID 92 · Quality 2 · PassivePlayable
Drop poolsItem Room, Boss Room
  • +1 Red heart containers
  • +2 Soul hearts
  • +1 HP Up
  • +2 Soul Hearts
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. +2 soul hearts. Heals 1 red hearts.
The GamekidID 93 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used Isaac transforms into pacman, which makes him invincible for 6 seconds and does 40 contact damage to enemies per chomp
  • Everytime you 'eat' 2 enemies, you regain 1/2 heart of red health
  • You can't shoot tears while the effect is active
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Gamekid
  • This build: When used Isaac transforms into pacman, which makes him invincible for 6 seconds and does 40 contact damage to enemies per chomp. Everytime you 'eat' 2 enemies, you regain 1/2 heart of red health.
Sack of PenniesID 94 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A bag that floats around following Isaac and drops a random coin every 2 rooms
  • This build: A bag that floats around following Isaac and drops a random coin every 2 rooms.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: dropper
  • Familiar Every: 2
  • Familiar Drop: coin
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Robo-BabyID 95 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar which follows Isaac and shoots lasers, similar to the Technology item
  • Robo-Baby's laser is spectral and piercing (It will pass through rocks and objects in the environment)
  • Robo-Baby's lasers deal 3.5 damage per hit
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar which follows Isaac and shoots lasers, similar to the Technology item. Robo-Baby's laser is spectral and piercing (It will pass through rocks and objects in the environment).
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Little C.H.A.DID 96 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room, C.H.A.D. Boss
No direct change.
  • A familiar which follows Isaac and drops half a red heart every 3 rooms
  • This build: A familiar which follows Isaac and drops half a red heart every 3 rooms.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: dropper
  • Familiar Every: 3
  • Familiar Drop: heart:1
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
The Book of SinID 97 · Quality 2 · ActivePlayable
Drop poolsItem Room, Library, Devil Room
No direct change.
  • Spawns a random pickup on the floor
  • Any pickups are possible from this item, including Bombs, hearts, keys, coins, pills, batteries, tarot cards, runes etc
  • Doesn't produce microbatteries, only regular sized ones and rarely golden/mega batteries
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Book of Sin
  • This build: Spawns a random pickup on the floor. Any pickups are possible from this item, including Bombs, hearts, keys, coins, pills, batteries, tarot cards, runes etc.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
The RelicID 98 · Quality 3 · Passive, FamiliarPlayable
Drop poolsItem Room, Angel Room
No direct change.
  • A blue cross that follows Isaac and drops a soul heart every 7 or 8 rooms
  • This build: A blue cross that follows Isaac and drops a soul heart every 7 or 8 rooms.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: dropper
  • Familiar Every: 7 / 8
  • Familiar Drop: soulHeart
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Little GishID 99 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room, Gish Boss
No direct change.
  • A familiar that follows Isaac and fires black tar tears, which slow enemy movement and projectile speed for a few seconds
  • Little Gish's tears do 3.5 damage
  • Little Gish fires tears at a rate of 1 tear per second
  • A Guaranteed drop from the Gish boss fight
  • This build: A familiar that follows Isaac and fires black tar tears, which slow enemy movement and projectile speed for a few seconds. Little Gish's tears do 3.5 damage.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 3.5
  • Familiar Cd: 1
  • Familiar Slow: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Little StevenID 100 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room, Steven Boss
No direct change.
  • A familiar that follows Isaac and fires homing tears that deal 3.5 damage each
  • Has a high chance to drop from the Steven boss fight
  • Little Steven fires tears at a rate of 1 tear per second with a slightly longer range than other familiars
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • This build: A familiar that follows Isaac and fires homing tears that deal 3.5 damage each. Has a high chance to drop from the Steven boss fight.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 3.5
  • Familiar Cd: 0.5
  • Familiar Homing: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
The HaloID 101 · Quality 2 · PassivePlayable
Drop poolsItem Room, Angel Room
  • +1 Red heart containers
  • +0.3 Damage
  • +0.2 Tears per second
  • +0.38 Range
  • +0.3 Movement speed
  • +1 HP Up
  • +0.3 Damage Up
  • +0.2 Tears Up
  • +0.38 Range Up
  • +0.3 Speed Up
  • Heals one red heart container when picked up
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • Heal: 1
  • This build: +1 heart containers. +0.3 damage. +0.2 tears/s. +0.38 range. +0.3 speed. Heals 1 red hearts.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Mom's Bottle of PillsID 102 · Quality 1 · ActivePlayable
Drop poolsItem Room, Shop, Challenge Room, Beggar, Demon Beggar, Mom's Chest
No direct change.
  • When used, gives Isaac a random pill
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mom's Bottle of Pills
  • This build: When used, gives Isaac a random pill.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
The Common ColdID 103 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Tears now have a random chance to apply a poison effect, causing double your tear damage per tick to enemies over time
  • The chance to fire poison shots is affected by your luck stat and at +12 Luck it will activate every time
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears now have a random chance to apply a poison effect, causing double your tear damage per tick to enemies over time.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
The ParasiteID 104 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Isaac's tears now split into two upon contact with enemies or the environment
  • Tears that split off from the main tear do less damage (tear damage * 0.5)
  • Tears can keep splitting if they still have range and damage above 1
  • This build: Impact tears split sideways for half damage and may split again.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
The D6ID 105 · Quality 4 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, replaces all pedestal items in the current room with another random item. Re-rolled items pick from the current room's item pool
  • Isaac starts with this item after it is unlocked
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The D6
  • This build: When used, replaces all pedestal items in the current room with another random item. Re-rolled items pick from the current room's item pool.
Mr. MegaID 106 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Bomb Beggar, Super Wrath Miniboss
No direct change.
  • +5 Bombs
  • Bombs now do 185 damage (up from 100) and have a larger blast radius
  • Can be found in the secret room
  • Has a chance to drop from the Super Wrath miniboss fight
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. Bombs now do 185 damage (up from 100) and have a larger blast radius. Can be found in the secret room. Has a chance to drop from the Super Wrath miniboss fight.
Pinking ShearsID 107 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Cuts Isaac's head from his body for the current room, allowing him to fly and leaving the decapitated body to run around attacking enemies for 5.5 damage per tick
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Pinking Shears
  • This build: Cuts Isaac's head from his body for the current room, allowing him to fly and leaving the decapitated body to run around attacking enemies for 5.5 damage per tick.
The WaferID 108 · Quality 4 · PassivePlayable
Drop poolsItem Room, Angel Room
No direct change.
  • All damage taken is reduced to half a heart
  • Damaged reduction is reduced from every source in the game except Devil Deals and health down pills
  • Does not prevent death (i.e. Suicide King or using The Bible on Isaac, ??? or Satan)
  • The Wafer becomes most effective in the Womb and beyond where enemies all deal a whole heart of damage
  • The Wafer causes the Sharp Plug item to only cost 1/2 a heart per use
  • Has no effect with the Keeper - there's no such thing as half a coin health point
  • Wafer
  • This build: Damage is capped at half a heart.
Money = PowerID 109 · Quality 3 · PassivePlayable
Drop poolsItem Room, Devil Room
No direct change.
  • +0.04 Damage Up for every coin you currently have
  • At 99 coins this item gives +3.96 Damage Up
  • +0.04 per coin is the amount added before the damage formula is calculated, as this is the only way to show a consistent amount of damage given. You may see more or less than this on the Found HUD overlay, however this number varies based on your other damage increasing items
  • This build: +0.04 damage per held coin.
Mom's ContactsID 110 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Challenge Room, Mom's Chest
No direct change.
  • Tears now have a random chance to freeze enemies in place
  • The chance to freeze enemies is affected by your luck stat
  • +0.38 Range Up
  • Chance to activate increases with luck, up to around 50% chance at +20 luck
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears now have a random chance to freeze enemies in place. The chance to freeze enemies is affected by your luck stat. +0.38 Range Up.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
The BeanID 111 · Quality 0 · ActivePlayable
Drop poolsItem Room, Beggar
No direct change.
  • Upon use, this item causes Isaac to fart and poison any enemies in close proximity
  • The Bean deals 5 damage, then poisons enemies for 6 total ticks of damage
  • The poison deals your current tear damage per tick
  • Recharge Time: 1 room
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Bean
  • This build: 5 nearby damage, then six poison ticks at tear damage.
Guardian AngelID 112 · Quality 2 · Passive, OrbitalPlayable
Drop poolsAngel Room
No direct change.
  • An orbital which does 7 contact damage per tick, blocks shots and increases the speed of all other orbitals
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • This build: An orbital which does 7 contact damage per tick, blocks shots and increases the speed of all other orbitals.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 7
  • Familiar Radius: 60
  • Familiar Speed: 2.2
  • Familiar Block: true
  • Familiar Boost: 1.5
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined, Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Demon BabyID 113 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room, Devil Room
No direct change.
  • A familiar which follows Isaac and automatically fires tears that deal 3 damage each at any enemies in close range
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • This build: A familiar which follows Isaac and automatically fires tears that deal 3 damage each at any enemies in close range.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 3
  • Familiar Cd: 0.5
  • Familiar Auto: true
  • Familiar Range: 210
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Mom's KnifeID 114 · Quality 4 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room, Devil Room, Challenge Room, Mom's Chest
No direct change.
  • Tears are replaced with a knife which can be charged and thrown in a boomerang style action
  • The knife can also do damage without being thrown as a close range melee weapon
  • When used as a melee weapon, Mom's Knife deals your tear damage * 2 per tick
  • At the furthest point from Isaac the knife deals your tear damage * 6
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears are replaced with a knife which can be charged and thrown in a boomerang style action. The knife can also do damage without being thrown as a close range melee weapon.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Ouija BoardID 115 · Quality 2 · PassivePlayable
Drop poolsItem Room, Devil Room
  • +0.4 Tears per second
  • Gives Isaac spectral tears which allows them to travel through objects in the environment (i.e. rocks)
  • +0.4 Tears Up
  • Spectral
  • This build: +0.4 tears/s. Tears pass through scenery.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
9 VoltID 116 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Automatically gives you 1 bar of charge after using your spacebar item
  • Fully recharges your current spacebar item when picked up
  • Any items which are normally a 1 room recharge are now timed instead
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Automatically gives you 1 bar of charge after using your spacebar item. Fully recharges your current spacebar item when picked up. Any items which are normally a 1 room recharge are now timed instead.
Dead BirdID 117 · Quality 0 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • When Isaac takes damage, the dead bird will spawn and attack nearby enemies in the current room for 2 damage per tick
  • Eve starts with this item
  • This build: deadBird.
BrimstoneID 118 · Quality 4 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Tears are replaced with the ability to charge and fire a powerful laser that travels in a straight line across the room, dealing a lot of damage (tear damage hits for 9 ticks per laser) to any enemies it comes into contact with
  • Does not directly affect your Damage stat but hits enemies 9 times per charge
  • Synergizes very well with a lot of items including Tammy's Head, Tiny Planet, Inner Eye (Triple Shot), Mutant Spider (Quad Shot) and many others
  • If you somehow manage to get a second Brimstone, the laser becomes massive and deals double damage
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears are replaced with the ability to charge and fire a powerful laser that travels in a straight line across the room, dealing a lot of damage (tear damage hits for 9 ticks per laser) to any enemies it comes into contact with.
Blood BagID 119 · Quality 2 · PassivePlayable
Drop poolsNone (Blood Donation machine only), Item Room
  • +1 Red heart containers
  • +0.3 Movement speed
  • +1 HP Up
  • +0.3 Speed Up
  • Heals for 5 full red hearts
  • Has a chance to drop while playing any Blood Donation machine
  • Heal: 5
  • This build: +1 heart containers. +0.3 speed. Heals 5 red hearts.
Odd Mushroom (Thin)ID 120 · Quality 2 · PassivePlayable
Drop poolsItem Room, Secret Room
  • +1.7 Tears per second
  • +0.3 Movement speed
  • Damage ×0.9
  • Gives you a high rate of fire in exchange for a damage down
  • +1.7 Tears Up
  • +0.3 Speed Up
  • Damage Down (damage * 0.9 - 0.4)
  • Counts as 1 of 3 mushroom items needed towards the Fun Guy transformation
  • Post Damage: -0.4
  • This build: +1.7 tears/s. +0.3 speed. damage x0.9. -0.4 damage after multiplier.
  • Reference transformation families: Fun Guy. Set bonuses and costumes remain a separate unfinished overhaul.
Odd Mushroom (Large)ID 121 · Quality 2 · PassivePlayable
Drop poolsItem Room, Secret Room
  • +1 Red heart containers
  • +1 Damage
  • +0.38 Range
  • -0.2 Movement speed
  • +1 HP Up
  • +1.0 Damage Up
  • +0.38 Range Up
  • -0.2 Speed Down
  • Heals one red heart container when picked up
  • Counts as 1 of 3 mushroom items needed towards the Fun Guy transformation
  • Heal: 1
  • This build: +1 heart containers. +1 damage. +0.38 range. -0.2 speed. Heals 1 red hearts.
  • Reference transformation families: Fun Guy. Set bonuses and costumes remain a separate unfinished overhaul.
Whore of BabylonID 122 · Quality 2 · PassivePlayable
Drop poolsDevil Room, Demon Beggar
No direct change.
  • When you only have half a red heart remaining or less, you enter a curse state which adds +1.5 damage and +0.3 speed
  • When playing as Eve, this item activates with one FULL heart remaining or less AND also removes her 0.75 damage multiplier, raising it up to 1.0
  • The effect is permanently active for characters with no red hearts (e.g. Blue Baby, The Lost)
  • One of Eve's starting items
  • This build: whoreOfBabylon.
Monster ManualID 123 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Devil Room, Library
No direct change.
  • When used, gives a random familiar for the entire floor
  • It can spawn familiars you haven't unlocked yet!
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Monster Manual
  • This build: When used, gives a random familiar for the entire floor. It can spawn familiars you haven't unlocked yet!.
Dead Sea ScrollsID 124 · Quality 1 · ActivePlayable
Drop poolsItem Room, Angel Room
No direct change.
  • Upon use, the dead sea scrolls gives a random active item effect
  • An item that can be found in the Angel room
  • The name of the effect given is displayed when used.
  • Cannot give the Kamikaze effect
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Dead Sea Scrolls
  • This build: Upon use, the dead sea scrolls gives a random active item effect. An item that can be found in the Angel room. The name of the effect given is displayed when used. Cannot give the Kamikaze effect.
Bobby - BombID 125 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Bomb Beggar
No direct change.
  • +5 Bombs
  • All of Isaac's bombs now having a homing effect when placed on the floor
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. All of Isaac's bombs now having a homing effect when placed on the floor.
Razor BladeID 126 · Quality 0 · ActivePlayable
Drop poolsItem Room, Curse Room, Demon Beggar
No direct change.
  • When used, deals damage to Isaac in exchange for +1.2 damage up which lasts for the current room
  • This item takes 1 full heart of damage per use, and will take red hearts first before any other
  • Eve starts with this item after donating 439 coins to the Greed Donation Machine
  • Recharge Time: Instant
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Razor Blade
  • This build: Costs one red heart; +1.2 damage this room.
Forget Me NowID 127 · Quality 3 · ActivePlayable
Drop poolsItem Room, Secret Room, Devil Room, Demon Beggar
No direct change.
  • Upon use, this item refreshes the current floor with brand new rooms, monsters and items, as if you had entered a new floor
  • Recharge Time: Instant (One time use)
  • Active charge policy: once; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Forget Me Now
  • This build: Upon use, this item refreshes the current floor with brand new rooms, monsters and items, as if you had entered a new floor.
Forever AloneID 128 · Quality 1 · Passive, OrbitalPlayable
Drop poolsItem Room
No direct change.
  • An orbiting fly which deals 2 contact damage per tick to enemies
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: An orbiting fly which deals 2 contact damage per tick to enemies.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 2
  • Familiar Radius: 44
  • Familiar Speed: 2.6
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Bucket of LardID 129 · Quality 1 · PassivePlayable
Drop poolsItem Room, Super Gluttony Miniboss
  • +2 Red heart containers
  • -0.2 Movement speed
  • +2 Health Up
  • -0.2 Speed Down
  • Has a chance to drop from the Super Gluttony miniboss fight
  • This build: +2 heart containers. -0.2 speed.
A PonyID 130 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsNone (Headless horseman only), Item Room
No direct change.
  • Allows Isaac to fly while the Pony is held
  • Sets your speed stat to 1.5 if it isn't already that high
  • When the active attack is used, Isaac will dash across the screen dealing scaling contact damage to anything he hits (damage * 4 + 28)
  • Drops from the Headless Horseman boss fight
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: A Pony
  • This build: Allows Isaac to fly while the Pony is held. Sets your speed stat to 1.5 if it isn't already that high.
Bomb BagID 131 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A bag of bombs that will drop a bomb pickup every 2 rooms
  • This build: A bag of bombs that will drop a bomb pickup every 2 rooms.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: dropper
  • Familiar Every: 2
  • Familiar Drop: bomb
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
A Lump of CoalID 132 · Quality 3 · PassivePlayable
Drop poolsNone (Krampus only), Item Room
No direct change.
  • Tears gain a damage up and increase in size based on the distance they travel
  • The length of a normal room roughly gives +6 damage, but this can be higher with double rooms or Tiny Planet
  • This item synergises with beam items such as Brimstone and Tech, allowing them to do more damage the further away the enemy is
  • This build: Tears gain a damage up and increase in size based on the distance they travel. The length of a normal room roughly gives +6 damage, but this can be higher with double rooms or Tiny Planet.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Guppy's PawID 133 · Quality 3 · ActivePlayable
Drop poolsDevil Room, Curse Room, Red Chest
No direct change.
  • When used, removes one heart container and gives you 3 soul hearts
  • Bone hearts cannot be converted
  • Counts as 1 of 3 cat items needed towards the Guppy transformation
  • Recharge Time: Instant
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Guppy's Paw
  • This build: Trades a heart container for three soul hearts.
  • Reference transformation families: Guppy. Set bonuses and costumes remain a separate unfinished overhaul.
Guppy's TailID 134 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room, Red Chest
No direct change.
  • Gives a 1/3 chance for room clear rewards to become a normal or locked chest, and a 1/3 chance to reward nothing at all
  • Doesn't affect coins dropped after waves in Greed Mode
  • Counts as 1 of 3 cat items needed towards the Guppy transformation
  • Not in random drops: Reward detection also changes drops from the final enemy; needs the room-clear reward hook.
  • This build: guppysTail.
  • Reference transformation families: Guppy. Set bonuses and costumes remain a separate unfinished overhaul.
IV BagID 135 · Quality 1 · ActivePlayable
Drop poolsNone (Blood donation machine only), Item Room
No direct change.
  • Upon use, the IV Bag takes half a red heart and spawns 1-3 coins (the same effect as a blood donation machine)
  • Can drop from a blood donation machine after playing it
  • In the Womb and beyond this deals 1 full heart of damage
  • If no red hearts exist, other types of hearts are consumed instead
  • With the Keeper this is changed to spawning 0-1 coins per use instead
  • Recharge Time: Instant
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: IV Bag
  • This build: Upon use, the IV Bag takes half a red heart and spawns 1-3 coins (the same effect as a blood donation machine). Can drop from a blood donation machine after playing it.
Best FriendID 136 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Places a decoy on the floor which attracts enemies and explodes after a period of time
  • When it explodes, it deals 185 damage to everything in radius (Same damage as Mr Mega bombs)
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Best Friend
  • This build: Places a decoy on the floor which attracts enemies and explodes after a period of time. When it explodes, it deals 185 damage to everything in radius (Same damage as Mr Mega bombs).
Remote DetonatorID 137 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Shop, Bomb Beggar
No direct change.
  • +5 Bombs
  • Bombs no longer automatically explode and will only do so when you activate the remote detonator
  • Can be used to detonate Dr. Fetus bombs early
  • Recharge Time: Instant
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Remote Detonator
  • This build: +5 Bombs. Bombs no longer automatically explode and will only do so when you activate the remote detonator. Can be used to detonate Dr. Fetus bombs early.
StigmataID 138 · Quality 2 · PassivePlayable
Drop poolsItem Room
  • +1 Red heart containers
  • +0.3 Damage
  • +1 HP Up
  • +0.3 Damage Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. +0.3 damage. Heals 1 red hearts.
Mom's PurseID 139 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Mom's Chest
No direct change.
  • Isaac can now hold two trinkets at the same time
  • Drops a random trinket on the floor when picked up
  • Allows you to pick up more trinkets while also holding The Tick
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac can now hold two trinkets at the same time. Drops a random trinket on the floor when picked up. Allows you to pick up more trinkets while also holding The Tick.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Bob's CurseID 140 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Super Sloth Miniboss, Bomb Beggar
No direct change.
  • +5 Bombs
  • Isaac's bombs now poison nearby enemies and leave behind a gas cloud that poisons enemies that move through it. Poisoned enemies take 4 or 6 damage per tick for a few seconds
  • Has a chance to drop from the Super Sloth miniboss fight
  • Counts as 1 of 3 poison items needed towards the Bob transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. Isaac's bombs now poison nearby enemies and leave behind a gas cloud that poisons enemies that move through it. Poisoned enemies take 4 or 6 damage per tick for a few seconds.
  • Reference transformation families: Bob. Set bonuses and costumes remain a separate unfinished overhaul.
Pageant BoyID 141 · Quality 0 · PassivePlayable
Drop poolsBoss Room
No direct change.
  • Spawns 7 random coins around Isaac on the floor
  • Isaac wears a pink crown on his head
  • This build: pageantBoy.
ScapularID 142 · Quality 2 · PassivePlayable
Drop poolsItem Room, Angel Room
No direct change.
  • Once per room when you are damaged down to your final half a heart, you gain 1 soul heart
  • Re-entering a room allows this effect to be triggered again
  • Scapular won't grant its soul heart if the player is attempting to proc it with certain heart donation mechanics (such as IV Bag)
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • This build: scapular.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Speed BallID 143 · Quality 2 · PassivePlayable
Drop poolsItem Room, Boss Room, Demon Beggar
  • +0.3 Movement speed
  • +0.2 Shot speed
  • +0.3 Speed Up
  • +0.2 Shot Speed Up
  • Counts as 1 of 3 syringe items needed towards the Spun transformation
  • This build: +0.3 speed. +0.2 shot speed.
  • Reference transformation families: Spun. Set bonuses and costumes remain a separate unfinished overhaul.
Bum FriendID 144 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A beggar who follows Isaac around and automatically picks up nearby coins
  • After picking up 6 coins he will drop a random pickup, e.g. hearts, keys, bombs, coins, pills, cards, trinkets, batteries etc
  • After the first drop, he has a 67% chance to drop a pickup after 3 coins and a 33% chance to drop a pickup after 4 coins
  • Bum friend also has a chance to spawn items from the Beggar Item Pool
  • Counts as 1 of 3 bum items needed towards the Super Bum transformation
  • This build: A beggar who follows Isaac around and automatically picks up nearby coins.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: bum
  • Familiar Collect: coin
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Super Bum. Set bonuses and costumes remain a separate unfinished overhaul.
Guppy's HeadID 145 · Quality 2 · ActivePlayable
Drop poolsDevil Room, Curse Room, Red Chest, Gold/Stone Chest
No direct change.
  • When used, spawns between 2-4 blue flies
  • Blue Flies do double your tear damage
  • Counts as 1 of 3 cat items needed towards the Guppy transformation
  • Recharge Time: 1 room
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Guppy's Head
  • This build: When used, spawns between 2-4 blue flies. Blue Flies do double your tear damage.
  • Reference transformation families: Guppy. Set bonuses and costumes remain a separate unfinished overhaul.
Prayer CardID 146 · Quality 3 · ActivePlayable
Drop poolsItem Room, Angel Room
No direct change.
  • Gives Isaac an eternal heart when used
  • Taking an eternal heart to the next floor or collecting two on the same floor gives you an extra heart container
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Prayer Card
  • This build: Grants one eternal heart.
Notched AxeID 147 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsShop, Crane Game
No direct change.
  • When activated, Isaac takes out the axe and gives you the ability to break rocks and damage enemies with it
  • It has a limited amount of uses per floor, decreasing with every hit that connects with a rock/enemy
  • Cannot break the stone blocks which appear in the environment
  • Creates bridges when breaking rocks next to pits
  • Recharge Time: At the start of each new floor
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: floor; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Notched Axe
  • This build: When activated, Isaac takes out the axe and gives you the ability to break rocks and damage enemies with it.
InfestationID 148 · Quality 0 · PassivePlayable
Drop poolsItem Room
No direct change.
  • When Isaac gets hit, 2-6 blue flies will randomly spawn
  • Blue Flies do double your tear damage
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: infestation.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
IpecacID 149 · Quality 4 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac's tears are replaced with explosive poison bombs, which will arc upwards and explode on contact with the floor, dealing huge damage and leaving a poison effect on enemies in range
  • Ipecac shots are given a flat +40 Damage on top of the normal 3.5 base damage
  • Tears Down (Tear delay * 2 + 10)
  • Ipecac explosion size scales with tear size
  • Shots will damage Isaac if he is in the blast radius when they explode
  • Counts as 1 of 3 poison items needed towards the Bob transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's tears are replaced with explosive poison bombs, which will arc upwards and explode on contact with the floor, dealing huge damage and leaving a poison effect on enemies in range.
  • Reference transformation families: Bob. Set bonuses and costumes remain a separate unfinished overhaul.
Tough LoveID 150 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Isaac has a random chance to fire a tooth shot instead of a tear sometimes
  • Teeth shots deal damage equal to your tear damage * 3.2
  • The chance to fire a tooth is affected by your luck stat and at +9 Luck it will activate every time
  • Synergizes well with some tear modifiers such as Ipecac, which causes it to do massive damage
  • This build: Chance to fire a tooth dealing 3.2x damage; guaranteed at 9 luck.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
The MulliganID 151 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac has a 1/6 chance to spawn a blue fly when one of his tears hits an enemy
  • Blue Flies do double your tear damage
  • The chance to activate this effect is not changed with your Luck stat
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac has a 1/6 chance to spawn a blue fly when one of his tears hits an enemy. Blue Flies do double your tear damage. The chance to activate this effect is not changed with your Luck stat.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Technology 2ID 152 · Quality 2 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac now also has a laser with unlimited range which fires continuously, dealing damage 15 times per second
  • Tears continue to fire from your left eye at a rate of 2/3
  • The laser deals damage equal to 1/7th of your tear damage, but very rapidly
  • The laser can apply status effects (e.g. Poison) rapidly due to how often it hits
  • Does not apply a negative damage multiplier as it used to prior to Repentance
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac now also has a laser with unlimited range which fires continuously, dealing damage 15 times per second. Tears continue to fire from your left eye at a rate of 2/3.
Mutant SpiderID 153 · Quality 3 · Passive, Tear ModifierPlayable
Drop poolsItem Room
No direct change.
  • Tears now shoot 4 at a time (Quad Shot)
  • Tears Down significantly (Tear delay * 2.1 + 3)
  • Synergizes well with a lot of tear effects - e.g. with Brimstone you get 4 lasers
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation
  • Quad
  • Fire-delay frames multiplied by 2.1, then 3 frames added.
  • This build: Four tears per shot.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Chemical PeelID 154 · Quality 2 · PassivePlayable
Drop poolsItem Room
No direct change.
  • +2 Damage Up for tears fired from Isaac's left eye
  • If playing as Cain or you have an item which modifies which eye you fire tears from, each shot has a 50% chance to do +2 Damage
  • This build: +2 damage for left-eye tears.
The PeeperID 155 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • Gives Isaac an eye companion that floats around the room and deals 8 damage per tick on contact with enemies
  • Damage from Isaac's left eye deal roughly +35% damage
  • This build: Gives Isaac an eye companion that floats around the room and deals 8 damage per tick on contact with enemies. Damage from Isaac's left eye deal roughly +35% damage.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: wander
  • Familiar Dmg: 8
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
HabitID 156 · Quality 2 · PassivePlayable
Drop poolsShop, Angel Room
No direct change.
  • When you take damage, this item recharges one room's worth of charge to your spacebar item
  • For example, with the D6 you would need to take damage 6 times to fully recharge it
  • This build: Taking damage restores one room charge to the held active.
Bloody LustID 157 · Quality 2 · PassivePlayable
Drop poolsItem Room, Devil Room
No direct change.
  • Each time you take damage, you gain a damage up which lasts for the rest of the floor and turn a darker red colour each time
  • After taking 6 hits Bloody Lust doesn't give you any further damage increases
  • Damage given for each hit increases as follows: +0.5, +0.7, +0.9, +1.1, +1.3, +1.5
  • Samson starts with this item
  • This build: bloodyLust.
Crystal BallID 158 · Quality 3 · ActivePlayable
Drop poolsNone (Fortune machine only), Item Room
No direct change.
  • Upon use, reveals the map and drops either a soul heart or a random card/rune (50% chance for each)
  • It reveals the location of the secret room, however it doesn't reveal the Super secret room
  • Has a chance to drop from playing a fortune machine
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Guarantees a Planetarium if an item room has been skipped, otherwise +15% chance for Planetariums to spawn while held. After entering a Planetarium the chance goes back to 1%. The floor generation can fail and cause the guaranteed Planetarium to not spawn sometimes.
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Crystal Ball
  • This build: Upon use, reveals the map and drops either a soul heart or a random card/rune (50% chance for each). It reveals the location of the secret room, however it doesn't reveal the Super secret room.
Spirit of the NightID 159 · Quality 3 · PassivePlayable
Drop poolsDevil Room, Demon Beggar
No direct change.
  • Gives Isaac the ability to fly and spectral tears
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation
  • Flying
  • Spectral
  • This build: Flight. Tears pass through scenery.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
Crack The SkyID 160 · Quality 2 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Creates 5 beams of light from the sky that deal damage equal to your tear damage + 20 to any enemies which come into contact with them
  • The beams have a high chance to spawn on top of enemies where possible
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Crack The Sky
  • This build: Creates 5 beams of light from the sky that deal damage equal to your tear damage + 20 to any enemies which come into contact with them.
AnkhID 161 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Upon death, you respawn in the previous room as Blue Baby with three Soul hearts
  • This is a one time use item and all new heart containers will be soul hearts
  • Can be used to unlock some of Blue Baby's secrets before having the character available
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Upon death, you respawn in the previous room as Blue Baby with three Soul hearts. This is a one time use item and all new heart containers will be soul hearts.
Celtic CrossID 162 · Quality 1 · PassivePlayable
Drop poolsItem Room, Angel Room
No direct change.
  • Upon taking damage, you have a 20% chance to gain an invulnerability shield for 7 seconds
  • The chance to gain a shield is affected by your luck stat and at +27 Luck it will activate every time
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • This build: celticCross.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Ghost BabyID 163 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room, Devil Room
No direct change.
  • A familiar which follows Isaac and shoots spectral tears that deal 3.5 damage
  • Ghost Baby fires tears at a rate of 1 tear per second
  • Can drop while destroying skulls in the Depths and Necropolis floors
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • This build: A familiar which follows Isaac and shoots spectral tears that deal 3.5 damage. Ghost Baby fires tears at a rate of 1 tear per second.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 3.5
  • Familiar Cd: 1
  • Familiar Spectral: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
The CandleID 164 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • A spacebar item which allows Isaac to fire a blue flame that damages anything in its path for 23 damage per tick
  • Can cause up to a total of 276 potential damage
  • The flame destroys enemy shots, making it useful for bullet hell bosses
  • Recharge Time: Timed (A few seconds)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 5
  • Name: The Candle
  • This build: A spacebar item which allows Isaac to fire a blue flame that damages anything in its path for 23 damage per tick. Can cause up to a total of 276 potential damage.
Cat-O-Nine-TailsID 165 · Quality 3 · PassivePlayable
Drop poolsBoss Room
  • +1 Damage
  • +0.23 Shot speed
  • +1.0 Damage Up
  • +0.23 Shot Speed Up
  • An item only found in the Boss room pool
  • This build: +1 damage. +0.23 shot speed.
D20ID 166 · Quality 2 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Upon use, re-rolls all pickup consumables in the current room into another random kind of pickup
  • This includes all types of pickup such as hearts, bombs, keys, coins, pills, tarot cards, chests, trinkets etc
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: D20
  • This build: Upon use, re-rolls all pickup consumables in the current room into another random kind of pickup.
Harlequin BabyID 167 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familiar which follows Isaac and shoots two normal tears at once in a V-shaped pattern
  • Each of Harlequin Baby's tears deal 4 damage
  • Harlequin Baby fires tears at a rate of 1 tear per second
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • This build: A familiar which follows Isaac and shoots two normal tears at once in a V-shaped pattern. Each of Harlequin Baby's tears deal 4 damage. Harlequin Baby fires tears at a rate of 1 tear per second.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 4
  • Familiar Cd: 0.5
  • Familiar V: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Epic FetusID 168 · Quality 4 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Tears now become missiles which deal huge damage to anything nearby
  • Missiles damage = damage * 20
  • This item places a controllable red target on the ground which will cause a missile to fall from the sky and hit it after a short period of time
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears now become missiles which deal huge damage to anything nearby. Missiles damage = damage * 20.
PolyphemusID 169 · Quality 4 · PassivePlayable
Drop poolsItem Room
  • +4 Damage
  • Damage ×2
  • High Damage Up - (damage + 4) * 2
  • Tears Down significantly (Tear delay * 2.1 + 3)
  • If a tear kills an enemy, it continues to travel forward with the leftover damage
  • Fire-delay frames multiplied by 2.1, then 3 frames added.
  • This build: +4 damage. damage x2. Killing tears continue with leftover damage; piercing tears retain full damage.
Daddy LonglegsID 170 · Quality 3 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A shadow follows Isaac and stomps on enemies randomly, dealing 40 damage per stomp (2 damage ticks at 20 damage each)
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • This build: A shadow follows Isaac and stomps on enemies randomly, dealing 40 damage per stomp (2 damage ticks at 20 damage each).
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: stomper
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Spider ButtID 171 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Upon use, does 10 damage to all enemies in the room and gives them a slowing effect for 4 seconds
  • Enemies killed by Spider Butt will spawn friendly blue spiders
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Spider Butt
  • This build: Upon use, does 10 damage to all enemies in the room and gives them a slowing effect for 4 seconds. Enemies killed by Spider Butt will spawn friendly blue spiders.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Sacrificial DaggerID 172 · Quality 2 · Passive, OrbitalPlayable
Drop poolsItem Room, Devil Room
No direct change.
  • Gives Isaac an orbital knife that blocks shots and deals 15 damage per tick on contact with enemies
  • The highest damage orbital in the game, dealing 225 damage per second
  • Synergises very well with invulnerability items such as Book of Shadows
  • This build: Gives Isaac an orbital knife that blocks shots and deals 15 damage per tick on contact with enemies. The highest damage orbital in the game, dealing 225 damage per second.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 15
  • Familiar Radius: 62
  • Familiar Speed: 3
  • Familiar Block: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
MitreID 173 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Angel Room
No direct change.
  • Gives a 33% chance of converting red heart drops into soul hearts
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives a 33% chance of converting red heart drops into soul hearts.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Rainbow BabyID 174 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar the follows Isaac and fires random tears
  • Rainbow Baby's tears can choose from any of the other familiars, such as homing, spectral, tar shots etc
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar the follows Isaac and fires random tears. Rainbow Baby's tears can choose from any of the other familiars, such as homing, spectral, tar shots etc.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Dad's KeyID 175 · Quality 2 · ActivePlayable
Drop poolsItem Room, Key Beggar
No direct change.
  • Upon use, opens all closed doors in the current room, including the ones which require a key to enter and secret room doors
  • Can be used to open the golden door that appears in the Dark Room or the Chest
  • Cannot be used to escape the Mom's Foot boss, open angel/devil rooms, or open the door to the Blue Womb floor
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Dad's Key
  • This build: Upon use, opens all closed doors in the current room, including the ones which require a key to enter and secret room doors.
Stem CellsID 176 · Quality 1 · PassivePlayable
Drop poolsItem Room, Boss Room
  • +1 Red heart containers
  • +0.16 Shot speed
  • +1 HP Up
  • +0.16 Shot Speed Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. +0.16 shot speed. Heals 1 red hearts.
Portable SlotID 177 · Quality 0 · ActivePlayable
Drop poolsShop, Beggar
No direct change.
  • Using the portable slot takes a coin and has a chance to give a pickup - similar to how the normal slot machines work
  • Recharge Time: Instant
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Portable Slot
  • This build: Using the portable slot takes a coin and has a chance to give a pickup - similar to how the normal slot machines work.
Holy WaterID 178 · Quality 3 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Angel Room
No direct change.
  • Spawns a familiar that follows Isaac and launches itself in the direction Isaac shoots
  • Upon hitting an enemy, it will deal 7 damage and shatter, creating a pool of damaging blue creep that also petrifies enemies that touch it
  • Once the pool disappears, the familiar will respawn and can be thrown again
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a familiar that follows Isaac and launches itself in the direction Isaac shoots.
FateID 179 · Quality 3 · PassivePlayable
Drop poolsGold Chest, Item Room
No direct change.
  • Gives Isaac an eternal heart and the ability to fly
  • Taking an eternal heart to the next floor or collecting two on the same floor gives you an extra heart container
  • Flying
  • Eternal: true
  • This build: Gives Isaac an eternal heart and the ability to fly. Taking an eternal heart to the next floor or collecting two on the same floor gives you an extra heart container.
The Black BeanID 180 · Quality 0 · PassivePlayable
Drop poolsItem Room, Beggar
No direct change.
  • Upon taking damage, Isaac will fart, causing all enemies in close proximity to become poisoned
  • Black Bean deals your tear damage for 6 ticks
  • This build: blackBean.
White PonyID 181 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsNone (Conquest boss only), Item Room
No direct change.
  • Allows Isaac to fly while the White Pony is held
  • While held, sets your speed stat to 1.5 if it isn't already that high. If your speed stat is already higher then that value is still used
  • Upon use, Isaac charges in the direction the pony is facing, becoming invulnerable during the charge and damaging enemies
  • While charging, Isaac spawns a trail of light beams that deal a lot of damage to enemies (damage * 4 + 10)
  • Drops from the Conquest boss fight
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: White Pony
  • This build: Allows Isaac to fly while the White Pony is held. While held, sets your speed stat to 1.5 if it isn't already that high. If your speed stat is already higher then that value is still used.
Sacred HeartID 182 · Quality 4 · Passive, Tear ModifierPlayable
Drop poolsAngel Room
  • +1 Red heart containers
  • -0.4 Tears per second
  • -0.25 Shot speed
  • Damage ×2.3
  • Tears are now white, do a lot more damage and move slower across the screen with a homing effect
  • Health Up
  • Damage Up (damage * 2.3 + 1)
  • -0.4 Tears Down
  • -0.25 Shot Speed Down
  • Full red heart heal
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • Homing
  • Post Damage: 1
  • Heal: full
  • This build: +1 heart containers. -0.4 tears/s. -0.25 shot speed. damage x2.3. +1 damage after multiplier. Refills red health. Homing tears.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
ToothpicksID 183 · Quality 3 · PassivePlayable
Drop poolsBoss Room
  • +0.7 Tears per second
  • +0.16 Shot speed
  • +0.7 Tears Up
  • +0.16 Shot Speed Up
  • Does not increase your damage, simply makes your tears red
  • This build: +0.7 tears/s. +0.16 shot speed.
Holy GrailID 184 · Quality 3 · PassivePlayable
Drop poolsAngel Room
  • +1 Red heart containers
  • +1 HP Up
  • Gives Isaac the ability to fly
  • Heals one red heart container when picked up
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • Flying
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts. Flight.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Dead DoveID 185 · Quality 3 · PassivePlayable
Drop poolsAngel Room
No direct change.
  • Gives Isaac the ability to fly and spectral tears
  • An item only found in the Angel room
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • Flying
  • Spectral
  • This build: Flight. Tears pass through scenery.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Blood RightsID 186 · Quality 0 · ActivePlayable
Drop poolsItem Room, Devil Room
No direct change.
  • Upon use, takes away one full heart and deals 40 damage to the entire room
  • Shields and invincibility effects do not prevent damage when using this item
  • Using with Isaac's Heart previously prevented you from taking damage, however in Repentance this was fixed
  • Using this item as The Lost will instantly kill him, even if you have Holy Mantle active
  • Recharge Time: Instant
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Blood Rights
  • This build: Upon use, takes away one full heart and deals 40 damage to the entire room. Shields and invincibility effects do not prevent damage when using this item.
Guppy's HairballID 187 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Follows behind Isaac and can be swung back and forth, dealing 5 contact damage per tick to anything it hits
  • Every time the hairball kills an enemy, it grows in size allowing it to deal more damage
  • This is one of the items which allows you to transform into Guppy
  • Moving to a new floor decreases the size of the hairball
  • Counts as 1 of 3 cat items needed towards the Guppy transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Follows behind Isaac and can be swung back and forth, dealing 5 contact damage per tick to anything it hits. Every time the hairball kills an enemy, it grows in size allowing it to deal more damage.
  • Reference transformation families: Guppy. Set bonuses and costumes remain a separate unfinished overhaul.
AbelID 188 · Quality 0 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar that mirrors the player's movements and shoots tears directly at Isaac
  • Abel's tears do 3.5 damage, unless playing as Cain in which case they do 5
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar that mirrors the player's movements and shoots tears directly at Isaac. Abel's tears do 3.5 damage, unless playing as Cain in which case they do 5.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
SMB Super FanID 189 · Quality 3 · PassivePlayable
Drop poolsItem Room
  • +1 Red heart containers
  • +0.3 Damage
  • +0.2 Tears per second
  • +1.5 Range
  • +0.2 Movement speed
  • Isaac turns red like Meatboy
  • +1 HP Up
  • +0.3 Damage Up
  • +0.2 Tears Up
  • +1.5 Range Up
  • +0.2 Speed Up
  • Full red heart heal
  • Heal: full
  • This build: +1 heart containers. +0.3 damage. +0.2 tears/s. +1.5 range. +0.2 speed. Refills red health.
PyroID 190 · Quality 3 · PassivePlayable
Drop poolsItem Room, Secret Room, Bomb Beggar
  • Bombs set to 99
  • Gives Isaac 99 bombs
  • This build: Gives Isaac 99 bombs.
3 Dollar BillID 191 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Grants Isaac random tear effects
  • Can pick from a list of 39 item effects, including 8 Inch Nails, 20/20, Apple!, Ball of Tar, Continuum, Cricket's Body, Dark Matter, Dead Eye, Death's Touch, Euthanasia, Explosivo, Eye of Belial, Fire Mind, Holy Light, Iron Bar, Little Horn, Lost Contact, Mom's Contacts, Mom's Eyeshadow, Mom's Perfume, Mutant Spider, My Reflection, Mysterious Liquid, Number One, Ouija Board, Parasitoid, Proptosis, Pupula Duplex, Rubber Cement, Sagittarius, Scorpio, Sinus Infection, Speed Ball, Spoon Bender, The Inner Eye, The Parasite, The Sad Onion, The Wiz and Tough Love
  • The tear type changes every 2-3 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Grants Isaac random tear effects.
Telepathy for DummiesID 192 · Quality 1 · ActivePlayable
Drop poolsItem Room, Library
No direct change.
  • When used, Isaac gains homing shots and +3.0 Range Up for the current room
  • Counts as 1 of 3 book items needed towards the Bookworm transormation
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Telepathy for Dummies
  • This build: When used, Isaac gains homing shots and +3.0 Range Up for the current room.
MEAT!ID 193 · Quality 2 · PassivePlayable
Drop poolsBoss Room
  • +1 Red heart containers
  • +0.3 Damage
  • +1 HP Up
  • +0.3 Damage Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. +0.3 damage. Heals 1 red hearts.
Magic 8 BallID 194 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +0.16 Shot speed
  • +0.16 Shot Speed Up
  • Gives Isaac a random tarot card when picked up
  • +15% chance for Planetariums to spawn
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • This build: +0.16 shot speed. magic8Ball.
Mom's Coin PurseID 195 · Quality 1 · PassivePlayable
Drop poolsShop, Boss Room, Challenge Room, Beggar, Demon Beggar, Mom's Chest
No direct change.
  • Drops 4 random pills on the floor around Isaac
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • This build: momsCoinPurse.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
SqueezyID 196 · Quality 3 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +2 Soul hearts
  • +0.4 Tears per second
  • +2 Soul Hearts
  • +0.4 Tears Up
  • This build: +2 soul hearts. +0.4 tears/s.
Jesus JuiceID 197 · Quality 2 · PassivePlayable
Drop poolsBoss Room, Angel Room
  • +0.5 Damage
  • +0.38 Range
  • +0.5 Damage Up
  • +0.38 Range Up
  • This build: +0.5 damage. +0.38 range.
BoxID 198 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsBoss Room, Challenge Room
No direct change.
  • When picked up, spawns 1 red heart, 1 key, 1 bomb, 1 coin, 1 card/rune, 1 pill and 1 trinket
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When picked up, spawns 1 red heart, 1 key, 1 bomb, 1 coin, 1 card/rune, 1 pill and 1 trinket.
Mom's KeyID 199 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop, Challenge Room, Key Beggar, Mom's Chest
No direct change.
  • +2 Keys
  • Doubles the yield of hearts, coins, bombs and keys that spawn from non-red chests
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +2 Keys. Doubles the yield of hearts, coins, bombs and keys that spawn from non-red chests.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Mom's EyeshadowID 200 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Challenge Room, Mom's Chest
No direct change.
  • Tears have a random chance to charm enemies
  • Charmed enemies will prioritize attacking other enemies in the room, otherwise they will still attack Isaac
  • The chance to charm enemies is affected by your luck stat and at +27 Luck it will activate every time
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears have a random chance to charm enemies. Charmed enemies will prioritize attacking other enemies in the room, otherwise they will still attack Isaac.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Iron BarID 201 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +0.3 Damage Up
  • Tears now have a chance to concuss enemies, causing them to walk around dazed and confused for a short period of time
  • The chance to concuss enemies is affected by your luck stat and at +27 Luck it will activate every time
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +0.3 Damage Up. Tears now have a chance to concuss enemies, causing them to walk around dazed and confused for a short period of time.
Midas TouchID 202 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac's touch now petrifies enemies, turning them to gold for a few seconds.
  • If an enemy is killed while it is golden, it will drop between 1-4 coins
  • Contact damage is also dealt to enemies equal to the amount of coins Isaac is currently holding
  • Has a synergy with The Poop item, which gives it a high chance to spawn golden poops
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's touch now petrifies enemies, turning them to gold for a few seconds. If an enemy is killed while it is golden, it will drop between 1-4 coins.
Humbleing BundleID 203 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • All future pennies, keys, bombs and hearts have a chance to drop in pairs
  • Does not work for other pickups, such as soul hearts, nickels, dimes, cards, pills etc
  • Does not affect existing pickups that already dropped before taking this item
  • Not in random drops: Its original ability is not implemented yet.
  • This build: All future pennies, keys, bombs and hearts have a chance to drop in pairs. Does not work for other pickups, such as soul hearts, nickels, dimes, cards, pills etc.
Fanny packID 204 · Quality 1 · PassivePlayable
Drop poolsShop, Beggar
No direct change.
  • When you take damage, there is a 50% chance to drop a random heart, key, bomb or coin
  • This build: Taking damage has a 50% chance to drop a heart, key, bomb or coin.
Sharp PlugID 205 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • When your spacebar item is not fully charged, you can press spacebar to recharge it at the cost half of a heart per charge
  • Can be used on partially charged items
  • Will not kill you if used - it stops a half a heart left
  • Red hearts are taken before other kinds, i.e. soul or black hearts
  • Your devil deal chance isn't ruined by this item taking away red hearts
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When your spacebar item is not fully charged, you can press spacebar to recharge it at the cost half of a heart per charge. Can be used on partially charged items.
The GuillotineID 206 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +1.0 Damage Up
  • -1 Tear Delay (Tears Up)
  • Causes Isaac's head to detach and orbit his body, blocking shots and dealing 7 contact damage per tick
  • BFFs will cause the Guillotine head to do double damage (14 damage per tick)
  • Tears are still fired from Isaac's head but the hitbox remains around his body
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1.0 Damage Up. -1 Tear Delay (Tears Up). Causes Isaac's head to detach and orbit his body, blocking shots and dealing 7 contact damage per tick.
Ball of BandagesID 207 · Quality 2 · Passive, OrbitalPlayable
Drop poolsNone (Horsemen boss only), Item Room
No direct change.
  • Gives Isaac an orbital ball of bandages that deals 7 contact damage per tick and blocks enemy shots
  • Collecting a second Ball of Bandages in the run turns the orbital into a pink head that shoots tears that deal 7 damage each and have a chance to charm enemies
  • Getting a third Ball of Bandages will transform the head into bandage girl which will chase enemies dealing 3.5 contact damage per tick while firing charm tears
  • A fourth Ball of Bandages will make the Bandage Girl bigger and stronger, making her deal 5.5 damage per tick instead
  • Any further Ball of Bandages will repeat the cycle
  • Charmed enemies will prioritize attacking other enemies in the room, otherwise they will still attack Isaac
  • This build: Gives Isaac an orbital ball of bandages that deals 7 contact damage per tick and blocks enemy shots.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 7
  • Familiar Radius: 56
  • Familiar Speed: 2
  • Familiar Block: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Champion BeltID 208 · Quality 3 · PassivePlayable
Drop poolsShop
  • +1 Damage
  • +1.0 Damage Up
  • Increases the chance of champion enemies appearing by 15%
  • Doesn't affect the chance for champion bosses to spawn
  • An item only found in the Shop room pool
  • This build: +1 damage. Normal enemies are 15% more likely to be champions.
Butt BombsID 209 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Bomb Beggar
No direct change.
  • +5 bombs
  • Bombs now become poop bombs, which deal 10 damage to all enemies in the room and daze them for a short period of time
  • Butt Bombs heal the poop bosses (Dingle, Dangle, Brownie) by 25% of their max HP
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 bombs. Bombs now become poop bombs, which deal 10 damage to all enemies in the room and daze them for a short period of time.
  • Reference transformation families: Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
Gnawed LeafID 210 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • If Isaac stands still and stops shooting for a second, he turns to stone, making him invincible until he moves/shoots again
  • Using bombs or your active item will remove the invicibility as well
  • This item is a reference to the Tanuki suit in Super Mario 3
  • Not in random drops: Its original ability is not implemented yet.
  • This build: If Isaac stands still and stops shooting for a second, he turns to stone, making him invincible until he moves/shoots again. Using bombs or your active item will remove the invicibility as well.
SpiderbabyID 211 · Quality 0 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Spawns 2-5 friendly attack spiders every time you take damage
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation
  • This build: spiderbaby.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Guppy's CollarID 212 · Quality 1 · PassivePlayable
Drop poolsDevil Room, Curse Room, Red Chest
No direct change.
  • When Isaac dies, he has a 50% chance to resurrect with 1/2 a heart
  • Counts as 1 of 3 cat items needed towards the Guppy transformation
  • This build: guppysCollar.
  • Reference transformation families: Guppy. Set bonuses and costumes remain a separate unfinished overhaul.
Lost ContactID 213 · Quality 2 · PassivePlayable
Drop poolsItem Room, Secret Room
  • -0.16 Shot speed
  • All of Isaac's tears now have a shield, allowing them to block an enemy projectile
  • If a tear blocks something, both Isaac's and the enemies tears are destroyed
  • -0.16 Shot Speed Down
  • Shielded
  • This build: -0.16 shot speed. shielded.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
AnemicID 214 · Quality 1 · PassivePlayable
Drop poolsItem Room
  • +1.5 Range
  • +1.5 Range Up
  • When Isaac takes damage, he will start to leave a trail of blood creep behind him as he walks for the current room. The creep deals 2 damage per tick while enemies stand in it
  • Lazarus' revived form (Lazarus II) respawns with this item
  • This build: +1.5 range. anemic.
Goat HeadID 215 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room
No direct change.
  • Gives Isaac a guaranteed devil or angel room on every floor that they can appear, even if you have already beaten the boss and it didn't show up originally
  • Taking the Goat Head (or any other item) in a Devil Deal bars you from encountering Angel Rooms naturally. After which, the only way to access an Angel Room is via the Sacrifice Room
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac a guaranteed devil or angel room on every floor that they can appear, even if you have already beaten the boss and it didn't show up originally.
Ceremonial RobesID 216 · Quality 3 · PassivePlayable
Drop poolsDevil Room, Curse Room, Demon Beggar
  • +3 Black hearts
  • +1 Damage
  • +3 Black Hearts
  • +1 Damage Up
  • When depleted, Black Hearts deal 40 damage to the entire room, in a Necronomicon style effect
  • This build: +3 black hearts. +1 damage.
Mom's WigID 217 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Challenge Room, Mom's Chest
No direct change.
  • Isaac now has a small chance to create friendly attack spiders everytime he fires a tear
  • Can create up to a maximum of 5 spiders in the room at one time
  • The Hive Mind item allows Mom's Wig to spawn a maximum of 10 spiders at once, and increases their damage
  • The chance to create a spider is affected by your luck stat and at +10 Luck it will activate every time
  • Heals you for 1 red heart when picked up
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac now has a small chance to create friendly attack spiders everytime he fires a tear. Can create up to a maximum of 5 spiders in the room at one time.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
PlacentaID 218 · Quality 2 · PassivePlayable
Drop poolsBoss Room
  • +1 Red heart containers
  • +1 HP Up
  • Gives a chance to heal 1/2 a red heart every time the in-game timer hits a new minute
  • Heals one red heart container when picked up
  • There are no restrictions on when the regeneration effect happens as long as the game is not paused, so you can simply afk and heal over time
  • Works in crawl spaces
  • It's possible to find this item by blowing up Polyps (the weird red rocks found in the Womb floors)
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts. Chance to heal half a heart at each minute.
Old BandageID 219 · Quality 2 · PassivePlayable
Drop poolsBoss Room
  • +1 Red heart containers
  • Grants one empty red heart container.
  • After taking damage, chance to drop a full red heart: 20% + 1% per luck, clamped to 0–100%.
  • Blood Oath rolls independently for each half heart drained.
  • This build: +1 heart containers. Empty heart container; damage has a 20% + 1% per luck chance to drop a red heart (0–100%); Blood Oath rolls per half heart.
  • Repentance formula from wiki.gg; earlier-version 10% / 50% luck formula is not used. Blocked hits do not roll; host creates the pickup.
Sad BombsID 220 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Bomb Beggar
No direct change.
  • +5 Bombs
  • Everytime a bomb explodes, it will release a circle of 10 tears outwards, much like the Tammy's Head effect
  • The tears from each bomb deal a flat 25 damage and are affected by any tear modifiers Isaac has
  • The tears caused by Sad Bombs are much larger and do a lot more damage than Isaac's normal tears
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. Everytime a bomb explodes, it will release a circle of 10 tears outwards, much like the Tammy's Head effect.
Rubber CementID 221 · Quality 3 · PassivePlayable
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Isaac's tears now bounce off walls and objects in the environment, such as rocks and pots
  • Allows tears to hit the same enemy multiple times
  • If you also have Lost Contact, tears will bounce off enemy projectiles instead of being destroyed
  • Bouncing
  • This build: bouncing.
Anti-GravityID 222 · Quality 2 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • -2 Tear Delay (Tears Up)
  • As you hold down the fire button, shots will float in the same place until you release the fire key again
  • Allows you to store up a lot of tears in the air and release them all at once
  • When the tears are released, they will fire off in the direction that Isaac was originally facing when it was created
  • Not in random drops: Its original ability is not implemented yet.
  • This build: -2 Tear Delay (Tears Up). As you hold down the fire button, shots will float in the same place until you release the fire key again.
PyromaniacID 223 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +5 Bombs
  • All explosions now heal Isaac for 0.5 red hearts instead of hurting him
  • Pyromaniac grants Isaac immunity to fire, but does not protect against stomps or shockwave effects
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. All explosions now heal Isaac for 0.5 red hearts instead of hurting him. Pyromaniac grants Isaac immunity to fire, but does not protect against stomps or shockwave effects.
Cricket's BodyID 224 · Quality 3 · PassivePlayable
Drop poolsItem Room
  • -1.3 Range
  • -1 Tear Delay (Tears Up)
  • -1.3 Range Down
  • x1.2 Tear Size
  • Makes tears break into 4 smaller tears on impact with anything, which deal half of your damage
  • Tear Size: 1.2
  • Fire-delay frames multiplied by 1, then -1 frames added.
  • This build: -1.3 range. Tear size x1.2. Impacts split into four half-damage tears.
GimpyID 225 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Devil Room, Curse Room, Demon Beggar
No direct change.
  • When getting hit, this item has a chance to drop a soul heart or black heart
  • The chance to spawn a heart is affected by your luck stat and at +22 Luck it will activate 50% of the time
  • Enemies have a chance to drop half a red heart when killed
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When getting hit, this item has a chance to drop a soul heart or black heart. The chance to spawn a heart is affected by your luck stat and at +22 Luck it will activate 50% of the time.
Black LotusID 226 · Quality 2 · PassivePlayable
Drop poolsSecret Room
  • +1 Red heart containers
  • +1 Soul hearts
  • +1 Black hearts
  • +1 HP Up
  • +1 Soul Heart
  • +1 Black Heart
  • Heals one red heart container when picked up
  • When depleted, Black Hearts deal 40 damage to the entire room, in a Necronomicon style effect
  • An item only found in the secret room pool
  • Heal: 1
  • This build: +1 heart containers. +1 soul hearts. +1 black hearts. Heals 1 red hearts. blackLotus.
Piggy BankID 227 · Quality 1 · PassivePlayable
Drop poolsItem Room, Shop
No direct change.
  • +3 Coins when picked up
  • When you take damage, 1-2 coins will drop on the floor
  • When playing as the Keeper, this item drops 0-1 coins instead
  • This build: piggyBank.
Mom's PerfumeID 228 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Challenge Room, Mom's Chest
No direct change.
  • -1 Tear Delay (Tears Up)
  • Isaac's tears have a 15% chance of causing a fear effect
  • Feared enemies will run away from Isaac temporarily
  • The chance to fear enemies is affected by your luck stat and at +85 Luck it will activate every time
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: -1 Tear Delay (Tears Up). Isaac's tears have a 15% chance of causing a fear effect. Feared enemies will run away from Isaac temporarily.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Monstro's LungID 229 · Quality 2 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Tears can now be charged and released in a shotgun style effect, much like Monstro's main attack
  • Tears down (Tear delay * 4.3)
  • Partial charging does nothing - must be fully charged to use
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears can now be charged and released in a shotgun style effect, much like Monstro's main attack. Tears down (Tear delay * 4.3). Partial charging does nothing - must be fully charged to use.
AbaddonID 230 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Demon Beggar
  • +1.5 Damage
  • +0.2 Movement speed
  • On pickup Abaddon converts all your heart containers to black hearts, then gives you +2 more black hearts
  • +1.5 Damage Up
  • +0.2 Speed Up
  • Tears now have a chance to induce the fear effect, causing enemies to run away from Isaac for a short period
  • The chance to fear enemies is affected by your luck stat and at +85 Luck it will activate every time
  • When depleted, Black Hearts deal 40 damage to the entire room, in a Necronomicon style effect
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation
  • When taken as The Keeper, your coin health is reduced to 1
  • Not in random drops: Luck-scaled fear tears are not implemented.
  • This build: +1.5 damage. +0.2 speed. abaddon.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
Ball of TarID 231 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac leaves a trail of tar behind him which will slow down enemies that walk over it
  • Tears have a chance to slow enemies and their projectiles for a short period of time
  • The chance to slow enemies can improve based on your luck stat and will always slow enemies at +18 Luck
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac leaves a trail of tar behind him which will slow down enemies that walk over it. Tears have a chance to slow enemies and their projectiles for a short period of time.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Stop WatchID 232 · Quality 4 · PassivePlayable
Drop poolsShop
  • +0.3 Movement speed
  • +0.3 Speed Up
  • The Stop Watch applies a permanent but slight slowing effect to all enemies and their projectiles
  • The slowing effect has a reduced effect against Brimstone lasers fired by enemies
  • This build: +0.3 speed. stopWatch.
Tiny PlanetID 233 · Quality 0 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Range greatly increased
  • Grants spectral tears
  • Tears now revolve around Isaac's Body at a fixed distance until they hit the ground
  • The tears orbit close to Isaac, offset slightly in the direction fired. Changing the firing direction will redirect all previously fired tears
  • Causes a lot of great synergies with items such as Lump of Coal, Brimstone, Rubber Cement, Technology and most of the worm trinkets
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Range greatly increased. Grants spectral tears. Tears now revolve around Isaac's Body at a fixed distance until they hit the ground.
Infestation 2ID 234 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Creates a friendly blue spider when you kill an enemy
  • Spiders are spawned at the location where the enemy died
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • This build: infestation2.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
E. ColiID 236 · Quality 1 · PassivePlayable
Drop poolsItem Room
No direct change.
  • E. Coli turns normal enemies into poop if they touch you
  • Enemies can turn into poop even if they do not do contact damage, allowing you to apply the effect without taking damage
  • Can be combined with Midas Touch to turn enemies into Golden Poop
  • This does not work on mini-bosses and bosses
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation
  • This build: E. Coli turns normal enemies into poop if they touch you. Enemies can turn into poop even if they do not do contact damage, allowing you to apply the effect without taking damage.
  • Reference transformation families: Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
Death's TouchID 237 · Quality 3 · Passive, Tear ModifierPlayable
Drop poolsItem Room, Devil Room
  • +1.5 Damage
  • -0.3 Tears per second
  • +1.5 Damage Up
  • -0.3 Tears Down
  • x2 Tear Size
  • Isaac's tears turn into large scythes that pierce through enemies (Similar to how Death's scythes look)
  • Piercing
  • Tear Size: 2
  • This build: +1.5 damage. -0.3 tears/s. Tears pass through enemies. Tear size x2.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Key Piece #1ID 238 · Quality 0 · Passive, FamiliarPlayable
Drop poolsSpecial reward only
No direct change.
  • Increases your chances to find an Angel Room instead of a Devil Room. See the dedicated Devil room page for more details
  • First half of the key required to enter the door to the Mega Satan boss
  • Drops from one of the angels which appear by bombing the statue in an angel room
  • Not in random drops: Special reward from its angel guardian; excluded from ordinary item pools.
  • This build: An inert key familiar. Adds a separate 25% Angel Room replacement roll. Combine both angel pieces to open the Golden Gate; both pieces are consumed when it opens.
Key Piece #2ID 239 · Quality 0 · Passive, FamiliarPlayable
Drop poolsSpecial reward only
No direct change.
  • Increases your chances to find an Angel Room instead of a Devil Room. See the dedicated Devil room page for more details
  • Second half of the key required to enter the door to the Mega Satan boss
  • Drops from one of the angels which appear by bombing the statue in an angel room
  • Not in random drops: Special reward from its angel guardian; excluded from ordinary item pools.
  • This build: An inert key familiar. Adds a separate 25% Angel Room replacement roll. Combine both angel pieces to open the Golden Gate; both pieces are consumed when it opens.
Experimental TreatmentID 240 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Boss Room, Demon Beggar
No direct change.
  • Randomly increases 4 of your stats, and decreases 2 of them
  • Possible stat changes are fixed values: ±1 health, ±1 damage, ±0.2 speed, ±0.5 range, ±0.5 tears, ±0.2 shot speed, ±1 luck
  • Counts as 1 of 3 syringe items needed towards the Spun transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Randomly increases 4 of your stats, and decreases 2 of them. Possible stat changes are fixed values: ±1 health, ±1 damage, ±0.2 speed, ±0.5 range, ±0.5 tears, ±0.2 shot speed, ±1 luck.
  • Reference transformation families: Spun. Set bonuses and costumes remain a separate unfinished overhaul.
Contract From BelowID 241 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room, Demon Beggar
No direct change.
  • Doubles pickups and chests from clearing a room
  • Also gives a 30% chance for room clear rewards to not spawn
  • Doesn't affect coins spawned in Greed Mode
  • Not in random drops: Reward detection also changes drops from the final enemy; needs the room-clear reward hook.
  • This build: contractFromBelow.
InfamyID 242 · Quality 2 · PassivePlayable
Drop poolsItem Room, Secret Room
No direct change.
  • Gives a 50% chance to not take damage from projectiles
  • This build: Gives a 50% chance to not take damage from projectiles.
Trinity ShieldID 243 · Quality 2 · PassivePlayable
Drop poolsAngel Room
No direct change.
  • Puts a shield in front of Isaac which blocks projectiles
  • The shield will rotate based on the direction in which Isaac is firing tears
  • This build: trinityShield.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shield
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Tech.5ID 244 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives Isaac a laser that will fire at random intervals in addition to your normal tears
  • Each laser does damage equal to your current tear damage
  • The laser will occasionally fire with one of these effects: Hook Worm, Spoon Bender, Tiny Planet, Mysterious Liquid, Rubber Cement
  • Luck has no effect on the rate at which Tech.5 fires and does not scale with items that increase your tears stat
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac a laser that will fire at random intervals in addition to your normal tears. Each laser does damage equal to your current tear damage.
20/20ID 245 · Quality 4 · Passive, Tear ModifierPlayable
Drop poolsItem Room
  • Damage ×0.75
  • Isaac now shoots two tears at once
  • 0.75x damage multiplier
  • Unlike the Inner Eye and Mutant Spider items, this double shot item does not give a tears down
  • Double
  • This build: damage x0.75. double.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Blue MapID 246 · Quality 2 · PassivePlayable
Drop poolsShop, Beggar, Key Beggar
No direct change.
  • Reveals the locations of the secret and super secret room for the current floor and all future floors
  • This build: Reveals the locations of the secret and super secret room for the current floor and all future floors.
BFFS!ID 247 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Key Beggar
No direct change.
  • Makes all of Isaac's familiars stronger and bigger
  • Causes most familiars to deal double damage
  • Has no effect on most familiars that scale with Isaac's tear damage
  • Not in random drops: The familiar-size and collision-area changes are not implemented.
  • This build: Makes all of Isaac's familiars stronger and bigger. Causes most familiars to deal double damage. Has no effect on most familiars that scale with Isaac's tear damage.
Hive MindID 248 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Causes your friendly blue spiders and flies to become bigger and do x2 more damage
  • Allows Mom's Wig to spawn a maximum of 10 spiders at once instead of 5
  • Fly and spider familiars become stronger similar to BFFS
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Causes your friendly blue spiders and flies to become bigger and do x2 more damage. Allows Mom's Wig to spawn a maximum of 10 spiders at once instead of 5.
  • Reference transformation families: Beelzebub, Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
There's OptionsID 249 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Two items now spawn after beating a boss fight and the boss rush, however only one can be taken
  • The additional item will pick from the Boss Item Pool
  • Does nothing after the Krampus fight
  • Unlocked by donating to the donation machine in the shop
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Two items now spawn after beating a boss fight and the boss rush, however only one can be taken. The additional item will pick from the Boss Item Pool. Does nothing after the Krampus fight.
Bogo BombsID 250 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • All bomb pickups are now 1+1 bombs
  • An item only found in the Shop item pool
  • Not in random drops: Its original ability is not implemented yet.
  • This build: All bomb pickups are now 1+1 bombs. An item only found in the Shop item pool.
Starter DeckID 251 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Spawns a random card
  • Isaac can now hold 2 cards or runes at once. Tap the drop button to cycle between each one
  • All future pill drops will now instead become cards
  • An item only available in the Shop room
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a random card. Isaac can now hold 2 cards or runes at once. Tap the drop button to cycle between each one. All future pill drops will now instead become cards.
Little BaggyID 252 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Allows for 2 pills to be held. Tap the drop button to cycle between each one
  • Drops a pill on the floor when picked up
  • Changes all card and rune drops into pills. Any Tarot card or rune on the floor or current held when picking this item up will change into a pill
  • Dice Shard counts as a card and will be converted
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Allows for 2 pills to be held. Tap the drop button to cycle between each one. Drops a pill on the floor when picked up.
Magic ScabID 253 · Quality 2 · PassivePlayable
Drop poolsBoss Room
  • +1 Red heart containers
  • +1 Luck
  • +1 HP Up
  • +1.0 Luck Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. +1 luck. Heals 1 red hearts.
Blood ClotID 254 · Quality 2 · PassivePlayable
Drop poolsBoss Room
No direct change.
  • +1.0 Damage Up (Left eye only)
  • +1.5 Range Up (Left eye only)
  • The above stats only apply to tears fired from Isaac's left eye or with a 50% chance if you have an item which causes you to fire from a single source only
  • This build: Left-eye tears gain +1 damage and +1.5 range.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
ScrewID 255 · Quality 3 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +0.5 Tears per second
  • +0.2 Shot speed
  • +0.5 Tears Up
  • +0.2 Shot Speed Up
  • This build: +0.5 tears/s. +0.2 shot speed.
Hot BombsID 256 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Bomb Beggar
No direct change.
  • +5 Bombs
  • Grants immunity to fire
  • Enemies touching placed bombs take 16 damage
  • Gives all bombs a burning effect when they explode, leaving fire on the floor which deals 22 damage to enemies
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. Grants immunity to fire. Enemies touching placed bombs take 16 damage. Gives all bombs a burning effect when they explode, leaving fire on the floor which deals 22 damage to enemies.
Fire MindID 257 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac's tears now set enemies on fire, leaving a damage over time effect that does 4 or 6 damage per tick
  • There is a chance that tears that hit enemies will explode, leaving a small fire on the floor that damages enemies
  • Exploding tears deal damage * 2 + 22 per tick
  • The chance for tears to explode is affected by your luck stat and at +13 Luck it will activate every time
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's tears now set enemies on fire, leaving a damage over time effect that does 4 or 6 damage per tick.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Missing NoID 258 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • When picked up, and at the start of each floor this rerolls all your current items, giving you a new item to replace each of the ones you had
  • Also rerolls all your stats at the same time, giving a random flat modifier that changes each time
  • Doesn't affect important items such as Polaroid, Negative and Key Pieces
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When picked up, and at the start of each floor this rerolls all your current items, giving you a new item to replace each of the ones you had.
Dark MatterID 259 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Demon Beggar
No direct change.
  • +1.0 Damage Up
  • Tears now have a chance to apply the fear effect to enemies, which causes them to run away from Isaac
  • The chance to fear enemies is affected by your luck stat and at +20 Luck it will activate every time
  • An item only found in the devil room pool (Note: The Fallen boss pulls items from the Devil Room Pool)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1.0 Damage Up. Tears now have a chance to apply the fear effect to enemies, which causes them to run away from Isaac.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Black CandleID 260 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop, Curse Room
No direct change.
  • +1 Black Heart
  • Immunity to all floor curses (e.g. Curse of the Lost)
  • Black Candle removes the teleportation effect of Cursed Eye
  • +15% chance of a devil or angel room opening after the boss fight
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1 Black Heart. Immunity to all floor curses (e.g. Curse of the Lost). Black Candle removes the teleportation effect of Cursed Eye. +15% chance of a devil or angel room opening after the boss fight.
ProptosisID 261 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives Isaac high damage tears with a short range
  • Tear size and damage falls off very fast with this item, the further the tear travels the less damage it does
  • Tear damage starts at triple (300%) and decreases over range to eventually be 0%
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac high damage tears with a short range. Tear size and damage falls off very fast with this item, the further the tear travels the less damage it does.
Missing Page 2ID 262 · Quality 0 · PassivePlayable
Drop poolsDevil Room, Demon Beggar, Secret Room
  • +1 Black hearts
  • +1 Black Heart
  • If the total sum of all your health is at one heart after taking damage, the necronomicon effect will activate, dealing 40 damage to the entire room
  • Missing Page 2 now doubles all black heart and Necronomicon damage to 80
  • This build: +1 black hearts. missingPage2.
Clear RuneID 263 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsSecret Room, Crane Game
No direct change.
  • When used, copies the effect of the Rune or Soul stone you are holding (like the Blank Card)
  • Drops a random rune on the floor when picked up
  • The recharge time of this item depends on the Rune/Soul Stone held:
  • 1 room: Soul of Lazarus
  • 2 rooms: Rune of Ansuz, Rune of Berkano, Rune of Hagalaz, Soul of Cain
  • 3 rooms: Rune of Algiz, Blank Rune, Soul of Magdalene, Soul of Judas, Soul of ???, Soul of the Lost
  • 4 rooms: Rune of Ehwaz, Rune of Perthro, Black Rune, Soul of Isaac, Soul of Eve, Soul of Eden, Soul of the Forgotten, Soul of Jacob and Esau
  • 6 rooms: Rune of Dagaz, Soul of Samson, Soul of Azazel, Soul of Apollyon, Soul of Bethany
  • 12 rooms: Rune of Jera, Soul of Lilith, Soul of the Keeper
  • Recharge Time: Varies
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Variable Pending: true
  • Name: Clear Rune
  • This build: When used, copies the effect of the Rune or Soul stone you are holding (like the Blank Card). Drops a random rune on the floor when picked up.
Smart FlyID 264 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room, Key Beggar
No direct change.
  • A yellow orbital fly that will block shots and when Isaac gets hit, will seek out the nearest enemy and attack it
  • If the fly is in its attacking state and there are no longer any enemies in range, it will return to Isaac and go back to being a defensive orbital
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: A yellow orbital fly that will block shots and when Isaac gets hit, will seek out the nearest enemy and attack it.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 0
  • Familiar Radius: 48
  • Familiar Speed: 2.6
  • Familiar Block: true
  • Familiar Smart: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Dry BabyID 265 · Quality 3 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familiar that follows Isaac and blocks any shots that hit it
  • If a projectile is blocked by Dry Baby, he has a 10% chance to activate the Necronomicon effect, dealing 40 damage to the entire room
  • The chance to activate the effect is not changed by your Luck stat
  • Can drop while destroying skulls in the Depths and Necropolis floors
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • This build: A familiar that follows Isaac and blocks any shots that hit it. If a projectile is blocked by Dry Baby, he has a 10% chance to activate the Necronomicon effect, dealing 40 damage to the entire room.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: dry
  • Familiar Chance: 0.1
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Juicy SackID 266 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familiar that follows isaac around dropping white creep which slows down enemies that walk over it
  • Spawns 1-2 familiar blue spiders after every room
  • Blue Spiders do x2 of Isaac's damage
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • This build: A familiar that follows isaac around dropping white creep which slows down enemies that walk over it. Spawns 1-2 familiar blue spiders after every room. Blue Spiders do x2 of Isaac's damage.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: creeper
  • Familiar Dmg: 0
  • Familiar Slow Creep: true
  • Familiar Spiders: 1 / 2
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Robo-Baby 2.0ID 267 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar that is controlled via the arrow keys and will automatically fire a laser if anything is in its line of sight
  • Robo-Baby 2.0's lasers deal 3.5 damage per hit
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar that is controlled via the arrow keys and will automatically fire a laser if anything is in its line of sight. Robo-Baby 2.0's lasers deal 3.5 damage per hit.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Rotten BabyID 268 · Quality 3 · Passive, FamiliarPlayable
Drop poolsItem Room, Devil Room
No direct change.
  • A familiar which follows Isaac and spawns a blue flies as you're firing tears
  • Rotten Baby can only create one fly at a time, meaning if he has created a fly he cannot make another until it is used
  • Blue Flies do double your tear damage
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • This build: A familiar which follows Isaac and spawns a blue flies as you're firing tears. Rotten Baby can only create one fly at a time, meaning if he has created a fly he cannot make another until it is used.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: flyer
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Headless BabyID 269 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room, Devil Room
No direct change.
  • A familiar that follows Isaac and leaves blood creep on the floor as it floats, hurting enemies that walk over it for 2 damage per tick
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • This build: A familiar that follows Isaac and leaves blood creep on the floor as it floats, hurting enemies that walk over it for 2 damage per tick.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: creeper
  • Familiar Dmg: 2
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
LeechID 270 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • Spawns a familiar leech on the ground that hunts down enemies and heals you for half a heart each time it eats one
  • The Leech deals 1.5 contact damage per tick
  • This build: Spawns a familiar leech on the ground that hunts down enemies and heals you for half a heart each time it eats one. The Leech deals 1.5 contact damage per tick.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: seeker
  • Familiar Dmg: 1.5
  • Familiar Range: 260
  • Familiar Heal: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Mystery SackID 271 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room, Beggar, Secret Room
No direct change.
  • A bag that follows Isaac and drops a random heart, coin, bomb or key every 5-6 rooms (alternating, 5 rooms then 6, then repeats)
  • Can drop any kind of heart, coin, bomb or key
  • This build: A bag that follows Isaac and drops a random heart, coin, bomb or key every 5-6 rooms (alternating, 5 rooms then 6, then repeats). Can drop any kind of heart, coin, bomb or key.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: dropper
  • Familiar Every: 5 / 6
  • Familiar Alternate: true
  • Familiar Drop: heart / coin / bomb / key
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
BBFID 272 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A large familiar black fly that bounces around the room, exploding on contact with enemies dealing 70 damage
  • Does not explode if it hits Isaac, however if it explodes on an enemy while Isaac is in range, he will take damage
  • Respawns after 10 seconds or by moving to another room
  • Picking up this item as well as 2 other fly-type items will allow you to transform into Lord of the Flies
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: A large familiar black fly that bounces around the room, exploding on contact with enemies dealing 70 damage.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: bbf
  • Familiar Dmg: 70
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Bob's BrainID 273 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room, Rotten Beggar
No direct change.
  • A green brain that launches in the direction you are firing your tears and will explode on contact with enemies, dealing damage and poisoning anything in the blast radius
  • Bob's Brain deals 100 damage and applies a poison damage over time effect, which deals double your tear damage per tick
  • Regenerates over time
  • Will hurt Isaac if he is in the blast radius
  • Counts as 1 of 3 poison items needed towards the Bob transformation
  • This build: A green brain that launches in the direction you are firing your tears and will explode on contact with enemies, dealing damage and poisoning anything in the blast radius.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: brain
  • Familiar Dmg: 100
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Bob. Set bonuses and costumes remain a separate unfinished overhaul.
Best BudID 274 · Quality 0 · Passive, OrbitalPlayable
Drop poolsItem Room, Key Beggar
No direct change.
  • When Isaac takes damage, a white attack fly will spawn that orbits him at a similar distance to the Distant Admiration fly
  • The fly orbits a lot faster than Distant Admiration or Forever Alone and deals 10 damage per tick
  • Picking up this item as well as 2 other fly-type items will allow you to transform into Lord of the Flies
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: When Isaac takes damage, a white attack fly will spawn that orbits him at a similar distance to the Distant Admiration fly.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Lil BrimstoneID 275 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Devil Room
No direct change.
  • A familiar that follows Isaac and can fire up and charge brimstone shots, exactly how the normal Brimstone item works but with less damage
  • Each laser deals 3 damage per tick, up to 8 times for a total of 24 damage
  • A familiar found in the devil room
  • Lil Brimstone is now unable to start charging until he is finished attacking
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar that follows Isaac and can fire up and charge brimstone shots, exactly how the normal Brimstone item works but with less damage.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Isaac's HeartID 276 · Quality 0 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Prevents Isaac from taking any damage, but instead summons a familiar heart that follows you around. If the heart is hit, Isaac will take damage
  • It will attempt to hide behind you when shooting
  • Most enemies will target the heart over Isaac himself
  • Isaac's Heart has a charge attack, which when released will push enemies away and fire blood tears in all directions
  • Spikes, Curse Rooms and Spiked Chests no longer deal damage to you, but sacrifice rooms still work as normal
  • Sharp Plug becomes useless with this item, due to how damage is prevented on Isaac's body
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Prevents Isaac from taking any damage, but instead summons a familiar heart that follows you around. If the heart is hit, Isaac will take damage. It will attempt to hide behind you when shooting.
Lil HauntID 277 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familiar ghost that follows Isaac around and chases enemies close-by, damaging them for 2 contact damage and causing a fear effect
  • This build: A familiar ghost that follows Isaac around and chases enemies close-by, damaging them for 2 contact damage and causing a fear effect.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: seeker
  • Familiar Dmg: 2
  • Familiar Range: 180
  • Familiar Fear: 3
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Dark BumID 278 · Quality 3 · Passive, FamiliarPlayable
Drop poolsItem Room, Devil Room, Demon Beggar
No direct change.
  • A familiar beggar similar to Bum Friend that follows Isaac and collects red hearts, giving Isaac black hearts, pills, cards, runes or spiders in return
  • For every 1.5 red hearts he takes, he will give a reward
  • Reward chances: Black Heart - 40%, Card/Rune - 20%, Pill - 20%, Blue Spider - 10%, Spider 10%
  • Counts as 1 of 3 bum items needed towards the Super Bum transformation
  • This build: A familiar beggar similar to Bum Friend that follows Isaac and collects red hearts, giving Isaac black hearts, pills, cards, runes or spiders in return.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: darkbum
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Super Bum. Set bonuses and costumes remain a separate unfinished overhaul.
Big FanID 279 · Quality 2 · Passive, OrbitalNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A very large orbital that moves around Isaac very slowly, blocking shots and dealing 2 contact damage per tick
  • Affects the speed of all other orbitals, slowing them down a lot (NOTE: This effect does not happen until you get a new orbital after Big Fan)
  • Does not count as one of your three standard orbital slots
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A very large orbital that moves around Isaac very slowly, blocking shots and dealing 2 contact damage per tick.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Sissy Long LegsID 280 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • An adorable friendly blue spider that walks around the room laying other blue spiders which attack enemies
  • Blue Spiders do x2 of Isaac's damage
  • She can only spawn a maximum of up to 5 spiders at a time and will only do so while there are enemies in the room
  • Sissy Long Legs also charms enemies on contact
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: An adorable friendly blue spider that walks around the room laying other blue spiders which attack enemies. Blue Spiders do x2 of Isaac's damage.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Punching BagID 281 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Spawns a friendly Mulligan that walks around the room. Mulligan can be hit by enemy projectiles, making him a good shield
  • Enemies will sometimes target the Mulligan if he is closer
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a friendly Mulligan that walks around the room. Mulligan can be hit by enemy projectiles, making him a good shield. Enemies will sometimes target the Mulligan if he is closer.
How To JumpID 282 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Library
No direct change.
  • When used, makes Isaac leap in the air, similar to the leaper enemies
  • Maintains momentum if you are already moving in the same direction
  • If you already have an item which gives you flying, this item becomes a dash effect instead
  • Can be used in the Isaac boss fight to jump over the beams of light he spawns
  • Recharge Time: Instant
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: How To Jump
  • This build: When used, makes Isaac leap in the air, similar to the leaper enemies. Maintains momentum if you are already moving in the same direction.
D100ID 283 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, the D100 will activate the effects of all other dice items at once, including D1, D4, The D6, D7, D8, D10, D12 and D20. Search 'Dice effect' to see all those items and their relevant effects
  • Note: Full run reroll effects (such as D4) are able to remove heart containers and transformations if losing the respective items during the reroll
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: D100
  • This build: When used, the D100 will activate the effects of all other dice items at once, including D1, D4, The D6, D7, D8, D10, D12 and D20. Search 'Dice effect' to see all those items and their relevant effects.
D4ID 284 · Quality 2 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, the D4 re-rolls each item you currently have into another random item from the same item pool
  • If you have an item with no room pool (e.g. Blood Bag) it will be rerolled into a random Item Room item
  • Full run reroll effects such as D4 are able to remove heart containers and transformations if losing the respective items during the reroll
  • Cannot remove Azazel's Brimstone laser, or The Lost's Holy Mantle
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: D4
  • This build: When used, the D4 re-rolls each item you currently have into another random item from the same item pool.
D10ID 285 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, rerolls all enemies in the room which are currently alive into another random type of enemy
  • D10 attempts to reroll enemies into enemies of similar health where possible
  • Cannot reroll mini-bosses or bosses
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: D10
  • This build: When used, rerolls all enemies in the room which are currently alive into another random type of enemy. D10 attempts to reroll enemies into enemies of similar health where possible.
Blank CardID 286 · Quality 2 · ActivePlayable
Drop poolsShop, Secret Room
No direct change.
  • When used, copies the effect of the card you are currently holding without consuming it
  • The charge time depends on the quality of the card you're holding, and will update with each activation
  • Using this with the ? card will teleport you to the I AM ERROR room
  • Recharge Time: Varies
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Blank Card
  • This build: When used, copies the effect of the card you are currently holding without consuming it. The charge time depends on the quality of the card you're holding, and will update with each activation.
Book of SecretsID 287 · Quality 1 · ActivePlayable
Drop poolsItem Room, Library, Secret Room
No direct change.
  • When used, you have a chance of getting one of the three following effects: Treasure Map (floor layout), Compass (map icons) or Blue Map (secret room locations)
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Book of Secrets avoids giving mapping effects that you already have. If the player has all mapping effects, it grants the 'I can see forever!' effect for the floor
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Book of Secrets
  • This build: When used, you have a chance of getting one of the three following effects: Treasure Map (floor layout), Compass (map icons) or Blue Map (secret room locations).
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
Box of SpidersID 288 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, spawns 4-8 friendly blue spiders on the floor
  • Blue Spiders do x2 of Isaac's damage
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Box of Spiders
  • This build: When used, spawns 4-8 friendly blue spiders on the floor. Blue Spiders do x2 of Isaac's damage.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Red CandleID 289 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • When used, the candle is raised above Isaac's head. Upon pressing any fire button, a red flame will slide across the floor in that direction, dealing 23 damage per tick to enemies that come into contact with it
  • Each flame deals 125 total damage and disappears after 10 seconds
  • The flame will shrink in size when deals damage to something and eventually disappear
  • Recharge Time: Timed (A few seconds)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 2.5
  • Name: Red Candle
  • This build: When used, the candle is raised above Isaac's head. Upon pressing any fire button, a red flame will slide across the floor in that direction, dealing 23 damage per tick to enemies that come into contact with it.
The JarID 290 · Quality 0 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Isaac can now pick up hearts while at full health, which will be stored in the Jar and can be spawned again using the spacebar
  • Up to 4 hearts can be stored in The Jar
  • Soul hearts and black hearts cannot be stored
  • If used in a Black heart or Eternal heart super secret room, it will spawn the relevant heart
  • Recharge Time: Instant
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Jar
  • This build: Isaac can now pick up hearts while at full health, which will be stored in the Jar and can be spawned again using the spacebar. Up to 4 hearts can be stored in The Jar.
FLUSH!ID 291 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, turns every normal enemy in the room into poop!
  • Does not work on mini-bosses and bosses
  • Kills poop bosses when used - Dingle, Dangle and Brownie
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: FLUSH!
  • This build: When used, turns every normal enemy in the room into poop!. Does not work on mini-bosses and bosses. Kills poop bosses when used - Dingle, Dangle and Brownie.
  • Reference transformation families: Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
Satanic BibleID 292 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Library, Devil Room
No direct change.
  • When used, gives Isaac +1 Black Heart
  • Using this book once before the boss dies, causes the boss item on the current floor to become a devil deal instead, where it will cost heart containers to pick up. Taking this item DOES count as a devil deal, preventing future angel rooms.
  • When depleted, Black Hearts deal 40 damage to the entire room, in a Necronomicon style effect
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Satanic Bible
  • This build: When used, gives Isaac +1 Black Heart.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
Head of KrampusID 293 · Quality 2 · ActivePlayable
Drop poolsNone (Krampus only), Item Room
No direct change.
  • When used, fires a 4 way brimstone laser in all cardinal directions, dealing a lot of damage to any enemies
  • Laser damage does not scale with your damage stat - its a fixed 10 damage per tick for 20 ticks (200 total per use)
  • Has a chance to drop after you beat Krampus
  • If you get close enough to an enemy that has a large hitbox, you can hit it with 2 of the laser beams, allowing you to deal more damage
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Head of Krampus
  • This build: When used, fires a 4 way brimstone laser in all cardinal directions, dealing a lot of damage to any enemies.
Butter BeanID 294 · Quality 1 · ActivePlayable
Drop poolsItem Room, Beggar
No direct change.
  • When used, farts on nearby enemies and knocks them backwards forcefully away from Isaac
  • Allows you to reflect projectiles away from Isaac
  • If a pushed enemy hits a rock or wall forcefully enough, they take 10 damage
  • Recharge Time: Timed (A few seconds)
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Butter Bean
  • This build: When used, farts on nearby enemies and knocks them backwards forcefully away from Isaac. Allows you to reflect projectiles away from Isaac.
Magic FingersID 295 · Quality 1 · ActivePlayable
Drop poolsItem Room, Shop
No direct change.
  • Upon use, consumes a coin and deals damage to everything in the room
  • Damage dealt is equal to your tear damage * 2 + 10
  • Recharge Time: Instant
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Magic Fingers
  • This build: Upon use, consumes a coin and deals damage to everything in the room. Damage dealt is equal to your tear damage * 2 + 10.
ConverterID 296 · Quality 2 · ActivePlayable
Drop poolsShop
No direct change.
  • When used, converts 1 soul/black heart into 1 red heart container
  • This item will take from your soul hearts first
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Converter
  • This build: When used, converts 1 soul/black heart into 1 red heart container. This item will take from your soul hearts first.
Pandora's BoxID 297 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsShop, Red Chest
No direct change.
  • When used, this item will spawn a set of items or consumables based on which chapter you are currently on
  • Basement 1: 2 Soul hearts. Basement 2: 2 Bombs + 2 Keys
  • Caves 1: 1 Boss Item. Caves 2: 1 Boss Item + 2 Soul Hearts
  • Depths 1: 4 Soul hearts. Depths 2: 20 coins
  • Womb 1: 2 Boss Items. Womb 2: Bible
  • Blue Womb: Nothing!. The Void: Nothing!
  • Sheol: 1 Devil Room Item + 1 Black Heart. Cathedral: 1 Angel Room Item + 1 Eternal Heart
  • Chest: 1 coin. Dark Room: Nothing!
  • Home: Gives Red Key.
  • Pandora's Box considers XL floors to always be the first floor of a chapter
  • Alternative floors drop the same stuff e.g. Corpse II drops same as Womb II
  • Recharge Time: One time use
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: once; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Pandora's Box
  • This build: When used, this item will spawn a set of items or consumables based on which chapter you are currently on. Basement 1: 2 Soul hearts. Basement 2: 2 Bombs + 2 Keys.
Unicorn StumpID 298 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, turns Isaac invincible and gains +0.28 speed for a 5 seconds
  • You cannot fire tears while the stump is active
  • Very similar to the My Little Unicorn item but does not deal contact damage
  • When used with Mom's Knife, you can still deal contact damage but will be unable to change the way the knife faces while the effect is active
  • Recharge Time: 1 room
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Unicorn Stump
  • This build: When used, turns Isaac invincible and gains +0.28 speed for a 5 seconds. You cannot fire tears while the stump is active. Very similar to the My Little Unicorn item but does not deal contact damage.
TaurusID 299 · Quality 1 · PassivePlayable
Drop poolsItem Room
  • -0.3 Movement speed
  • -0.3 Speed Down
  • While in a hostile room your speed raises at a rate of +0.065 per game tick
  • When you hit a speed stat of 2.0, Isaac will gain an invincibility effect for 5 seconds, increasing speed and allowing him to run into enemies to deal 40 contact damage per hit
  • The time it takes for the effect to activate becomes shorter with a higher base Speed stat
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • This build: -0.3 speed. taurus.
  • The rage effect activates once per room and lasts five seconds. Re-entering a used room does not restart it; charge speed is frame-rate independent.
AriesID 300 · Quality 2 · PassivePlayable
Drop poolsItem Room
  • +0.25 Movement speed
  • +0.25 Speed up
  • Running into enemies while at a high speed will deal 25 damage. Moving at this speed also prevents contact damage
  • Will not deal contact damage unless you are moving fast enough (at least 0.85 speed)
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • This build: +0.25 speed. aries.
  • Contact protection and damage require actual movement equivalent to at least 0.85 speed, independent of frame rate.
CancerID 301 · Quality 3 · PassivePlayable
Drop poolsItem Room
  • +3 Soul hearts
  • +3 Soul Hearts
  • After getting hit once, you gain a damage reduction for the rest of the room similar to The Wafer item (-50% damage taken)
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • This build: +3 soul hearts. cancer.
LeoID 302 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac increases in size, gets a lion's mane and now has the ability to crush rocks by walking over them
  • Crushed rocks and poop can fill holes if you walk in their direction
  • Allows you to crush Red Poops and sometimes not take damage. However, If you also have flying you will always take damage
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Counts as 1 of 3 size-increasing items needed towards the Stompy transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac increases in size, gets a lion's mane and now has the ability to crush rocks by walking over them. Crushed rocks and poop can fill holes if you walk in their direction.
  • Reference transformation families: Stompy. Set bonuses and costumes remain a separate unfinished overhaul.
VirgoID 303 · Quality 2 · PassivePlayable
Drop poolsItem Room
No direct change.
  • A random chance when you take damage to get an invincibility shield for 7 seconds
  • The chance to get an invincibility shield is affected by your luck stat and at +10 Luck it will activate every time you get hit
  • Converts all negative pills into their positive counterparts e.g. Stat Down becomes Stat Up, 'Bad Trip' turns into 'Balls of Steel' and 'Amnesia' turns into 'I can see forever'
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • This build: A random chance when you take damage to get an invincibility shield for 7 seconds.
LibraID 304 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives you 6 keys, 6 bombs and 6 coins
  • Balances out your main stats to bring the high and low stats closer to an average value
  • All future stat upgrading items will now instead spread out across all other stats. For example, an item which usually gives +1 Damage would instead give a small 'all stats up'
  • Stats effected by this item are: Damage, Tears, Range, Speed
  • When taken with another item which gives an extreme value in a certain stat (e.g. Soy Milk) can lead to interesting synergies
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you 6 keys, 6 bombs and 6 coins. Balances out your main stats to bring the high and low stats closer to an average value.
ScorpioID 305 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Isaac's tears turn bright green and always apply a poison effect to enemies which deals a total of double your tear damage
  • This is essentially a superior version of The Common Cold item
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Poison
  • This build: Isaac's tears turn bright green and always apply a poison effect to enemies which deals a total of double your tear damage. This is essentially a superior version of The Common Cold item.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
SagittariusID 306 · Quality 3 · PassivePlayable
Drop poolsItem Room
  • +0.2 Movement speed
  • +0.2 Speed Up
  • Grants piercing tears
  • Tears do not travel through rocks with this item
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Piercing
  • This build: +0.2 speed. Tears pass through enemies.
CapricornID 307 · Quality 3 · PassivePlayable
Drop poolsItem Room
  • +1 Red heart containers
  • +0.5 Damage
  • +0.1 Movement speed
  • +0.75 Range
  • +1 Keys
  • +1 Bombs
  • +1 Coins
  • +1 HP Up
  • +0.5 Damage Up
  • -1 Tear Delay (Tears Up)
  • +0.1 Speed Up
  • +0.75 Range Up
  • +1 Key, +1 Bomb, +1 Coin
  • Heals one red heart container when picked up
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Heal: 1
  • Fire-delay frames multiplied by 1, then -1 frames added.
  • This build: +1 heart containers. +0.5 damage. +0.1 speed. +0.75 range. +1 keys. +1 bombs. +1 coins. Heals 1 red hearts.
AquariusID 308 · Quality 2 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Leaves a trail of tears on the floor behind Isaac which damages enemies that walk over it for 2 damage per tick
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Aquarius synergizes with tear effects
  • This build: aquarius.
PiscesID 309 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • -1 Tear Delay (Tears Up)
  • x1.25 Tear Size Up
  • Tears now have a bigger knockback effect, which pushes enemies backwards
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Not in random drops: Its original ability is not implemented yet.
  • This build: -1 Tear Delay (Tears Up). X1.25 Tear Size Up. Tears now have a bigger knockback effect, which pushes enemies backwards.
Eve's MascaraID 310 · Quality 3 · PassivePlayable
Drop poolsItem Room
  • -0.5 Shot speed
  • Damage ×2
  • Tears per second ×0.5
  • x2 Damage Multiplier
  • Tears Down by exactly half (Tear delay * 2)
  • -0.5 Shot Speed Down
  • The tears down from this item is a x2.0 multiplier after the formula, meaning it will always halve your tear rate (Unless you have Monstro's Lung or Soy Milk)
  • This build: -0.5 shot speed. damage x2. tears x0.5.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Judas' ShadowID 311 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • When you die with this item, you respawn in the previous room as Dark Judas with 2 black hearts for health
  • Dark Judas has a damage multiplier of 2.00 (double Isaac's damage) and an additional +0.1 Speed
  • Dark Judas is considered a separate character by the game, however he can be used to unlock Judas' secrets/achievements
  • Dark Judas cannot gain red heart containers, HP upgrades give soul hearts instead
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When you die with this item, you respawn in the previous room as Dark Judas with 2 black hearts for health.
Maggy's BowID 312 · Quality 2 · PassivePlayable
Drop poolsItem Room
  • +1 Red heart containers
  • +1 HP Up
  • Heals one red heart container when picked up
  • All future red hearts now heal for double. Half hearts heal a whole heart and full hearts heal 2 red hearts
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts. maggysBow.
Holy MantleID 313 · Quality 4 · PassivePlayable
Drop poolsItem Room, Angel Room
No direct change.
  • Each time you enter a new room, damage is negated for the first time you get hit
  • Can be used to go in and out of a Curse Room without taking damage
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • The Lost starts with this item after donating 879 coins to the Greed Donation Machine.
  • REPENTANCE - The Lost's Holy Mantle can no longer be re-rolled using an item like D4.
  • Mantle
  • This build: Blocks the first hit in each room.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Thunder ThighsID 314 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
  • +1 Red heart containers
  • -0.4 Movement speed
  • +1 HP Up
  • -0.4 Speed Down
  • You can now break obstacles by walking over them
  • Heals one red heart container when picked up
  • Holes in the ground can be filled by crushing adjacent rocks, similar to how this can be done with bombs
  • Allows you to crush Red Poops and sometimes not take damage. However, If you also have flying you will always take damage
  • Not in random drops: Red-poop crushing and hole-filling interactions are not implemented.
  • Heal: 1
  • This build: +1 heart containers. -0.4 speed. Heals 1 red hearts. thunderThighs.
Strange AttractorID 315 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Enemies and pickups (keys, bombs etc.) are now magnetically attracted to Isaac's tears
  • Can cause some enemies to have unpredictable movement
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Enemies and pickups (keys, bombs etc.) are now magnetically attracted to Isaac's tears. Can cause some enemies to have unpredictable movement.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Cursed EyeID 316 · Quality 0 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room, Secret Room
No direct change.
  • Tears are now charged up and fired rapidly in a burst of up to 5 shots at once
  • The amount of tears fired in the charge depends on how long you charge for
  • The eye has three states, white (not firing), black (first second of charging) and blinking between black and white. If you get hit while Cursed eye is a solid black colour you are guaranteed to be teleported to another random room on the floor. If you get hit in either of the other 2 states you will not be teleported
  • The Black Candle item will remove the Cursed Eye's teleportation effect
  • REPENTANCE - Burst now has 5 shots instead of 4
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears are now charged up and fired rapidly in a burst of up to 5 shots at once. The amount of tears fired in the charge depends on how long you charge for.
Mysterious LiquidID 317 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When Isaac's tears hit anything, they leave a green toxic creep on the floor that damages enemies for 1 damage per tick
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When Isaac's tears hit anything, they leave a green toxic creep on the floor that damages enemies for 1 damage per tick.
GeminiID 318 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familar that is attached to Isaac, which will seek out and damage any enemies close by for 3 contact damage
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • This build: A familar that is attached to Isaac, which will seek out and damage any enemies close by for 3 contact damage.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: seeker
  • Familiar Dmg: 3
  • Familiar Range: 140
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Cain's Other EyeID 319 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar eye that follows Isaac and copies all his tear modifiers/effects, but shoots in random directions
  • Tears from this familiar deal 75% of Isaac's tear damage
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar eye that follows Isaac and copies all his tear modifiers/effects, but shoots in random directions. Tears from this familiar deal 75% of Isaac's tear damage.
???'s Only FriendID 320 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar fly that can be moved around via use of the arrow keys dealing 2.5 contact damage per tick, similar to the Ludovico Technique's mechanic
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar fly that can be moved around via use of the arrow keys dealing 2.5 contact damage per tick, similar to the Ludovico Technique's mechanic.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Samson's ChainsID 321 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Secret Room
No direct change.
  • An iron ball and chain attached to Isaac, similar to Guppy's Hairball that you can fling around to deal 5 damage per tick
  • The ball will block enemy shots and can also destroy environmental objects such as rocks, mushrooms and skulls
  • Does not decrease your movement speed stat at all however the ball has to be dragged around causing Isaac to slow down slightly when the chain is fully extended
  • Not in random drops: Its original ability is not implemented yet.
  • This build: An iron ball and chain attached to Isaac, similar to Guppy's Hairball that you can fling around to deal 5 damage per tick.
Mongo BabyID 322 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar that will follow Isaac and copy the effect of one of your other familiars
  • If you don't have any other familiars, he will just shoot normal tears
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • REPENTANCE - Removed the double damage multiplier on Mongo Baby's attacks
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar that will follow Isaac and copy the effect of one of your other familiars. If you don't have any other familiars, he will just shoot normal tears.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Isaac's TearsID 323 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • A spacebar item that fires 8 of Isaac's tears in a circle around him
  • Tears spawned from this item keep most effect that Isaac currently has applied to his tears, and deal an additional +5 flat damage
  • Recharge Time: 1 bar per tear fired
  • Active charge policy: shots; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Isaac's Tears
  • This build: A spacebar item that fires 8 of Isaac's tears in a circle around him.
UndefinedID 324 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Upon use, teleports you to one of the following rooms at random: Item room, Secret room, Super secret room, the I AM ERROR room or the Black Market (very low chance)
  • There are no I AM ERROR rooms on the final floors, preventing looping with this item
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Undefined
  • This build: Upon use, teleports you to one of the following rooms at random: Item room, Secret room, Super secret room, the I AM ERROR room or the Black Market (very low chance).
ScissorsID 325 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used will cut your head from your body. Isaac's head will remain stationary and fire tears. His body can be controlled and spews blood nearby
  • Tears fired by the head do a flat 3.5 damage and don't scale
  • REPENTANCE - Scissors has been redesigned. The stationary head is now affected by Isaac's stats and attack modifiers, and the body will spew a controllable fountain of blood shots. Charge time increased to 4 (from 2)
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Scissors
  • This build: When used will cut your head from your body. Isaac's head will remain stationary and fire tears. His body can be controlled and spews blood nearby.
Breath of LifeID 326 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Holding the active item button will deplete the charge bar. When the charge bar gets to zero it will grant you a brief period of invincibility
  • If the spacebar is held for too long (about 1 second) when it has no charge, you will take damage
  • During the invincibility period, Isaac deals 3.5 contact damage to enemies and beams of light will strike down from the sky, dealing 15 damage
  • If damage is blocked perfectly at the exact second the charge bar reaches zero, it will release holy beams in four directions and grant a brief shile effect
  • The invincibility effect is shown via a rapid flashing animation
  • Recharge Time: Timed (1 bar per second)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 5
  • Name: Breath of Life
  • This build: Holding the active item button will deplete the charge bar. When the charge bar gets to zero it will grant you a brief period of invincibility.
The PolaroidID 327 · Quality 2 · PassivePlayable
Drop poolsSpecial reward only
No direct change.
  • After taking damage, if you have half a red heart or less, The Polaroid will give you an invincibility shield for 5 seconds
  • Grants access to the Chest floor
  • Allows you to open the door at the beginning of Depths II that leads to the Mausoluem
  • When unlocked, is guaranteed to drop after the Mom's Foot boss fight
  • The Polaroid will always spawn on the left pedestal
  • Not in random drops: Special progression reward; excluded from ordinary item pools.
  • This build: thePolaroid.
The NegativeID 328 · Quality 2 · PassivePlayable
Drop poolsSpecial reward only
  • +1 Damage
  • +1.0 Damage Up
  • After taking damage, if you have half a red heart or less, The Negative will deal 40 damage to all enemies in the room
  • Gives you access to the Dark Room floor
  • Allows you to open the door at the beginning of Depths II that leads to the Mausoluem
  • When unlocked, is guaranteed to drop after the Mom's Foot boss fight
  • The Negative will always spawn on the right pedestal
  • Not in random drops: Special progression reward; excluded from ordinary item pools.
  • This build: +1 damage. theNegative.
The Ludovico TechniqueID 329 · Quality 2 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • You no longer shoot tears and instead now control a single large tear with the arrow keys
  • Items which increase your tears stat will cause the tear to deal damage at a faster rate
  • Items which increase your shot speed cause the tear to travel faster across the screen
  • Ludo and Brimstone create a large controllable red ring of death that does massive damage to anything in its path
  • Taking this with Mom's Knife allows you to remote control the knife around the room, dealing huge damage
  • Not in random drops: Its original ability is not implemented yet.
  • This build: You no longer shoot tears and instead now control a single large tear with the arrow keys. Items which increase your tears stat will cause the tear to deal damage at a faster rate.
Soy MilkID 330 · Quality 2 · Passive, Tear ModifierPlayable
Drop poolsItem Room
  • Damage ×0.2
  • Tears per second ×5.5
  • Very high Tears Up: Tears * 5.5
  • -80% Damage Down
  • x0.5 Tear Size
  • REPENTANCE - Soy Milk tears now cause drastically less knockback
  • Tear Size: 0.5
  • This build: damage x0.2. tears x5.5. Tear size x0.5.
GodheadID 331 · Quality 4 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Isaac's tears become homing and have an aura around them, which will deal a flat 2 damage per tick to anything inside its radius
  • +0.5 Damage Up
  • -0.3 Tears Down
  • -0.3 Shot Speed Down
  • Multiple GodHeads doesn't stack the aura damage
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's tears become homing and have an aura around them, which will deal a flat 2 damage per tick to anything inside its radius. +0.5 Damage Up. -0.3 Tears Down. -0.3 Shot Speed Down.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Lazarus' RagsID 332 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Angel Room
No direct change.
  • Gives Isaac an extra life on death, exactly the same as Lazarus' default respawn effect
  • When you die with this item, you respawn in the same room with 1 heart and the Anemic item
  • The game considers you to be a different character (Lazarus II) when this effect activates
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac an extra life on death, exactly the same as Lazarus' default respawn effect. When you die with this item, you respawn in the same room with 1 heart and the Anemic item.
The MindID 333 · Quality 3 · PassivePlayable
Drop poolsItem Room, Angel Room
No direct change.
  • Gives Isaac a full mapping effect, revealing the entire floor and locations of all secret rooms
  • This build: Gives Isaac a full mapping effect, revealing the entire floor and locations of all secret rooms.
The BodyID 334 · Quality 3 · PassivePlayable
Drop poolsItem Room, Angel Room
  • +3 Red heart containers
  • +3 Health Up
  • The three heart containers are pre-filled with red hearts
  • Heal: 3
  • This build: +3 heart containers. Heals 3 red hearts.
The SoulID 335 · Quality 3 · PassivePlayable
Drop poolsItem Room, Angel Room
  • +2 Soul hearts
  • +2 Soul Hearts
  • Enemy projectiles will now slowly curve away from Isaac and avoid hitting him
  • This build: +2 soul hearts. theSoul.
Dead OnionID 336 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac's tears become large, brown and will penetrate all objects and enemies (piercing + spectral)
  • -1.2 Range Down
  • -0.4 Shot Speed Down
  • x1.5 Tear Size
  • Despite the increase in tear size, Dead Onion does NOT increase your damage stat. It also doesn't do poison damage despite having the tagline 'toxic aura tears'
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's tears become large, brown and will penetrate all objects and enemies (piercing + spectral). -1.2 Range Down. -0.4 Shot Speed Down. X1.5 Tear Size.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Broken WatchID 337 · Quality 1 · PassivePlayable
Drop poolsShop
No direct change.
  • Upon entering every 4th unexplored room, the Broken Watch will either slow down or speed up all enemies in the room
  • The slow effect is much more common than the speed up
  • An item only found in the Shop item pool
  • This build: brokenWatch.
BoomerangID 338 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • A blue boomerang which can be thrown in a similar fashion to Mom's Knife, to stun any enemies it hits and deal damage
  • The damage dealt by the Boomerang is equal to double your tear damage
  • The boomerang can also be used to grab pickups and consumables from a distance, similar to the legend of zelda boomerang
  • The range of the boomerang is affected by range, with number one the distance is very short and makes the item a lot less effective
  • The Boomerang can be used to kill shopkeeper corpses, allowing you to farm their drops for coins, items, Steam Sale etc
  • REPENTANCE - Boomerang is now piercing, and has far less downtime between throwing it and being able to fire tears again
  • Recharge Time: Timed (A few seconds)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Boomerang
  • This build: A blue boomerang which can be thrown in a similar fashion to Mom's Knife, to stun any enemies it hits and deal damage. The damage dealt by the Boomerang is equal to double your tear damage.
Safety PinID 339 · Quality 1 · PassivePlayable
Drop poolsBoss Room
  • +1.5 Range
  • +0.16 Shot speed
  • +1 Black hearts
  • +1.5 Range Up
  • +0.16 Shot Speed Up
  • +1 Black Heart
  • When depleted, Black Hearts deal 40 damage to the entire room, in a Necronomicon style effect
  • This build: +1.5 range. +0.16 shot speed. +1 black hearts.
Caffeine PillID 340 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsBoss Room
  • +0.3 Movement speed
  • +0.3 Speed Up
  • Decreases the size of Isaac, and your player hitbox, making you less likely to be hit
  • Gives you a random pill when picked up
  • An item only found in the boss room pool
  • Not in random drops: Player/hitbox shrinking is not implemented.
  • This build: +0.3 speed. caffeinePill.
Torn PhotoID 341 · Quality 3 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +0.7 Tears per second
  • +0.16 Shot speed
  • +0.7 Tears Up
  • +0.16 Shot Speed Up
  • This build: +0.7 tears/s. +0.16 shot speed.
Blue CapID 342 · Quality 3 · PassivePlayable
Drop poolsBoss Room
  • +1 Red heart containers
  • +0.7 Tears per second
  • -0.16 Shot speed
  • +1 HP Up
  • +0.7 Tears Up
  • -0.16 Shot Speed Down
  • Heals one red heart container when picked up
  • An item only found in the Boss Room pool
  • Counts as 1 of 3 mushroom items needed towards the Fun Guy transformation
  • Heal: 1
  • This build: +1 heart containers. +0.7 tears/s. -0.16 shot speed. Heals 1 red hearts.
  • Reference transformation families: Fun Guy. Set bonuses and costumes remain a separate unfinished overhaul.
Latch KeyID 343 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest, Key Beggar
  • +1 Luck
  • +1 Soul hearts
  • +1 Luck Up
  • +1 Soul Heart
  • Spawns 2 keys on the ground
  • This build: +1 luck. +1 soul hearts. latchKey.
Match BookID 344 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +1 Black hearts
  • +1 Black Heart
  • +3 Bombs
  • When depleted, Black Hearts deal 40 damage to the entire room, in a Necronomicon style effect
  • REPENTANCE - Also drops the Match Stick trinket
  • This build: +1 black hearts. matchBook.
SynthoilID 345 · Quality 3 · PassivePlayable
Drop poolsBoss Room
  • +1 Damage
  • +1.5 Range
  • +1.0 Damage Up
  • +1.5 Range Up
  • Counts as 1 of 3 syringe items needed towards the Spun transformation
  • This build: +1 damage. +1.5 range.
  • Reference transformation families: Spun. Set bonuses and costumes remain a separate unfinished overhaul.
A SnackID 346 · Quality 1 · PassivePlayable
Drop poolsBoss Room
  • +1 Red heart containers
  • +1 HP Up
  • Heals one red heart container when picked up
  • Heal: 1
  • This build: +1 heart containers. Heals 1 red hearts.
DiplopiaID 347 · Quality 3 · ActivePlayable
Drop poolsShop
No direct change.
  • A one-time use item which when used, will duplicate any pedestal items or consumables in the current room
  • If used in a shop, the duplicated items can be taken for free
  • If used on a trinket, another random trinket will spawn instead of a duplicate
  • If used in the Boss Rush, all the duplicates can be taken for free as well as one of the original items
  • If used in a Devil Room or Black Market, the duplicates can be taken for free
  • Recharge Time: Instant (One time use)
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Diplopia
  • This build: A one-time use item which when used, will duplicate any pedestal items or consumables in the current room. If used in a shop, the duplicated items can be taken for free.
PlaceboID 348 · Quality 2 · ActivePlayable
Drop poolsShop, Greed Mode Shop
No direct change.
  • When used, copies the effect of the pill you are currently holding without consuming it
  • The charge time of this item depends on the quality of the pill you're holding
  • Does not copy effects of Cards or Runes
  • Recharge Time: Varies
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Placebo
  • This build: When used, copies the effect of the pill you are currently holding without consuming it. The charge time of this item depends on the quality of the pill you're holding.
Wooden NickelID 349 · Quality 1 · ActivePlayable
Drop poolsShop, Greed Mode Item Room
No direct change.
  • When used, has a 50% chance to drop one random type of coin (penny, nickel or dime)
  • Keeper starts with this item after beating Isaac with Keeper
  • Recharge Time: 1 room
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Wooden Nickel
  • This build: When used, has a 50% chance to drop one random type of coin (penny, nickel or dime). Keeper starts with this item after beating Isaac with Keeper.
Toxic ShockID 350 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • With this item, at the start of every room you will deal double your tear damage to the entire room in a poison effect
  • Enemies killed now also leave a pool of creep on the ground where they died. This deals 1 damage per tick
  • High tear damage will cause this item to become very powerful for rooms with a lot of enemies, since they can die instantly and render the room harmless
  • Enemies which spawn after the first few seconds of each room are not affected by this item, e.g. Flies spawned from a Mulligan dying
  • This build: toxicShock.
Mega BeanID 351 · Quality 1 · ActivePlayable
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • 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 in close proximity and send a wave of spikes across the room in the direction you are facing
  • The enemies in close range will take 5 damage then have a poison over time effect which deals your tear damage 4 or 6 times
  • The spike wave will deal 10 damage to any enemies in contact with it
  • Can be used to open secret rooms
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mega Bean
  • This build: 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 in close proximity and send a wave of spikes across the room in the direction you are facing.
Glass CannonID 352 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Glass Cannon allows you to fire one huge spectral tear that deals a lot of damage.
  • When taking damage, the cannon will break and remain broken until recharged (Recharge time: 4 rooms)
  • When you take damage and the cannon breaks, you take an additional 2 full hearts of damage and gain the Anemic effect for the room.
  • The damage done by Glass Cannon is calculated as follows: dmg = (dmg * 10) + 10 (i.e. at base damage of 3.5, that's 45 damage)
  • Self-inflicted damage such as Blood Donation machines don't trigger this effect
  • Recharge Time: 5 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 5
  • Name: Glass Cannon
  • This build: Glass Cannon allows you to fire one huge spectral tear that deals a lot of damage. When taking damage, the cannon will break and remain broken until recharged (Recharge time: 4 rooms).
Bomber BoyID 353 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room, Bomb Beggar
No direct change.
  • +5 bombs
  • Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide)
  • This also affects troll bombs
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 bombs. Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide). This also affects troll bombs.
Crack JacksID 354 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsBoss Room, Gold/Stone Chest
No direct change.
  • +1 HP Up
  • Spawns a random trinket on the floor
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1 HP Up. Spawns a random trinket on the floor.
Mom's PearlsID 355 · Quality 2 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest, Mom's Chest
  • +0.38 Range
  • +1 Luck
  • +1 Soul hearts
  • +0.38 Range Up
  • +1 Luck Up
  • +1 Soul Heart
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • This build: +0.38 range. +1 luck. +1 soul hearts.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Car BatteryID 356 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop, Greed Mode Shop
No direct change.
  • The Car Battery causes your spacebar item to activate twice on each use
  • For example, with Yum Heart you would heal 2 full red hearts instead of 1
  • Not in random drops: Its original ability is not implemented yet.
  • This build: The Car Battery causes your spacebar item to activate twice on each use. For example, with Yum Heart you would heal 2 full red hearts instead of 1.
Box of FriendsID 357 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsShop, Greed Mode Item Room
No direct change.
  • Upon use, gives you a duplicate of each familiar you have for the current room
  • It will not 'double' your familiars as the tagline suggests - if you have 2 of one kind, it will only give you an extra one
  • If the familiar only appears when taking damage (i.e. Dead Bird) then Box of Friends will cause it to spawn but won't create duplicates
  • This can be used multiple times in the same room to generate more familiars, meaning you can get a level 4 meatboy or bandage girl by using this item 3 times in the same room
  • If used when you have no familiars, it will give you a Demon Baby temporarily
  • Recharge Time: 3 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Box of Friends
  • This build: Upon use, gives you a duplicate of each familiar you have for the current room.
The WizID 358 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Isaac wears a dunce hat and fires 2 tears at once diagonally, similar to the R U A WIZARD pill tear pattern
  • Gives Isaac spectral tears which allows them to travel through objects in the environment (i.e. rocks)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac wears a dunce hat and fires 2 tears at once diagonally, similar to the R U A WIZARD pill tear pattern.
8 Inch NailsID 359 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • +1.5 Damage Up
  • Replaces Isaac's tears with nails, which have increased knockback
  • The increased knockback will also affect Brimstone, which usually has no knockback at all
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1.5 Damage Up. Replaces Isaac's tears with nails, which have increased knockback. The increased knockback will also affect Brimstone, which usually has no knockback at all.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
IncubusID 360 · Quality 4 · Passive, FamiliarPlayable
Drop poolsDevil Room, Greed Mode Devil Room
No direct change.
  • Gives you a familiar demon incubus that follows you and shoots tears that scale with your own tears in terms of damage, stats and also effects
  • It will mimic any tear effects you currently have and also copy your current stats, meaning it will fire with the same damage, fire rate and range
  • Lilith starts with this item
  • Incubus' damage is reduced by 25% when playing as characters other than Lilith
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • This build: Gives you a familiar demon incubus that follows you and shoots tears that scale with your own tears in terms of damage, stats and also effects.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Copy: true
  • Familiar Cd: 0.4
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Fate's RewardID 361 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familiar blue head that will follow Isaac and fire tears copying his tear damage and effects
  • This familiar is very similar to Incubus, however it only copies damage and is not affected by tears or range upgrades
  • This build: A familiar blue head that will follow Isaac and fire tears copying his tear damage and effects.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Copy: true
  • Familiar Cd: 0.4
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Lil ChestID 362 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room, Greed Mode Item Room, Beggar
No direct change.
  • A familiar chest that follows Isaac and has a 25% chance to drop a pickup after clearing a room
  • Possible drops include hearts, coins, bombs, key, pills, card, runes, batteries, trinket
  • There's a 10% chance to spawn a trinket
  • This build: A familiar chest that follows Isaac and has a 25% chance to drop a pickup after clearing a room. Possible drops include hearts, coins, bombs, key, pills, card, runes, batteries, trinket.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: chest
  • Familiar Chance: 0.25
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Sworn ProtectorID 363 · Quality 3 · Passive, FamiliarPlayable
Drop poolsAngel Room, Greed Mode Angel Room
No direct change.
  • An orbital angel which does 7 contact damage per tick and blocks shots
  • The angel will attract bullets towards it and block them
  • Sworn Protector will drop an eternal heart if it blocks 10 shots in one room. Can only happen once per room
  • Visually this is almost identical to the Guardian Angel item, but without a face
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • This build: An orbital angel which does 7 contact damage per tick and blocks shots. The angel will attract bullets towards it and block them.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 7
  • Familiar Radius: 58
  • Familiar Speed: 1.8
  • Familiar Block: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined, Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Friend ZoneID 364 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room, Greed Mode Item Room, Key Beggar
No direct change.
  • 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
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: 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.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 3
  • Familiar Radius: 54
  • Familiar Speed: 2.4
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Lost FlyID 365 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room, Key Beggar
No direct change.
  • 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 every 7 frames
  • Nearby enemies will be forced to target and attack it
  • 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
  • Not in random drops: Its original ability is not implemented yet.
  • This build: 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.
Scatter BombsID 366 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room, Bomb Beggar
No direct change.
  • +5 bombs
  • Causes your bombs to explode into 2-4 tiny bombs
  • The smaller bombs deal half damage and have a smaller explosion area. They also retain most of your bomb synergizing items
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 bombs. Causes your bombs to explode into 2-4 tiny bombs. The smaller bombs deal half damage and have a smaller explosion area. They also retain most of your bomb synergizing items.
Sticky BombsID 367 · Quality 2 · Passive, Bomb ModifierNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room, Bomb Beggar, Bomb Beggar
No direct change.
  • This item causes your bombs to stick to enemies and when exploding will leave white creep on the ground which slows enemies
  • When one of your bombs kills an enemy, a bunch of blue spiders are spawned to fight by your side, which deal x2 your current damage
  • +5 Bombs
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item causes your bombs to stick to enemies and when exploding will leave white creep on the ground which slows enemies.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
EpiphoraID 368 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Shooting in one direction increases your fire rate until a cap is reached
  • The maximum effect is to halve your delay, which takes roughly 10 seconds to achieve
  • The accuracy of your tears is also reduced as your fire rate increases
  • As soon as you change firing direction, your fire rate is reset to its normal amount
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Shooting in one direction increases your fire rate until a cap is reached. The maximum effect is to halve your delay, which takes roughly 10 seconds to achieve.
ContinuumID 369 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • +3 Range Up
  • Tears will now travel through walls and appear out of the opposite wall, similar to a portal-type mechanic
  • Your tears can now also travel over rocks and objects in the environment
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +3 Range Up. Tears will now travel through walls and appear out of the opposite wall, similar to a portal-type mechanic. Your tears can now also travel over rocks and objects in the environment.
Mr. DollyID 370 · Quality 3 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +0.7 Tears per second
  • +1.5 Range
  • +0.7 Tears Up
  • +1.5 Range Up
  • Spawns 3 random types of hearts on the floor
  • This build: +0.7 tears/s. +1.5 range. mrDolly.
Curse of The TowerID 371 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Red Chest, Curse Room, Greed Mode Item Room
No direct change.
  • Causes Isaac to spawn 6 troll bombs on the floor every time he gets hit, similar to the Anarchist Cookbook mechanic
  • Doesn't trigger on damage taken from blood donation machines and devil beggars (but still triggers on other forms of intentional self damage such as IV Bag)
  • Not in random drops: Self-inflicted damage does not trigger its bomb effect.
  • This build: curseOfTheTower.
Charged BabyID 372 · Quality 3 · Passive, FamiliarPlayable
Drop poolsShop, Greed Mode Shop
No direct change.
  • A familiar baby that has a random chance to drop a battery pickup or freeze all enemies in the room for a short while
  • Charged Baby also has a chance to add one charge to your spacebar item
  • These effects can only occur while in a hostile room with enemies
  • This build: A familiar baby that has a random chance to drop a battery pickup or freeze all enemies in the room for a short while. Charged Baby also has a chance to add one charge to your spacebar item.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: charged
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Dead EyeID 373 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Gives Isaac a +25% damage up for every tear that successfully hits an enemy
  • The bonus from Dead Eye maxes out at double your damage (+100%)
  • If a tear misses an enemy, there is a chance for the multiplier to be reset back to 1. It's a 20% chance on first miss, 33% for a second miss and 50% for anything beyond that
  • Piercing shots work with this item and multiple hits with a single tear will each give a damage bonus
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac a +25% damage up for every tear that successfully hits an enemy. The bonus from Dead Eye maxes out at double your damage (+100%).
Holy Light!ID 374 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room, Angel Room
No direct change.
  • Isaac has a random chance to fire a Holy tear, which when it hits an enemy, will spawn a light beam on the same enemy, dealing damage
  • The beams from this item deal damage equal to 400% of your tear damage (4x damage multiplier for the beams only)
  • The chance to fire a Holy tear is affected by your luck stat, maxing out at a 50% chance
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac has a random chance to fire a Holy tear, which when it hits an enemy, will spawn a light beam on the same enemy, dealing damage.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Host HatID 375 · Quality 3 · PassivePlayable
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • A familiar host that sits on Isaac's head and has a 20% chance to block enemy shots
  • When a shot is blocked, Host Hat will fire 3 bullets back at the enemy
  • Causes you to become immune to explosions, but doesn't protect against stomps or shockwaves
  • Blocks damage from projectiles falling from above
  • This build: A familiar host that sits on Isaac's head and has a 20% chance to block enemy shots. When a shot is blocked, Host Hat will fire 3 bullets back at the enemy.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: hat
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
RestockID 376 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Beggar
No direct change.
  • Causes your shops to instantly restock their items when you buy them
  • New items generated by Restock are from the shop item pool
  • The cost increases exponentially every time you purchase an item. For Items it increases by 2 coins * the number of purchases. For everything it increases by 1 coin * the number of purchases
  • The max price of an item is always 99c with this item
  • Works with Keeper's Box and the Member Card extra shop
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Causes your shops to instantly restock their items when you buy them. New items generated by Restock are from the shop item pool.
Bursting SackID 377 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Most spider enemies no longer target or deal contact damage to Isaac
  • This is very similar to a Skatole for spiders instead of flies
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Most spider enemies no longer target or deal contact damage to Isaac. This is very similar to a Skatole for spiders instead of flies.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
No. 2ID 378 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Continuously firing or charging tears for 3 seconds causes Isaac to fart and drop a Butt Bomb
  • Only 1 Butt Bomb can be dropped per charge, so you'll need to stop firing then start again to drop another one
  • 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
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Continuously firing or charging tears for 3 seconds causes Isaac to fart and drop a Butt Bomb.
  • Reference transformation families: Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
Pupula DuplexID 379 · Quality 2 · PassivePlayable
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Transforms Isaac's tears into a wide arc shape which doubles their size and hitbox
  • Gives Isaac spectral tears which allows them to travel through objects in the environment (i.e. rocks)
  • Spectral
  • Tear Size: 2
  • This build: Tears pass through scenery. Tear size x2.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Pay To PlayID 380 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Greed Mode Item Room, Greed Mode Shop
No direct change.
  • +5 coins
  • This item turns all doors that require a key into doors which need a coin to enter instead
  • This affects shops, item rooms, libraries, double locked doors, key blocks, chests and other key doors
  • Changes the appearance of doors and objects that this item works on to show a coin slot instead of a keyhole
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 coins. This item turns all doors that require a key into doors which need a coin to enter instead.
Eden's BlessingID 381 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +0.7 Tears Up
  • Gives you a random item at the start of your next run (You need to start a fresh run to receive the item)
  • Important progression items such as Key Pieces or the Mom's Shovel pieces cannot be given by Eden's Blessing
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +0.7 Tears Up. Gives you a random item at the start of your next run (You need to start a fresh run to receive the item).
Friendly BallID 382 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • When used, can be thrown at enemies to capture them (similar to a Poké Ball)
  • After capturing an enemy, the next use of the Friendly Ball will re-spawn the same enemy as a friendly companion which will attack other enemies
  • The companion will persist between rooms and floors until it dies by taking enough damage
  • Walking over the thrown ball after capturing an enemy will immediately recharge it
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Friendly Ball
  • This build: When used, can be thrown at enemies to capture them (similar to a Poké Ball).
Tear DetonatorID 383 · Quality 1 · ActivePlayable
Drop poolsShop, Greed Mode Item Room
No direct change.
  • When used, will detonate any tears currently on the screen and cause each one to split into 6 more tears which will fire in a circle, similar to Tammy's Head
  • Luck-based items such as Holy Light are applied to each tear individually
  • Recharge Time: 15 seconds
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Tear Detonator
  • This build: When used, will detonate any tears currently on the screen and cause each one to split into 6 more tears which will fire in a circle, similar to Tammy's Head.
Lil GurdyID 384 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Gives Isaac a familiar Gurdy that will charge around the room dealing contact damage to enemies
  • The Gurdy is charged by holding down the fire button and letting go. The longer the button is held the faster Gurdy will fling itself across the screen
  • Deals a fixed amount of damage depending on charge level, at lowest being ~5 and at max being ~20
  • Lil Gurdy bounces off of enemies and obstacles
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac a familiar Gurdy that will charge around the room dealing contact damage to enemies.
BumboID 385 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Beggar
No direct change.
  • A beggar head which floats around the room and picks up any nearby coins. Every 6 coins Bumbo will evolve to a new form except for level 4 which takes 12 coins
  • Level 2: Bumbo gains a body and crawls around the room, sometimes dropping random pickups
  • Level 3: It now fires tears in the same direction Isaac does
  • Level 4: Bumbo no longer fires tears but instead will chase enemies slowly and deal contact damage. It will also sometimes randomly drop bombs
  • After reaching level 4 (and at a much lower chance before level 4), Bumbo will also continue to collect coins and drop random pickups, similar to the Bum Friend item, but can also drop pedestal items very rarely.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A beggar head which floats around the room and picks up any nearby coins. Every 6 coins Bumbo will evolve to a new form except for level 4 which takes 12 coins.
D12ID 386 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Shop
No direct change.
  • When used, the D12 re-rolls any rocks into another random type of object (e.g. poop, pots, TNT, red poop, stone blocks, spikes, fireplaces etc.)
  • Recharge Time: 3 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: D12
  • This build: When used, the D12 re-rolls any rocks into another random type of object (e.g. poop, pots, TNT, red poop, stone blocks, spikes, fireplaces etc.).
CenserID 387 · Quality 3 · Passive, FamiliarPlayable
Drop poolsAngel Room, Greed Mode Angel Room
No direct change.
  • Gives Isaac a familiar golden Censer which creates a huge aura of light that slows down any enemies inside it
  • This build: Gives Isaac a familiar golden Censer which creates a huge aura of light that slows down any enemies inside it.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: censer
  • Familiar Radius: 95
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Key BumID 388 · Quality 0 · Passive, FamiliarPlayable
Drop poolsItem Room, Secret Room, Key Beggar
No direct change.
  • A familiar beggar similar to Bum Friend that follows Isaac and collects keys, giving random chests in return
  • Doesn't pick up golden keys
  • Counts as 1 of 3 bum items needed towards the Super Bum transformation
  • This build: A familiar beggar similar to Bum Friend that follows Isaac and collects keys, giving random chests in return. Doesn't pick up golden keys.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: bum
  • Familiar Collect: key
  • Familiar Reward: chest
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Super Bum. Set bonuses and costumes remain a separate unfinished overhaul.
Rune BagID 389 · Quality 3 · Passive, FamiliarPlayable
Drop poolsItem Room, Secret Room
No direct change.
  • A bag that follows Isaac and drops a random Rune or Soul Stone every 7 or 8 rooms
  • This build: A bag that follows Isaac and drops a random Rune or Soul Stone every 7 or 8 rooms.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: dropper
  • Familiar Every: 7 / 8
  • Familiar Drop: rune
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
SeraphimID 390 · Quality 3 · Passive, FamiliarPlayable
Drop poolsItem Room, Angel Room, Greed Mode Angel Room
No direct change.
  • A familiar angel which follows Isaac and fires Sacred Heart tears which deal 10 damage at -25% shot speed and a reduced fire rate
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • This build: A familiar angel which follows Isaac and fires Sacred Heart tears which deal 10 damage at -25% shot speed and a reduced fire rate.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 10
  • Familiar Cd: 1.1
  • Familiar Speed Mult: 0.75
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
BetrayalID 391 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room, Devil Room, Greed Mode Devil Room
No direct change.
  • This item causes enemy projectiles to be able to hit other enemies. When an enemy takes damage from an enemy projectile, it will attempt to target the enemy that fired it
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item causes enemy projectiles to be able to hit other enemies. When an enemy takes damage from an enemy projectile, it will attempt to target the enemy that fired it.
ZodiacID 392 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Zodiac will give you a random zodiac item effect that changes after every floor
  • Possible item effects include: Taurus, Aries, Cancer, Leo, Virgo, Libra, Scorpio, Sagittarius, Capricorn, Aquarius, Gemini or Pisces
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Zodiac will give you a random zodiac item effect that changes after every floor.
Serpent's KissID 393 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Tears now have a random chance to apply a poison effect, dealing damage equal to your tears each tick, for 2 ticks
  • 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 by contact damage have a 20% chance to drop a black sin heart when killed. Only contact poison has this effect - poison from tears doesn't work
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears now have a random chance to apply a poison effect, dealing damage equal to your tears each tick, for 2 ticks.
MarkedID 394 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • 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
  • Every time you leave the room this effect turns off until you press a shoot button again
  • +0.7 Tears Up
  • +3.0 Range Up
  • Has no effect with Lilith's Incubus
  • Not in random drops: Its original ability is not implemented yet.
  • This build: 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.
Tech XID 395 · Quality 4 · Passive, Tear modifierNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Tears are replaced with the ability to charge and fire a laser ring that travels across the room
  • The size of the ring will depend on how long you charge it
  • The laser ring does damage scaling based on charge, from 25% at minimum to 100% at max
  • Rings have infinite range and travel until they hit a wall
  • Multiple Tech X stacks - every one taken adds another laser ring (doesn't affect your fire rate)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears are replaced with the ability to charge and fire a laser ring that travels across the room. The size of the ring will depend on how long you charge it.
Ventricle RazorID 396 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Allows you to create one brown tunnel and one blue tunnel in the floor, that can be used to teleport between wherever you placed each one
  • This item will let you port out of the devil room but not back into it
  • Very useful in the boss rush and challenge rooms
  • Recharge Time: Instant
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Ventricle Razor
  • This build: Allows you to create one brown tunnel and one blue tunnel in the floor, that can be used to teleport between wherever you placed each one.
Tractor BeamID 397 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Isaac's tears now travel directly forwards following a beam of light, but will also move sideways based on your player movement
  • +0.5 Tears Up
  • +1.5 Range Up
  • +0.16 Shot Speed Up
  • Allows for more accurate correction when firing tears, as their direction can be controlled even after they have been fired
  • If you switch the direction in which you are firing tears, the beam of light and all your tears will also be transported to the new direction
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's tears now travel directly forwards following a beam of light, but will also move sideways based on your player movement. +0.5 Tears Up. +1.5 Range Up. +0.16 Shot Speed Up.
God's FleshID 398 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Tears now have a random chance to apply a shrinking effect, causing enemies to shrink in size for 5 seconds and also run away from Isaac
  • Shrunk enemies can be crushed and killed by walking over them
  • Counts as 1 of 3 mushroom items needed towards the Fun Guy transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears now have a random chance to apply a shrinking effect, causing enemies to shrink in size for 5 seconds and also run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.
  • Reference transformation families: Fun Guy. Set bonuses and costumes remain a separate unfinished overhaul.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Maw of The VoidID 399 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Greed Mode Devil Room
No direct change.
  • After firing tears for 3 seconds, a red cross appears on Isaac's head that, upon releasing the fire button, creates a black ring which deals a lot of damage to any enemies inside it
  • The ring deals damage equal to your tear damage rapidly to any enemies in contact with it, for a total of 30 ticks of damage
  • You have to keep the fire button held down for the full 3 seconds to cause this effect
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: After firing tears for 3 seconds, a red cross appears on Isaac's head that, upon releasing the fire button, creates a black ring which deals a lot of damage to any enemies inside it.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
Spear of DestinyID 400 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsAngel Room, Greed Mode Angel Room
No direct change.
  • In addition to tears, Isaac now holds a spear infront of him which deals damage equal to 2 times your tear damage
  • The spear occasionally inflicts fear on enemies it damages.
  • The spear cannot be thrown like Mom's Knife but deals damage while it is in contact with an enemy
  • Not in random drops: Its original ability is not implemented yet.
  • This build: In addition to tears, Isaac now holds a spear infront of him which deals damage equal to 2 times your tear damage. The spear occasionally inflicts fear on enemies it damages.
ExplosivoID 401 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Tears now have a random chance to become sticky bombs, which will attach to enemies and explode after a few seconds
  • The bomb explosion deals your tear damage + 60
  • Explosivo shots deal regular tear damage upon sticking to an enemy
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears now have a random chance to become sticky bombs, which will attach to enemies and explode after a few seconds. The bomb explosion deals your tear damage + 60.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
ChaosID 402 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop, Secret Room
No direct change.
  • Causes all item pedestals to be chosen from a random item pool instead of the pre-defined ones which normally exist
  • When picked up, drops between 1-6 random pickups on the floor
  • Makes it possible to see items that have been rerolled away, preventing emptying the item pool and Breakfasting
  • Fixed item drops won't be replaced - e.g. Cube of Meat after defeating a Horseman
  • Chaos assigns a weight to item pools based on how many items are in the pool. The more items in a pool, the more likely that pool will be picked
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Causes all item pedestals to be chosen from a random item pool instead of the pre-defined ones which normally exist. When picked up, drops between 1-6 random pickups on the floor.
Spider ModID 403 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsShop, Greed Mode Shop
No direct change.
  • A familiar grey spider that wanders around and allows you to see your tear damage and the health bars of all enemies
  • The spider will inflict a random status effect on any enemies it comes into contact with (e.g. slow, shrink, fear)
  • Spider Mod will also randomly drop battery consumables or blue spiders when a room is completed
  • For the sake of simplicity for players, all damage values displayed are multiplied by 10 and rounded to the nearest number
  • This item is a reference to Spider853, creator of Spidermod for the original game and one of the lead developers that worked on Rebirth and its DLCs
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar grey spider that wanders around and allows you to see your tear damage and the health bars of all enemies.
Farting BabyID 404 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar that follows Isaac and blocks tears
  • If a tear hits Farting Baby, there is a 10% chance for it to fart, with 3 possible effects: Charm, Poison or Knock back
  • Charm deals 5 damage. Poison deals 5 damage initially and then 3.5
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar that follows Isaac and blocks tears. If a tear hits Farting Baby, there is a 10% chance for it to fart, with 3 possible effects: Charm, Poison or Knock back.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
GB BugID 405 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Secret Room, Greed Mode Shop
No direct change.
  • Spawns a familiar that follows Isaac.
  • Double tapping the fire button launches it forward, causing it to reroll the first monster, trinket, or pickup it hits
  • GB Bug respawns after a room has been cleared
  • Cannot reroll bosses - instead just deals 8 contact damage
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a familiar that follows Isaac. Double tapping the fire button launches it forward, causing it to reroll the first monster, trinket, or pickup it hits.
D8ID 406 · Quality 2 · ActivePlayable
Drop poolsItem Room, Greed Mode Shop
No direct change.
  • When used, the D8 rerolls all of your stats
  • Will only effect your damage, tears, range and speed stats
  • Each stat is given a multiplier that applies after all other adjustments
  • Recharge Time: 4 Rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: D8
  • This build: When used, the D8 rerolls all of your stats. Will only effect your damage, tears, range and speed stats. Each stat is given a multiplier that applies after all other adjustments.
PurityID 407 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Angel Room, Greed Mode Item Room, Greed Mode Angel Room
No direct change.
  • Purity will boost one of Isaac's stats depending on the colour of the aura around him
  • When you take damage, the aura will be removed and replaced with another random one when you enter the next room
  • Colour code is as follows:
  • Red = +4.0 Damage
  • Blue = -4 Tear Delay
  • Yellow = +0.5 Speed Up
  • Orange = +3.0 Range Up
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Purity will boost one of Isaac's stats depending on the colour of the aura around him. When you take damage, the aura will be removed and replaced with another random one when you enter the next room.
AthameID 408 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room, Greed Mode Devil Room
No direct change.
  • Adds a chance for a black ring to spawn around killed enemies, dealing damage to others that touch it
  • The ring damage scales with your tear damage
  • The chance for a ring to spawn scales with your luck stat
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Adds a chance for a black ring to spawn around killed enemies, dealing damage to others that touch it. The ring damage scales with your tear damage.
Empty VesselID 409 · Quality 2 · PassivePlayable
Drop poolsDevil Room, Demon Beggar
  • +2 Black hearts
  • +2 Black Hearts
  • When Isaac has no red hearts, this item gives Isaac the ability to fly. Every 40 seconds spent in the same room since last activating, when the timer displays 00, 20 or 40 seconds, a shield triggers, nullifying all types of damage for 10 seconds
  • As soon as Isaac has half a red heart or more, this item deactivates
  • This build: +2 black hearts. emptyVessel.
Evil EyeID 410 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • While firing tears this item gives you 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 evil eye shots will be destroyed if they come into contact with enemies or obstacles
  • Not in random drops: Its original ability is not implemented yet.
  • This build: While firing tears this item gives you 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.
Lusty BloodID 411 · Quality 3 · PassivePlayable
Drop poolsItem Room, Devil Room, Greed Mode Item Room
No direct change.
  • Each time Isaac kills an enemy, you get a temporary +0.5 damage up which lasts for the current room
  • Each subsequent kill will stack further damage up to a maximum of +5 Damage Up after 10 kills
  • This item is the same principle as the Bloody Lust item from the original flash game
  • This build: lustyBlood.
Cambion ConceptionID 412 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Greed Mode Devil Room
No direct change.
  • After taking enough damage you will gain a permanent demon familiar
  • Possible familiars include: Dark Bum, Demon Baby, Leech, Lil' Brimstone, Succubus, Incubus, Lil Abaddon, Twisted Pair
  • The effect is shown visually in 3 stages with the character's belly getting larger each time until it finally gives birth to a familiar.
  • The first and second familiars spawn after 15 hits, then 30 hits for the third and fourth
  • Cambion Conception cannot grant more than 4 familiars in total
  • Lilith starts with this item
  • Not in random drops: Its original ability is not implemented yet.
  • This build: After taking enough damage you will gain a permanent demon familiar. Possible familiars include: Dark Bum, Demon Baby, Leech, Lil' Brimstone, Succubus, Incubus, Lil Abaddon, Twisted Pair.
Immaculate ConceptionID 413 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsAngel Room, Greed Mode Angel Room
No direct change.
  • After picking up 15 hearts, Isaac gains a permanent angelic familiar and a soul heart drops
  • Possible familiars include: Holy Water, Guardian Angel, Sworn Protector, The Relic and Seraphim
  • It is possible to get multiple followers by continuing to pick up hearts, at intervals of 15 hearts each
  • After all 5 familiars have spawned, it will just drop a soul heart every 15 hearts collected
  • Not in random drops: Its original ability is not implemented yet.
  • This build: After picking up 15 hearts, Isaac gains a permanent angelic familiar and a soul heart drops. Possible familiars include: Holy Water, Guardian Angel, Sworn Protector, The Relic and Seraphim.
More OptionsID 414 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Two items now spawn in each of your item rooms, however only one can be taken and the other will disappear
  • Doesn't work for half-sized item rooms
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Two items now spawn in each of your item rooms, however only one can be taken and the other will disappear. Doesn't work for half-sized item rooms.
Crown of LightID 415 · Quality 4 · PassiveNot ready — excluded from drops
Drop poolsAngel Room, Greed Mode Angel Room
No direct change.
  • +2 Soul Hearts
  • A crown that replaces normal tears with blue diamond tears while you don't have any empty red heart containers or bone hearts
  • While the effect is active, tears do double damage and have -0.30 Shot Speed
  • The crown will glow blue while active, if inactive it will appear grey
  • The effect will also deactivate for the rest of the current room when you take damage, regardless of your health
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +2 Soul Hearts. A crown that replaces normal tears with blue diamond tears while you don't have any empty red heart containers or bone hearts.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Deep PocketsID 416 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Greed Mode Item Room, Greed Mode Shop
No direct change.
  • Increases your money cap to 999
  • When a room clear would otherwise yield no rewards, it now spawns 1-3 pennies
  • Previously this item would add an extra card/pill slot, however this was removed with the Repentance rebalance
  • Not in random drops: Room-clear reward detection and the three-digit currency HUD need completion.
  • This build: deepPockets.
SuccubusID 417 · Quality 3 · Passive, FamiliarPlayable
Drop poolsDevil Room, Demon Beggar
No direct change.
  • A flying familiar that bounces around the room with a damaging aura, dealing rapid damage to any enemies inside it and boosting Isaac's tear damage
  • While standing in the black aura, Isaac has a temporary 1.5x damage multiplier (this will stack if you have more than one Succubus)
  • The aura deals 2.5 damage per tick or about 7.5 - 10 damage per second
  • This build: A flying familiar that bounces around the room with a damaging aura, dealing rapid damage to any enemies inside it and boosting Isaac's tear damage.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: bounce
  • Familiar Dmg: 0
  • Familiar Aura: [object Object]
  • Familiar Speed: 110
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Fruit CakeID 418 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives you a different tear effect with every tear that you fire
  • Tear effects include: Anti-Gravity, Ball of Bandages (Lvl 4), Bumbo (Lvl 3), Continuum, Cupid's Arrow, Compound Fracture, Euthanasia, Explosivo, Eye of Greed, Fire Mind, Flat Stone, Flat Worm, God's Flesh, Godhead, Head of the Keeper, Holy Light, Hook Worm, Ipecac, Iron Bar, Jacob's Ladder, Knockout Drops, Lachryphagy, Little Horn, Lodestone, Mom's Contacts, Mom's Eyeshadow, Mom's Perfume, Mucormycosis, My Reflection, Mysterious Liquid, Ocular Rift, Ouija Board, Ouroboros Worm, The Parasite, Parasitoid, Polyphemus, Pop!, Proptosis, Pulse Worm, Ring Worm, Rotten Tomato, Rubber Cement, Serpent's Kiss, Sinus Infection, Spider Bite, Strange Attractor, Sulfuric Acid, Technology Zero, Tiny Planet, Trisagion and Wiggle Worm
  • With Dr. Fetus, this item will also cycle through random Bomb Modifiers (e.g. Butt Bombs, Hot Bombs)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a different tear effect with every tear that you fire.
Teleport 2.0ID 419 · Quality 3 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used will teleport you to another random room that has not been explored yet
  • After all the normal rooms have been explored, the hierarchy of rooms chosen is: Super Secret Room, Shop, Item Room, Sacrifice Room, Dice Room, Library, Curse Room, Miniboss, Challenge Room, Bedroom, Arcade, Vault, Secret Room, Devil/Angel Room, I AM ERROR
  • This ordering means a Devil and I Am Error room can both be forced if all others have been visited
  • If used in a normal room with enemies it will teleport you out and back into the exact same room
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Teleport 2.0
  • This build: When used will teleport you to another random room that has not been explored yet.
Black PowderID 420 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Demon Beggar
No direct change.
  • Walking in a circle will spawn a pentagram symbol on the floor, which deals 10 damage per tick to any enemies inside it
  • The trail of black powder left on the floor will quickly disappear, meaning you are limited on the size of the pentagram symbol you can create
  • Will deal damage to flying enemies inside the pentagram
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Walking in a circle will spawn a pentagram symbol on the floor, which deals 10 damage per tick to any enemies inside it.
Kidney BeanID 421 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • When used, applies the charm effect to any enemies in close range and deals 5 damage
  • Charmed enemies will prioritize attacking other enemies in the room, otherwise they will still attack Isaac
  • REPENTANCE - Kidney Bean now has a bigger effect radius, no longer deals damage to the enemies it's charming, and charge time has been reduced to 1 (from 2).
  • Recharge Time: 1 Rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Kidney Bean
  • This build: When used, applies the charm effect to any enemies in close range and deals 5 damage. Charmed enemies will prioritize attacking other enemies in the room, otherwise they will still attack Isaac.
Glowing Hour GlassID 422 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Shop, Greed Mode Item Room
No direct change.
  • When used, this item will rewind time and put you back in the previous room, in the same state you were in at that moment
  • This means any damage taken or consumables used in the current room will be reset back to the previous state
  • Can be used to check the contents of an Item Room without affecting Planetarium spawn chances
  • Glowing Hour Glass has no cooldown, but can only be used 3 times per floor
  • Recharge Time: None (Max 3 use per floor)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Glowing Hour Glass
  • This build: When used, this item will rewind time and put you back in the previous room, in the same state you were in at that moment.
Circle of ProtectionID 423 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsAngel Room, Greed Mode Angel Room
No direct change.
  • Gives Isaac a large white halo around him, that deals a bit of damage to any enemies in contact with the ring
  • Every time an enemy bullet enters the ring, there is a chance it will reflect a homing tear back at the enemy
  • Not in random drops: The retaliatory hit is immediate; the reflected projectile flight is not implemented.
  • This build: circleOfProtection.
Sack HeadID 424 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop, Secret Room
No direct change.
  • Coins have a 10% chance to be replaced with Sack. Bombs, keys, cards, runes and batteries have a 20% chance
  • Spawns a sack when picked up
  • Can lead to game-breaking combinations with the D20 due to the amount of consumables and batteries spawned by the item sacks
  • REPENTANCE - Added to the Secret Room pool
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Coins have a 10% chance to be replaced with Sack. Bombs, keys, cards, runes and batteries have a 20% chance. Spawns a sack when picked up.
Night LightID 425 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsShop, Greed Mode Item Room
No direct change.
  • Gives Isaac a cone of light infront of him that slows any enemies inside it and their tears
  • The light faces the direction that you are facing, not the direction you are firing
  • Removes Curse of Darkness for the current floor, if picked up on a floor where the curse is active
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac a cone of light infront of him that slows any enemies inside it and their tears. The light faces the direction that you are facing, not the direction you are firing.
Obsessed FanID 426 · Quality 0 · Passive, FamiliarPlayable
Drop poolsItem Room, Key Beggar
No direct change.
  • A purple familiar fly that follows your exact movement on a 1 second delay and deals 2 contact damage to enemies
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: A purple familiar fly that follows your exact movement on a 1 second delay and deals 2 contact damage to enemies.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: delay
  • Familiar Dmg: 2
  • Familiar Delay: 1
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Mine CrafterID 427 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, places an explosive TNT barrel next to you
  • The TNT barrel can be pushed and used to explode rocks or damage enemies
  • If used a second time in the same room while the last TNT barrel is still there, it will remotely explode the first TNT and not spawn another
  • Recharge Time: 1 room
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mine Crafter
  • This build: When used, places an explosive TNT barrel next to you. The TNT barrel can be pushed and used to explode rocks or damage enemies.
PJsID 428 · Quality 2 · PassivePlayable
Drop poolsBoss Room, Gold/Stone Chest
  • +4 Soul hearts
  • +4 Soul Hearts
  • Fully restores your red health
  • REPENTANCE - Added to the Gold Chest Pool
  • Heal: full
  • This build: +4 soul hearts. Refills red health.
Head of the KeeperID 429 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDead shopkeeper, Item Room
No direct change.
  • Isaac's tears become coins and now have a 5% chance to drop pennies on the floor upon successfully hitting an enemy
  • Has a chance to drop when exploding a dead shopkeeper
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's tears become coins and now have a 5% chance to drop pennies on the floor upon successfully hitting an enemy. Has a chance to drop when exploding a dead shopkeeper.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Papa FlyID 430 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Key Beggar
No direct change.
  • A familiar blue fly that will follow Isaac's movement pattern but delayed by 1 second
  • Papa Fly will fire tears at nearby enemies that deal damage equal to Isaac's tear damage
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar blue fly that will follow Isaac's movement pattern but delayed by 1 second. Papa Fly will fire tears at nearby enemies that deal damage equal to Isaac's tear damage.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Multidimensional BabyID 431 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room, Devil Room, Greed Mode Devil Room
No direct change.
  • A familiar baby that will follow your movement pattern on a 2 second delay
  • Tears that pass through the baby will double up and gain x1.33 speed boost
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar baby that will follow your movement pattern on a 2 second delay. Tears that pass through the baby will double up and gain x1.33 speed boost.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Glitter BombsID 432 · Quality 2 · Passive, Bomb ModifierNot ready — excluded from drops
Drop poolsItem Room, Bomb Beggar
No direct change.
  • +5 bombs
  • Isaac's normal bombs become pink and causes them to drop random pickups when they explode (e.g. keys, coins, bombs, trinkets)
  • Bombs have a chance to charm enemies
  • The chance for pickups to spawn decreases by 1% each time Glitter Bombs provides something (resets at the next floor). This is to prevent a syngery like Dr. Fetus or a Golden Bomb giving you infinite resources
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 bombs. Isaac's normal bombs become pink and causes them to drop random pickups when they explode (e.g. keys, coins, bombs, trinkets). Bombs have a chance to charm enemies.
My ShadowID 433 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Greed Mode Devil Room
No direct change.
  • Isaac's shadow will follow closely behind him and when it comes into contact with enemies, will spawn friendly dark charger mobs
  • The chargers deal contact damage to enemies, and will be killed if it is hurt too much
  • Chargers disappear upon entering a new room
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac's shadow will follow closely behind him and when it comes into contact with enemies, will spawn friendly dark charger mobs.
Jar of FliesID 434 · Quality 2 · ActivePlayable
Drop poolsShop, Greed Mode Item Room, Greed Mode Shop
No direct change.
  • Every time you kill an enemy a fly will be added to the Jar, allowing you to stack up to 20
  • Using the Jar of Flies will release all the flies that are currently in the jar as friendly flies that will damage enemies
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • Recharge Time: Instant
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Jar of Flies
  • This build: Every time you kill an enemy a fly will be added to the Jar, allowing you to stack up to 20.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Lil LokiID 435 · Quality 1 · PassivePlayable
Drop poolsItem Room
No direct change.
  • A Loki familiar that follows Isaac and shoots tears 4 tears in a cross pattern, dealing a flat 3.5 damage each
  • This build: A Loki familiar that follows Isaac and shoots tears 4 tears in a cross pattern, dealing a flat 3.5 damage each.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Dmg: 3.5
  • Familiar Cd: 0.5
  • Familiar Cross: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Milk!ID 436 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Gives Isaac a familiar glass of milk that follows him and spills on the floor upon taking damage
  • After being spilt, the milk gives you a -2 Tear Delay (Tears up) for the rest of the room
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac a familiar glass of milk that follows him and spills on the floor upon taking damage. After being spilt, the milk gives you a -2 Tear Delay (Tears up) for the rest of the room.
D7ID 437 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, the D7 will restart the current room and bring back all enemies once again, enabling you to farm rewards that spawn at the end after beating the room
  • Can be used to generate infinite consumable combinations, gaining as many coins/keys/bombs as you need
  • This item has no effect in Greed Mode, Challenge Rooms and rooms that had no enemies in originally
  • If used in a Boss Room or Angel/Devil Room, you get teleported to another random room, which is reset instead of the boss/angel/devil room you were in
  • Enemies respawned by the D7 don't drop loot if they were champions and also don't grant score in daily run
  • Recharge Time: 3 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: D7
  • This build: When used, the D7 will restart the current room and bring back all enemies once again, enabling you to farm rewards that spawn at the end after beating the room.
BinkyID 438 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsBoss Room, Gold/Stone Chest
  • +1 Soul hearts
  • +0.75 Tears per second
  • +1 Soul heart
  • +0.75 Tears Up
  • Isaac size down
  • Makes Isaac very small like a baby, reducing his hitbox size
  • Not in random drops: Player/hitbox shrinking is not implemented.
  • This build: +1 soul hearts. +0.75 tears/s. binky.
Mom's BoxID 439 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsShop, Greed Mode Shop, Mom's Chest
No direct change.
  • When used, Mom's Box will drop a random trinket on the ground
  • +1 Luck while held
  • While held, doubles the effect of trinkets which make sense to be doubled (e.g. +4 damage from Curved Horn instead of 2, -4 Tear Delay from Cancer instead of 2)
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mom's Box
  • This build: When used, Mom's Box will drop a random trinket on the ground. +1 Luck while held.
Kidney StoneID 440 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • 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
  • REPENTANCE - Kidney Stone is no longer a speed downgrade
  • Not in random drops: Its original ability is not implemented yet.
  • This build: 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.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Mega BlastID 441 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsDevil Room, Greed Mode Devil Room
No direct change.
  • Upon use, fires a huge Mega Satan laser for 15 seconds, dealing your tear damage * 5 per tick to anything in its path and pushing Isaac back by the force
  • The laser persists for the entire 15 seconds even between rooms and floors
  • This item appears in the Devil Room but is weighted to be about 5 times rarer than all other devil room items
  • Recharge Time: 12 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 12. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mega Blast
  • This build: Upon use, fires a huge Mega Satan laser for 15 seconds, dealing your tear damage * 5 per tick to anything in its path and pushing Isaac back by the force.
Dark Prince's CrownID 442 · Quality 1 · PassivePlayable
Drop poolsDevil Room, Curse Room
No direct change.
  • A crown appears above your head and while at exactly 1 full red heart of health, you gain a +1.5 Range Up, +2.0 Tears Up and +0.20 Shot Speed Up
  • Any time your health changes to be not exactly 1 red heart you lose the effect
  • This item does nothing with The Lost
  • REPENTANCE - Dark Prince's Crown now grants more of an increase in rate of fire, and the bonus now breaks the soft tears cap.
  • This build: darkPrinceCrown.
Apple!ID 443 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives you a 6.66% chance to fire a razor blade which deals x4 damage
  • +0.3 Tears Up
  • This item also turns your tears red, but does not change your actual damage stat or the damage your normal tears do
  • The chance to fire a razor blade depends on your luck stat, and at +14 luck you will fire a razor blade every time
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a 6.66% chance to fire a razor blade which deals x4 damage. +0.3 Tears Up.
Lead PencilID 444 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Gold/Stone Chest
No direct change.
  • With every 15 tears fired, Isaac will fire a cluster of 12 tears instead of your normal tear
  • Causes your normal tears to fire out of one eye, which means tears will fire in a near-perfect line instead of slightly off-center
  • REPENTANCE - Lead Pencil's tear barrage no longer deals double damage
  • Not in random drops: Its original ability is not implemented yet.
  • This build: With every 15 tears fired, Isaac will fire a cluster of 12 tears instead of your normal tear.
Dog ToothID 445 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
  • +0.3 Damage
  • +0.1 Movement speed
  • +0.3 Damage Up
  • +0.1 Speed Up
  • When entering a room connected to a Secret Room or Super Secret Room, a howling sound will play
  • When entering a room with a crawl space trapdoor in it, a barking sound will play
  • Not in random drops: Secret-room and Crawl Space detection sounds are not implemented.
  • This build: +0.3 damage. +0.1 speed. dogTooth.
Dead ToothID 446 · Quality 1 · PassivePlayable
Drop poolsItem Room
No direct change.
  • While firing, you gain a green aura that poisons any enemies which touch it. The poison deals your tear damage per tick, for 2 ticks
  • Has no effect on Lilith, as she cannot fire tears
  • This build: deadTooth.
Linger BeanID 447 · Quality 0 · PassivePlayable
Drop poolsItem Room, Beggar
No direct change.
  • While firing tears constantly for 7.5 seconds, you spawn a poop cloud, which deals periodic damage to any enemies which come near it
  • The cloud deals damage equal to your base tear damage per tick, roughly 5 times per second
  • Clouds last 15 seconds before disappearing
  • The cloud can be pushed slightly by firing tears at it
  • This build: lingerBean.
Shard of GlassID 448 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Upon taking damage, Isaac starts to bleed, leaving a trail of blood and spraying blood tears everywhere which deal damage to nearby enemies
  • While bleeding, Isaac takes damage every 30 seconds
  • The blood sprays in the direction you are current firing, or just randomly near Isaac if not shooting your tears
  • The blood spray scales with your current tear damage and any future damage increases
  • This effect lasts until you pick up a red heart
  • Upon taking damage, this item gives a 25% chance to drop a full red heart
  • REPENTANCE - This entire item has been reworked
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Upon taking damage, Isaac starts to bleed, leaving a trail of blood and spraying blood tears everywhere which deal damage to nearby enemies. While bleeding, Isaac takes damage every 30 seconds.
Metal PlateID 449 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
  • +1 Soul hearts
  • +1 Soul Heart
  • Enemy bullets have a 25% chance to be deflected back at the enemy, which will hurt them and apply the concussive status effect, causing it to be stunned for a few seconds
  • Not in random drops: The reflected homing/concussion projectile is represented by instant damage; projectile behavior is not implemented.
  • This build: +1 soul hearts. metalPlate.
Eye of GreedID 450 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Every 20th tear fired will also fire a golden coin tear at the same time. This tear turns enemies to gold for a few seconds and causes them to drop 1-4 coins if killed while golden (similar to the Midas' Touch item)
  • When the Midas Touch tear effect triggers, it will remove 1 coin from your current total
  • The golden tear deals double your tear damage
  • The effect can still trigger even if you have no held coins
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Every 20th tear fired will also fire a golden coin tear at the same time. This tear turns enemies to gold for a few seconds and causes them to drop 1-4 coins if killed while golden (similar to the Midas' Touch item).
Tarot ClothID 451 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Curse Room
No direct change.
  • Drops a random card on pickup
  • Doubles the effect of most tarot cards. A slow pulsing outline HUD effect appears for cards that would be buffed by Tarot Cloth
  • To see the full list of Tarot Card effects, check out the Mechanics > Tarot Cloth page
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Drops a random card on pickup. Doubles the effect of most tarot cards. A slow pulsing outline HUD effect appears for cards that would be buffed by Tarot Cloth.
Varicose VeinsID 452 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Every time you take damage, 10 high damage tears are fired in a circle around you (similar to the Tammy's Head effect)
  • Tear damage is equal to Isaac's tear damage + 25 flat damage
  • Additionally, has a chance to activate the Anemic effect when taking damage for 2 seconds
  • Similar to Tammy's Head, this item synergizes with a lot of items (i.e. with Brimstone it fires 10 lasers)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Every time you take damage, 10 high damage tears are fired in a circle around you (similar to the Tammy's Head effect). Tear damage is equal to Isaac's tear damage + 25 flat damage.
Compound FractureID 453 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Turns your tears into bones, which shatter into 1-3 smaller bone shards upon hitting any object or enemy
  • The smaller bone shards deal damage equal to half your normal tear damage
  • +0.38 Range Up
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Turns your tears into bones, which shatter into 1-3 smaller bone shards upon hitting any object or enemy. The smaller bone shards deal damage equal to half your normal tear damage. +0.38 Range Up.
PolydactylyID 454 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Allows Isaac to carry two cards, runes or pills (or any combination of these) at the same time
  • Drops a random card, pill or rune on pickup
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Allows Isaac to carry two cards, runes or pills (or any combination of these) at the same time. Drops a random card, pill or rune on pickup.
Dad's Lost CoinID 455 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsBoss Room, Beggar, Gold/Stone Chest
No direct change.
  • +0.38 Range Up
  • Drops a lucky penny
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +0.38 Range Up. Drops a lucky penny.
Midnight SnackID 456 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Beggar, Gold/Stone Chest
  • +1 Red heart containers
  • +1 HP Up
  • REPENTANCE - This was renamed from Moldy Bread
  • This build: +1 heart containers.
Cone HeadID 457 · Quality 2 · PassivePlayable
Drop poolsItem Room
  • +1 Soul hearts
  • +1 Soul Heart
  • Each time you take damage from any source, Cone Head has a 20% chance to prevent it from reducing your health
  • Isaac flashes blue very briefly when damage is negated by this item
  • This build: +1 soul hearts. coneHead.
Belly ButtonID 458 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Drops one random trinket on pickup
  • Gives you an extra trinket slot
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Drops one random trinket on pickup. Gives you an extra trinket slot.
Sinus InfectionID 459 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Isaac's tears have a 20% chance to be a booger instead, which stick on to enemies and deal periodic poison damage until they die
  • Each tick of poison damage is equal to your normal tear damage
  • Each booger persists for 10 seconds or until the enemy dies
  • This build: 20% of tears stick for ten seconds, dealing tear damage each tick.
GlaucomaID 460 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Adds a chance to shoot a concussive tear, which will cause enemies to walk around dazed in confusion
  • The daze effect is effectively permanent for normal enemies, and has a much longer duration for bosses compared to other status effects
  • Makes all rooms slightly darker
  • The visual effect of a Glaucoma tear is hard to notice, however it is slightly lighter than normal tears and is not a perfect circle shape
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Adds a chance to shoot a concussive tear, which will cause enemies to walk around dazed in confusion.
ParasitoidID 461 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • This item gives you a chance that instead of firing tears you will fire an egg sack, which slows enemies on hit and drops a pool of white slowing creep below them
  • If a parasitoid shot successfully hits an enemy, a blue friendly fly or spider is spawned
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation.
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item gives you a chance that instead of firing tears you will fire an egg sack, which slows enemies on hit and drops a pool of white slowing creep below them.
  • Reference transformation families: Beelzebub, Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Eye of BelialID 462 · Quality 3 · PassivePlayable
Drop poolsDevil Room
  • +0.38 Range
  • Causes your tears to become piercing, allowing them to travel through enemies
  • After hitting its first enemy, each tear will double in damage and gain a homing effect
  • +0.38 Range Up
  • Piercing
  • This build: +0.38 range. Tears pass through enemies. Piercing tears double damage and gain homing after their first hit.
Sulfuric AcidID 463 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +0.3 Damage Up
  • Each tear has a chance to become acidic, allowing it to break rocks, pots and other breakable objects
  • Acidic tears can also be used to open secret rooms
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +0.3 Damage Up. Each tear has a chance to become acidic, allowing it to break rocks, pots and other breakable objects. Acidic tears can also be used to open secret rooms.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Glyph of BalanceID 464 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • +2 Soul Hearts
  • This item will modify drops from room clearing and champion enemies based on your current player state. The priority list of what will drop from champion enemies in order is as follows:
  • Soul Hearts - When you have no red heart containers and less than 2 soul hearts
  • Red Hearts (Full hearts) - While at 0.5 red hearts
  • Keys - When you have no keys
  • Bombs - When you have no Bombs
  • Red Hearts (Full hearts) - When you have at least half a red heart container empty
  • Coins - While at less than 15 cents
  • Keys - When you have less than 5 keys
  • Bombs - When you have less than 5 bombs
  • Trinkets - If you have no trinkets and there are no trinkets on the ground in the room
  • Soul Hearts - When you have less than 6 total heart containers of any kind
  • If none of the above conditions are true, champions will resume dropping their regular pickups
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +2 Soul Hearts.
Analog StickID 465 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +0.35 Tears Up
  • Allows you to fire tears diagonally by holding down two of the fire buttons at once
  • If you are using a gamepad, this item allows you to fire in any direction
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +0.35 Tears Up. Allows you to fire tears diagonally by holding down two of the fire buttons at once. If you are using a gamepad, this item allows you to fire in any direction.
ContagionID 466 · Quality 2 · PassivePlayable
Drop poolsItem Room
No direct change.
  • The first enemy you kill in each new room will now explode and poison all nearby enemies, causing them to take periodic damage until they also die and explode
  • If you have lots of enemies near each other this can cause a chain reaction, killing lots of enemies in one go
  • This build: contagion.
Finger!ID 467 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives Isaac a finger which floats infront of him and points in the same direction he is facing or firing. The finger deals 10% of your normal damage to all enemies in the same direction that the finger is pointing
  • The finger will also deal damage to entities such as fires and poops
  • Applies on-hit status effects such as the burning debuff from Fire Mind
  • Spawns guppy flies if you have the Guppy transformation
  • Not in random drops: Status transfer and interaction with fires/poop are not implemented.
  • This build: Gives Isaac a finger which floats infront of him and points in the same direction he is facing or firing. The finger deals 10% of your normal damage to all enemies in the same direction that the finger is pointing.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: finger
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
ShadeID 468 · Quality 0 · Passive, FamiliarPlayable
Drop poolsDevil Room, Curse Room
No direct change.
  • Isaac gains a shadow familiar that will follow Isaac's movement pattern by a 0.66 second delay and deal 5 contact damage to enemies per tick
  • Shade is absorbed by Isaac after dealing over 666 damage. This spawns friendly charger enemies and causes Isaac to deal 5 contact damage (same as the shade did). This effect stacks with multiple shades, scaling the contact damage each time
  • This build: Isaac gains a shadow familiar that will follow Isaac's movement pattern by a 0.66 second delay and deal 5 contact damage to enemies per tick.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: delay
  • Familiar Dmg: 5
  • Familiar Delay: 0.66
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
DepressionID 469 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • Isaac gains a cloud familiar that follows him and leaves a trail of tears on the floor which damages enemies for 2 damage per tick
  • Enemies touching the cloud have a chance to activate the Crack the Sky effect, which spawns a light beam that deals damage equal to your tear damage + 20
  • This build: Isaac gains a cloud familiar that follows him and leaves a trail of tears on the floor which damages enemies for 2 damage per tick.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: creeper
  • Familiar Dmg: 2
  • Familiar Crack: 0.05
  • Familiar Cloud: true
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
HushyID 470 · Quality 0 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • Gives Isaac a small Hush familiar that bounces diagonally around the room dealing 2 contact damage per tick
  • While you're firing tears Hushy will stop moving, which allows you to keep it in one place
  • Hushy will block enemy tears and projectiles
  • This build: Gives Isaac a small Hush familiar that bounces diagonally around the room dealing 2 contact damage per tick. While you're firing tears Hushy will stop moving, which allows you to keep it in one place.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: bounce
  • Familiar Dmg: 2
  • Familiar Block: true
  • Familiar Stop When Firing: true
  • Familiar Speed: 130
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Lil MonstroID 471 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives Isaac a small Monstro familar, who's tears can be charged and released in a shotgun style effect, much like Monstro's main attack
  • Lil Monstro's tears each deal base damage (3.5) and do not scale with damage upgrades
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac a small Monstro familar, who's tears can be charged and released in a shotgun style effect, much like Monstro's main attack.
King BabyID 472 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsShop
No direct change.
  • A baby familiar that follows you and causes other familiars to follow it. It stops moving while Isaac is firing tears and upon releasing the fire button, King Baby will teleport back to your location
  • King Baby will always appear first in the queue of familiars
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • REPENTANCE - Familiars now automatically aim at enemies when being commanded by King Baby
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A baby familiar that follows you and causes other familiars to follow it. It stops moving while Isaac is firing tears and upon releasing the fire button, King Baby will teleport back to your location.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Big ChubbyID 473 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familiar that follows Isaac and charges forwards very slowly, dealing 2.7 damage per tick to any enemies it comes into contact with
  • Almost identical to the Little Chubby familiar, but this one moves much more slowly and deals less damage
  • REPENTANCE - The damage tick rate on Big Chubby has been increased
  • This build: A familiar that follows Isaac and charges forwards very slowly, dealing 2.7 damage per tick to any enemies it comes into contact with.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: charger
  • Familiar Dmg: 2.7
  • Familiar Charge Speed: 110
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Plan CID 475 · Quality 0 · ActivePlayable
Drop poolsShop, Devil Room, Curse Room, Red Chest, Demon Beggar
No direct change.
  • Upon use, this item deals 9,999,999 damage to all enemies in the room and then kills you 3 seconds later
  • This is a single use active item, meaning it is destroyed after using it
  • Does not kill both phases of multi-phase bosses like Hush or Ultra Greed
  • If used to kill a boss, the kill still counts as a victory for post-it note completion marks, but the run will still get a game over
  • Delirium's death animation takes longer than 3 seconds, meaning you will die before it can count as a completion mark. One exception to this is if you are playing as Lazarus or have Lazarus' Rags - you will respawn in the same room and get the kill
  • Plan C is 5 times rarer than other items in the same item pool, making it less likely to appear
  • Recharge Time: One time use
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Plan C
  • This build: Upon use, this item deals 9,999,999 damage to all enemies in the room and then kills you 3 seconds later. This is a single use active item, meaning it is destroyed after using it.
D1ID 476 · Quality 2 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, the D1 duplicates 1 random pickup in the current room. This works with all normal pickups, including cards, runes, chests and trinkets. Duplicated items might not be identical copies of the original - for example duplicating a card may spawn a different card
  • Jera runes and trinkets cannot be duplicated using the D1
  • Duplicated chests can turn into another kind of chest randomly (e.g. Red chests)
  • Can be used in a shop to duplicate pickups which have not yet been purchased, and take the duplicate pickup for free
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: D1
  • This build: When used, the D1 duplicates 1 random pickup in the current room. This works with all normal pickups, including cards, runes, chests and trinkets. Duplicated items might not be identical copies of the original - for example duplicating a card may spawn a different card.
VoidID 477 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsDevil Room, Angel Room
No direct change.
  • When used, Void will consume any pedestal items in the current room
  • If an active item is consumed, its effect will be added to Void's effect when used, allowing you to consume multiple items and combine their effects
  • If a passive item is consumed, you gain a small stat upgrade to a random stat
  • Possible stat changes include: +1.0 flat damage, +0.5 tears, +0.2 speed, +0.2 shot speed, +0.5 range, +1.0 luck
  • Void does not work on devil deal or shop items unless they have been bought first
  • Using Void to absorb items in Boss Rush or Challenge Rooms counts as taking the items and will cause the encounter to start
  • Using Void on one time use items such as Mama Mega or Diplopia will cause their effect to instantly trigger and will not give you further uses through activating Void again
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Void
  • This build: When used, Void will consume any pedestal items in the current room.
PauseID 478 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Upon use, this item freezes all enemies in the room until you press the fire button again or 30 seconds passes (whichever happens first)
  • Unlike other active items, bosses are not immune to this effect
  • Touching a frozen enemy will still hurt you
  • This item doesn not affect troll bombs - they will still explode
  • Recharge Time: 2 rooms
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 5
  • Name: Pause
  • This build: Upon use, this item freezes all enemies in the room until you press the fire button again or 30 seconds passes (whichever happens first).
SmelterID 479 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Upon use, the Smelter will destroy your currently held trinket and give you the effect permanently, allowing you to stack up lots of different trinket effects
  • Holding the Smelter increases the chance for a trinket to drop. (2% chance for the end of room drop to become a trinket)
  • If a trinket has been smelted, it won't appear a second time unless the entire trinket pool is exhausted or you restart the run (e.g. by doing a victory lap)
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Smelter
  • This build: Upon use, the Smelter will destroy your currently held trinket and give you the effect permanently, allowing you to stack up lots of different trinket effects.
CompostID 480 · Quality 1 · ActivePlayable
Drop poolsShop
No direct change.
  • When used, Compost doubles up the current number of blue flies and spiders you have
  • When picked up, Compost will also destroy every consumable on the ground in the current room and turn each of them into a blue fly or blue spider
  • If you have no pickups on the ground in the current room and no other flies or spiders, Compost will spawn 1 blue fly or blue spider
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Compost
  • This build: When used, Compost doubles up the current number of blue flies and spiders you have.
DataminerID 481 · Quality 0 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, this item will distort all the sprites and music, rotating graphics 90 degrees and translating them diagonally up/left, while leaving the hitbox in the same place. This can make it confusing while navigating the room
  • Enemy hitboxes remain the same
  • Dataminer will randomly increase or decrease one of your stats by a small amount when used
  • Gives you the Fruit Cake effect for the room when used, which will give a random tear effect with every tear fired
  • All visual and tear effects reset after leaving the room
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Dataminer
  • This build: When used, this item will distort all the sprites and music, rotating graphics 90 degrees and translating them diagonally up/left, while leaving the hitbox in the same place. This can make it confusing while navigating the room.
ClickerID 482 · Quality 0 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, this item will randomly change you into another character and remove the last item you picked up
  • All stat changes of the new character are applied (e.g. character damage multipliers)
  • This item can only reduce your heart containers and will not increase them if you change back into a character with more health. This means if you roll into The Lost, changing back to another character will leave you with only 1/2 of a soul heart
  • Cannot turn you into a character that isn't unlocked yet
  • Also includes Lazarus II (Lazarus' revived form) and Dark Judas (effect of Judas' Shadow)
  • It's also possible that this item will pick the same character, making it seem like nothing happened
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Clicker
  • This build: When used, this item will randomly change you into another character and remove the last item you picked up. All stat changes of the new character are applied (e.g. character damage multipliers).
MaMa Mega!ID 483 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsShop, Bomb Beggar
No direct change.
  • A one time use item that when used will explode all objects (i.e. rocks, poop) in the room and deal 200 damage to all enemies in the current room, as well as every other room for the remainder of the floor
  • Also opens the boss rush door after Mom's Foot, blue womb door after Mom's Heart, secret rooms and super secret rooms
  • Like all single-use items, this item cannot be absorbed and used multiple times by the Void item
  • Entering a room with an angel statue will destroy it and automatically spawn one of the Angel mini bosses
  • REPENTANCE - This now blows up machines, beggars and fireplaces too
  • Recharge Time: One time use
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: MaMa Mega!
  • This build: A one time use item that when used will explode all objects (i.e. rocks, poop) in the room and deal 200 damage to all enemies in the current room, as well as every other room for the remainder of the floor.
Wait What?ID 484 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Upon use, this item will fart, pushing enemies away and causing a wave of rocks to spawn that spread outwards from Isaac in a circle, dealing 10 damage per hit to any enemies caught in it
  • Can be used to open secret rooms
  • Visually this item is very similar to Butter Bean
  • The rock waves can destroy destructible objects, e.g. poop
  • Recharge Time: 10 seconds
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 10
  • Name: Wait What?
  • This build: Upon use, this item will fart, pushing enemies away and causing a wave of rocks to spawn that spread outwards from Isaac in a circle, dealing 10 damage per hit to any enemies caught in it.
Crooked PennyID 485 · Quality 2 · ActivePlayable
Drop poolsItem Room, Shop, Beggar
No direct change.
  • When used, you have a 50% chance to double all items, consumables and chests in the current room
  • If the effect fails, all pickups and items are deleted and Crooked Penny spawns 1 coin
  • If there are no consumables currently on the floor, Crooked Penny spawns 1 coin
  • This item works with items which can be purchased such as shop items, allowing you to spawn a free version if the effect triggers
  • If used in a shop and the effect fails, a Restock box can be used to restore the shop items. This mechanic is very useful on Greed and Greedier modes
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Crooked Penny
  • This build: When used, you have a 50% chance to double all items, consumables and chests in the current room. If the effect fails, all pickups and items are deleted and Crooked Penny spawns 1 coin.
Dull RazorID 486 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Upon use this item hurts Isaac without actually taking health away, allowing you to activate any items which trigger when taking damage without losing health
  • Recharge Time: 2 rooms
  • Not in random drops: Not all existing on-damage item hooks are triggered.
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Dull Razor
  • This build: Upon use this item hurts Isaac without actually taking health away, allowing you to activate any items which trigger when taking damage without losing health.
Potato PeelerID 487 · Quality 2 · ActivePlayable
Drop poolsShop, Demon Beggar
No direct change.
  • When used, this item permanently removes one of your red heart containers and gives you a flat +0.2 Damage Up, the Anemic effect (+1.5 Range Up + red creep trail) and a Cube of Meat
  • The Anemic effect will only last for the current room, but the Cube of Meat and Damage Up are both permanent
  • Only works for red hearts and has no effect when used if you only have soul/black hearts
  • Has no recharge time and can be used as often as you like
  • It is possible to generate multiple meatboys by stacking more than 4 Cubes of Meat
  • Recharge Time: None
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Potato Peeler
  • This build: When used, this item permanently removes one of your red heart containers and gives you a flat +0.2 Damage Up, the Anemic effect (+1.5 Range Up + red creep trail) and a Cube of Meat.
MetronomeID 488 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, this item gives you the effect of a random item for the rest of the room
  • Using this item multiple times in the same room will replace the previous item's effect with a new one
  • Certain items can be activated with this item which have unexpected effects and many items will do nothing
  • Items do not grant consumable drops which would normally occur when that item is picked up
  • Most flight-granting items have cosmetic effects only, and will not allow you to fly
  • Items that usually give HP up will not give extra health when gained from Metronome
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Metronome
  • This build: When used, this item gives you the effect of a random item for the rest of the room. Using this item multiple times in the same room will replace the previous item's effect with a new one.
D InfinityID 489 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • This dice allows you to press the Drop key to cycle between all possible dice effects and pick one to use
  • Charge time scales based on the chosen dice, updating every time you use it
  • Possible dice include: D1, D4, D6, D8, D10, D12, D20, D100
  • REPENTANCE - This item was completely reworked for Repentance and no longer forces a random dice use each time. You can pick which dice you want to use.
  • Recharge Time: Varies
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Variable Pending: true
  • Name: D Infinity
  • This build: This dice allows you to press the Drop key to cycle between all possible dice effects and pick one to use. Charge time scales based on the chosen dice, updating every time you use it.
Eden's SoulID 490 · Quality 3 · ActivePlayable
Drop poolsAngel Room
No direct change.
  • A one time use active item that when used, will spawn 2 random item pedestals from the item pool associated with the current room (e.g. in an Angel room, this will spawn 2 Angel room items)
  • Starts with 0 charge and requires 12 charges to use
  • Recharge Time: 12 rooms (one time use)
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Initial: 0
  • Name: Eden's Soul
  • This build: A one time use active item that when used, will spawn 2 random item pedestals from the item pool associated with the current room (e.g. in an Angel room, this will spawn 2 Angel room items).
Acid BabyID 491 · Quality 2 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • Every 6-7 rooms Acid Baby will drop a random pill
  • The first pill drops after 2 rooms
  • Every time you use a pill, Acid Baby will deal 10 damage to all enemies and poison them for 6-7 ticks
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • REPENTANCE - Poison effect is stronger, but Acid Baby's pill drop rate has been reduced to every 6-7 rooms (previously every 2-3 rooms)
  • This build: Every 6-7 rooms Acid Baby will drop a random pill. The first pill drops after 2 rooms. Every time you use a pill, Acid Baby will deal 10 damage to all enemies and poison them for 6-7 ticks.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: acid
  • Familiar First: 2
  • Familiar Every: 6 / 7
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
YO LISTEN!ID 492 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Key Beggar
No direct change.
  • +1 Luck Up
  • A familiar fairy that will float around the room and highlight the location of any secret room doors, tinted rocks or trapdoors under rocks
  • Upon entering a new room, if there is an undiscovered secret room or tinted rock, it will move directly to the point of interest, otherwise it will just randomly fly around the room
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1 Luck Up. A familiar fairy that will float around the room and highlight the location of any secret room doors, tinted rocks or trapdoors under rocks.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
AdrenalineID 493 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Demon Beggar
No direct change.
  • For every empty red heart container, Isaac gains Damage Up and his body increases in size
  • Only works on full hearts - damage does not change if Isaac is missing 1/2 of a heart in one container
  • Healing empty red heart containers will remove the damage increases
  • Has no effect for The Lost and ???, as they cannot gain red heart containers (except for counting towards the Spun transformation)
  • Counts as 1 of 3 syringe items needed towards the Spun transformation
  • REPENTANCE - Adrenaline now grants an increasingly higher damage bonus the more empty heart containers Isaac has
  • Not in random drops: Its original ability is not implemented yet.
  • This build: For every empty red heart container, Isaac gains Damage Up and his body increases in size. Only works on full hearts - damage does not change if Isaac is missing 1/2 of a heart in one container.
  • Reference transformation families: Spun. Set bonuses and costumes remain a separate unfinished overhaul.
Jacob's LadderID 494 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Isaac gains electric tears, which fire 1-2 sparks of electricty in random directions upon hitting any object or enemy
  • The electricity will chain between nearby enemies
  • The electricty deals half of your normal tear damage
  • Tear effects will still apply to your electricty sparks in a lot of cases. Spoon Bender will give them a homing effect, and status effects like fear/poison will spread onto all enemies the electricity chains to
  • Tears which fall naturally to the floor at max range do not generate sparks
  • It's possible to fire tears at a wall to create electricity that damages enemies on the other side of the wall
  • This build: Hits release electricity that chains for half tear damage.
Ghost PepperID 495 · Quality 4 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Each tear now has a small chance to be a spectral blue flame instead, which deals damage to enemies that come in contact with it
  • The fire will remain in place and shrink in size when deals damage to something. After dealing enough damage it will eventually disappear
  • At full size the flame deals 6x your tear damage, scaling down to 3x at its smallest size
  • The chance to for each tear to become a flame is affected by your luck stat and at +10 Luck it will activate 50% of the time (starts at 8.33% at +0 Luck)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Each tear now has a small chance to be a spectral blue flame instead, which deals damage to enemies that come in contact with it.
EuthanasiaID 496 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Curse Room, Demon Beggar
No direct change.
  • Each tear now has a small chance (3.33%) to be a needle instead, which deals 3 times your tear damage
  • If a needle hits a non-boss enemy it will instantly kill it and will explode into a circle of 10 more needles
  • The 10 spawned needles will also deal 3 times your tear damage, but won't instantly kill enemies or explode into more needles
  • The chance to for each tear to become a needle is affected by your luck stat and at +15 Luck it will activate 50% of the time
  • Counts as 1 of 3 syringe items needed towards the Spun transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Each tear now has a small chance (3.33%) to be a needle instead, which deals 3 times your tear damage.
  • Reference transformation families: Spun. Set bonuses and costumes remain a separate unfinished overhaul.
Camo UndiesID 497 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Upon entering a new room, Isaac will become camouflaged and enemies won't attack until you start firing tears
  • Bosses are immune to this effect
  • Camo Undies grants +0.5 speed while cloaked
  • When uncloaking, all nearby enemies take damage, and Isaac gains a brief tears + damage up
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Upon entering a new room, Isaac will become camouflaged and enemies won't attack until you start firing tears. Bosses are immune to this effect. Camo Undies grants +0.5 speed while cloaked.
DualityID 498 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Angel Room
No direct change.
  • Any time a devil or angel room door opens after a boss, the other one will also spawn
  • The extra door will only spawn if a devil or angel room was randomly chosen to spawn already
  • After entering one of the doors, the other will disappear
  • If there isn't an available wall for the extra door to spawn on, only one door will spawn (i.e. in a small boss room)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Any time a devil or angel room door opens after a boss, the other one will also spawn. The extra door will only spawn if a devil or angel room was randomly chosen to spawn already.
EucharistID 499 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Gives you a 100% chance to find an Angel Room on every valid floor after defeating the boss
  • Doesn't spawn an angel room on any floor where it is normally not possible to find one (e.g. Basement 1, Cathedral, Sheol etc.)
  • Keeps the chance at 100% even after entering and leaving the angel room, meaning the door will not close after visiting
  • Makes it impossible to find Devil Rooms again, unless you find a way to remove or reroll this item away, or find the Duality item
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a 100% chance to find an Angel Room on every valid floor after defeating the boss.
Sack of SacksID 500 · Quality 3 · Passive, FamiliarNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • A sack familiar that drops a sack every 5 or 6 rooms cleared (alternates between 5 and 6)
  • Not in random drops: Drops consumables directly instead of an interactive sack.
  • This build: A sack familiar that drops a sack every 5 or 6 rooms cleared (alternates between 5 and 6).
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: dropper
  • Familiar Every: 5 / 6
  • Familiar Alternate: true
  • Familiar Drop: grabBag
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Greed's GulletID 501 · Quality 1 · PassivePlayable
Drop poolsSecret Room
No direct change.
  • Gives you an extra heart container for every 25 coins you are currently holding, up to a maximum of 4 extra HP at 99 coins held
  • If your coin counter goes below the required amount for a heart container, you will lose it again
  • This item works for the Keeper, allowing him to exceed his usual 2 health containers
  • However, if Keeper drops to under 2 health coins as a result of Greed's Gullet, he is unable to use a HP Up to increase his health back to 2, and has to regain the lost coins to do so
  • This build: greedsGullet.
Large ZitID 502 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives you a random chance while firing tears to also fire a creep shot, which deals double your tear damage and places white creep on the floor infront of you that slows enemies down if they walk through it
  • Unlike some similar tear effects, your luck stat does not alter the chance for this effect to activate
  • A creep shot is also fired in a random direction after taking damage
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a random chance while firing tears to also fire a creep shot, which deals double your tear damage and places white creep on the floor infront of you that slows enemies down if they walk through it.
Little HornID 503 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room, Demon Beggar
No direct change.
  • While firing tears you have a 5% chance to fire a void tear. Void tears that touch enemies will spawn Big Horn, who appears and grabs them, instantly killing that enemy
  • The chance to for each tear to become a void tear is affected by your luck stat and at +15 Luck it will activate 20% of the time
  • Isaac also grows a horn on his head, which causes you to deal contact damage to enemies by running into them (this effect deals base damage of 3.5 per tick)
  • Void tears from this item can also destroy blue/purple fires, spiked blocks and stone grimaces
  • Not in random drops: Its original ability is not implemented yet.
  • This build: While firing tears you have a 5% chance to fire a void tear. Void tears that touch enemies will spawn Big Horn, who appears and grabs them, instantly killing that enemy.
Brown NuggetID 504 · Quality 0 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, will spawn a fly turret that doesn't move and fires tears at nearby enemies
  • Only persists for the current room
  • The fly's bullets deal 3.5 damage each and do not scale with your own damage stat
  • REPENTANCE - Brown Nugget flies now have faster shot speed, and their damage has been increased to 3.5 (from 2).
  • Recharge Time: 7 seconds
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 7
  • Name: Brown Nugget
  • This build: When used, will spawn a fly turret that doesn't move and fires tears at nearby enemies. Only persists for the current room.
Poke GoID 505 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • At the start of each new hostile room, you have a 20% chance to gain a random charmed familiar which will fight for you
  • The charmed enemy has its own health bar and will die if it takes enough damage
  • Charmed enemies persist between each room and floor for as long as they stay alive
  • Allows you to have more than one charmed familiar at a time if you can keep them alive
  • Not in random drops: Its original ability is not implemented yet.
  • This build: At the start of each new hostile room, you have a 20% chance to gain a random charmed familiar which will fight for you.
BackStabberID 506 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Devil Room
No direct change.
  • Every time one of your tears hits an enemy, it has a chance to start bleeding, which will cause it to take damage every 5 seconds
  • The bleed damage dealt by BackStabber is based on how quickly an enemy is moving (faster enemies take more damage)
  • Damaging enemies from behind gives the bleed effect a 100% chance to apply
  • While an enemy bleeds, they leave behind creep that damages other enemies
  • The tear that inflicts the bleed effect also deals double damage
  • The bleed effect cannot be applied to immune enemies (e.g. bosses and mini bosses)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Every time one of your tears hits an enemy, it has a chance to start bleeding, which will cause it to take damage every 5 seconds.
Sharp StrawID 507 · Quality 2 · ActivePlayable
Drop poolsItem Room
No direct change.
  • When used, Sharp Straw will deal damage to all enemies in the room
  • The damage dealt is equal to Isaac's current tear damage plus 10% of the enemy's max health
  • Every time this item deals damage, it has a 15% chance to drop 1/2 red hearts
  • REPENTANCE - Sharp Straw is now only able to generate half red hearts (previously, it generated half soul hearts if the player had no heart containers)
  • Recharge Time: 8 seconds
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 8
  • Name: Sharp Straw
  • This build: When used, Sharp Straw will deal damage to all enemies in the room. The damage dealt is equal to Isaac's current tear damage plus 10% of the enemy's max health.
Mom's RazorID 508 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Mom's Chest
No direct change.
  • A razor blade orbital that deals contact damage and applies the bleeding status effect to enemies and bosses, which will cause them to take damage every 5 seconds
  • The contact damage dealt by Mom's Razor is based on how quickly an enemy is moving (faster enemies take more damage)
  • While an enemy bleeds, they leave behind creep that damages other enemies
  • This item DOES block enemy shots
  • Its speed is not affected by the Guardian Angel item
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A razor blade orbital that deals contact damage and applies the bleeding status effect to enemies and bosses, which will cause them to take damage every 5 seconds.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
Bloodshot EyeID 509 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • An eye orbital that shoots tears that deal 3.5 damage and deals 2 contact damage per tick to enemies
  • The damage dealt by this orbital does not scale with damage upgrades
  • Its speed is not affected by the Guardian Angel item
  • REPENTANCE - Bloodshot Eye now blocks enemy shots, has increased shot speed and rate of fire, and now only shoots when lined up with enemies
  • This build: An eye orbital that shoots tears that deal 3.5 damage and deals 2 contact damage per tick to enemies. The damage dealt by this orbital does not scale with damage upgrades.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 2
  • Familiar Radius: 58
  • Familiar Speed: 2
  • Familiar Block: true
  • Familiar No Boost: true
  • Familiar Eye: [object Object]
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
DeliriousID 510 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • When used, spawns a charmed random white delirium version of a boss, that will fight for you and kill other enemies for the rest of the current room
  • Possible bosses spawned include most bosses in the game
  • Some bosses' effects can harm Isaac. For example if the spawned boss leaves creep, it can damage Isaac
  • Recharge Time: 12 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Delirious
  • This build: When used, spawns a charmed random white delirium version of a boss, that will fight for you and kill other enemies for the rest of the current room.
Angry FlyID 511 · Quality 1 · Passive, FamiliarPlayable
Drop poolsItem Room
No direct change.
  • A familiar fly that orbits around a random enemy in the room until that enemy dies, dealing 2 contact damage to other enemies
  • Angry Fly will move to the next enemy after the one it is currently orbiting dies, until the room is cleared, at which point it will return to orbiting Isaac
  • Added as part of the Afterbirth+ Booster Pack #1 and based on the Steam Workshop mod created by Custom Phase
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: A familiar fly that orbits around a random enemy in the room until that enemy dies, dealing 2 contact damage to other enemies.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: angry
  • Familiar Dmg: 2
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Black HoleID 512 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A throwable active item that places a black hole on the ground where it lands, sucking all enemies into it for 6 seconds
  • Enemies stuck inside the black hole take rapid damage over time
  • The Black Hole will also suck Isaac into it, but with a much weaker effect than to enemies
  • The Black Hole will destroy nearby obstacles such as rocks and pots
  • Added as part of the Afterbirth+ Booster Pack #1 and based on the Steam Workshop mod created by Custom Phase
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Black Hole
  • This build: A throwable active item that places a black hole on the ground where it lands, sucking all enemies into it for 6 seconds. Enemies stuck inside the black hole take rapid damage over time.
BozoID 513 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +0.1 Damage Up
  • +1 Soul Heart
  • Adds a random chance for an enemy in the current room to become charmed or feared briefly
  • Adds a random chance to spawn a rainbow poop upon taking damage
  • Added as part of the Afterbirth+ Booster Pack #1 and based on the Steam Workshop mod created by Electoon
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +0.1 Damage Up. +1 Soul Heart. Adds a random chance for an enemy in the current room to become charmed or feared briefly. Adds a random chance to spawn a rainbow poop upon taking damage.
Broken ModemID 514 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Causes random enemies to 'lag' at random intervals, causing them to freeze in place for a second
  • The lag effect can also apply to tears, projectiles and consumables on the ground
  • While held, this item has a 25% chance to double up any end of room drops (similar to the Contract from Below effect)
  • Isaac's Luck stat affects how often the lag effect occurs
  • Added as part of the Afterbirth+ Booster Pack #1 and based on the Steam Workshop mod created by Freezenification
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Causes random enemies to 'lag' at random intervals, causing them to freeze in place for a second. The lag effect can also apply to tears, projectiles and consumables on the ground.
Mystery GiftID 515 · Quality 3 · ActivePlayable
Drop poolsShop
No direct change.
  • A one-time use item that spawns a random item from the current room's item pool, with a chance for it to spawn Lump of Coal or The Poop instead
  • Added as part of the Afterbirth+ Booster Pack #1 and based on the Steam Workshop mod created by Mills
  • Recharge Time: One time use
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Mystery Gift
  • This build: A one-time use item that spawns a random item from the current room's item pool, with a chance for it to spawn Lump of Coal or The Poop instead.
SprinklerID 516 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, spawns a Sprinkler that rotates in a circle, spraying tears in all directions
  • Will also synergize with some other items, such as Mom's Eye, Brimstone, Dr. Fetus, Tech X or Loki's Horns
  • Added as part of the Afterbirth+ Booster Pack #1 and based on the Steam Workshop mod created by Kieran and Stewartisme
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Sprinkler
  • This build: When used, spawns a Sprinkler that rotates in a circle, spraying tears in all directions. Will also synergize with some other items, such as Mom's Eye, Brimstone, Dr. Fetus, Tech X or Loki's Horns.
Fast BombsID 517 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +7 Bombs
  • Allows you to rapidly place bombs on the ground
  • Added as part of the Afterbirth+ Booster Pack #1
  • REPENTANCE - Bombs no longer knock each other around when the player has Fast Bombs, allowing for a more controlled line of explosions.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +7 Bombs. Allows you to rapidly place bombs on the ground. Added as part of the Afterbirth+ Booster Pack #1.
Buddy in a BoxID 518 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsShop
No direct change.
  • When picked up, gives Isaac a random familiar which has a random sprite and tear effect
  • The familiar will be fully randomized again upon entering the next floor
  • The appearance is chosen from a random co-op baby sprite
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Added as part of the Afterbirth+ Booster Pack #1 and based on the Steam Workshop mod created by Ashkait and Scayze
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When picked up, gives Isaac a random familiar which has a random sprite and tear effect. The familiar will be fully randomized again upon entering the next floor.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Lil DeliriumID 519 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsAngel Room, Devil Room
No direct change.
  • A familiar that will transform into another random familiar every 10 seconds, copying their behaviour and effect
  • Can be any other familiar, including (but not limited to) Lil Brimstone, Bob's Brain, BBF, Meatboy, Rotten Baby
  • Familiars appear as a white Delirium version of the original
  • Added as part of the Afterbirth+ Booster Pack #1 and based on the Steam Workshop mod created by Ashkait and Scayze
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar that will transform into another random familiar every 10 seconds, copying their behaviour and effect.
Jumper CablesID 520 · Quality 3 · PassivePlayable
Drop poolsGreed Mode Item Room, Shop
No direct change.
  • This item gives you 1 bar of charge on your active item for every 15 enemies you kill
  • Added as part of the Afterbirth+ Booster Pack #2 and based on the Steam Workshop mod created by Ashkait and Scayze
  • This build: jumperCables.
CouponID 521 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem room, Shop, Beggar
No direct change.
  • When used, the coupon causes one random item in the shop to become free
  • While held, guarantees a random item or pickup from the shop to be half price
  • The effect of this item also works in Devil Rooms, allowing you to take one random item for free
  • Added as part of the Afterbirth+ Booster Pack #2 and based on the Steam Workshop mod created by Plumbo
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Coupon
  • This build: When used, the coupon causes one random item in the shop to become free. While held, guarantees a random item or pickup from the shop to be half price.
TelekinesisID 522 · Quality 1 · ActivePlayable
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • An active that causes all enemy tears to be held in place and then thrown back away from Isaac for a period of 3 seconds
  • The aura from this item will repel nearby enemies
  • Added as part of the Afterbirth+ Booster Pack #2
  • Recharge Time: 6 seconds
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 6
  • Name: Telekinesis
  • This build: An active that causes all enemy tears to be held in place and then thrown back away from Isaac for a period of 3 seconds. The aura from this item will repel nearby enemies.
Moving BoxID 523 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • When used, the box will pick up a maximum of 6 items. Using the box again will put the picked up items back on the floor again, allowing you to move things between rooms
  • Can move any of the following: Batteries, Items, Trinkets, Hearts, Keys, Bombs, Coins, Chests and more
  • Using Moving Box with Car Battery will trigger 2 interactions at the same time: First it will drop all items currently inside the box and secondly will then pick up the current room's contents
  • When used in a room with 2 items you can choose from (e.g. There's Options, Double item room, Boss Rush) the Moving Box will pick only one of the items at random
  • Added as part of the Afterbirth+ Booster Pack #2 and based on the Steam Workshop mod created by HurleyFarrill
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Moving Box
  • This build: When used, the box will pick up a maximum of 6 items. Using the box again will put the picked up items back on the floor again, allowing you to move things between rooms.
Technology ZeroID 524 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Your tears will now be connected together by beams of electricity which deals damage to enemies they hit
  • The lasers from this item deal 30% of your current damage stat
  • Added as part of the Afterbirth+ Booster Pack #2 and based on the Steam Workshop mod created by Ashkait and Scayze
  • REPENTANCE - Technology Zero's lasers now deal 30% of the player's damage stat per tick (from 100%)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Your tears will now be connected together by beams of electricity which deals damage to enemies they hit. The lasers from this item deal 30% of your current damage stat.
LeprosyID 525 · Quality 1 · PassivePlayable
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Taking damage will spawn an orbital that rotates around Isaac, dealing contact damage to enemies and blocking enemy projectiles
  • A maximum of 3 Leprocy orbitals can be active at one time
  • Using the orbital to deal damage to enemies can cause it to break
  • Added as part of the Afterbirth+ Booster Pack #2. Based loosely on the Steam Workshop mod created by Extreme Ninja Home Makeover with changes by Edmund McMillen
  • This build: Taking damage will spawn an orbital that rotates around Isaac, dealing contact damage to enemies and blocking enemy projectiles. A maximum of 3 Leprocy orbitals can be active at one time.
7 SealsID 526 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Angel Room
No direct change.
  • Gives you a random Harbinger familiar that changes every 10 seconds
  • Each harbinger behaves differently, based on any of the original 5 horsemen bosses
  • REPENTANCE - The harbingers will also randomly spawn their relevant Locust variant. The locust fly will do different things for each harbinger - e.g. poison effect for Pestilence
  • Added as part of the Afterbirth+ Booster Pack #3. Based on the Steam Workshop mod created by by Scayze and Ashkait
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a random Harbinger familiar that changes every 10 seconds. Each harbinger behaves differently, based on any of the original 5 horsemen bosses.
Mr. ME!ID 527 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsShop, Key Beggar
No direct change.
  • Upon use, this item summons a ghost near Isaac that will follow him around. Also summons a blue crosshair which can be moved around freely. After a few seconds, the crosshair will disappear, and the Ghost will do certain things based on what you targeted:
  • Items, pickups, trinkets: Brings them to Isaac. Works in shops and devil deals as well, allowing you to take them for no cost. Stealing an item has a chance to fail (a buzzer sound will play if it fails)
  • Buttons: Presses the button
  • Enemies: Attacks the enemy until either the ghost or the enemy dies
  • Doors: Opens the door, even if it is locked
  • Secret room entrances: Explodes and opens the entrance
  • Boss rush door: Will open the Boss Rush door from either side, allowing you get into and escape the Boss Rush
  • Slot machines, dead shopkeepers: Charges towards them and explodes them
  • Added as part of the Afterbirth+ Booster Pack #3. Based on the Steam Workshop mod created by Jean-Alphonse
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mr. ME!
  • This build: Upon use, this item summons a ghost near Isaac that will follow him around. Also summons a blue crosshair which can be moved around freely. After a few seconds, the crosshair will disappear, and the Ghost will do certain things based on what you targeted:.
Angelic PrismID 528 · Quality 3 · Passive, OrbitalNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Grants a prism orbital with a large orbital radius
  • Isaac's tears that pass through the prism split into four multi-colored tears
  • Does not deal contact damage to enemies that it passes over
  • Added as part of the Afterbirth+ Booster Pack #3. Based on the Steam Workshop mod created by electoon and Erfly
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Grants a prism orbital with a large orbital radius. Isaac's tears that pass through the prism split into four multi-colored tears. Does not deal contact damage to enemies that it passes over.
Pop!ID 529 · Quality 1 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Replaces Isaac's tears with eyeballs that can bounce off of each other
  • Issac's tears are no longer limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle
  • Added as part of the Afterbirth+ Booster Pack #3. Based on the Steam Workshop mod created by Scayze and Ashkait
  • This build: Floating eyeballs collide with each other and vanish when they stop.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
Death's ListID 530 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Upon entering a room, a skull appears over a random enemy's head
  • Killing the marked enemy will cause the skull to move to a different enemy
  • If all enemies in the room are cleared in the order they are marked, Isaac gains a random reward from one of the following: Soul heart, Key, Pill, Bomb, Nickel, +0.2 Speed, +0.5 Range, +0.5 Tears, +1 Flat damage or +1 luck
  • Killing enemies in the wrong order will end the streak and deny you any extra rewards
  • Added as part of the Afterbirth+ Booster Pack #4. Based on the Steam Workshop mod created by Merlo
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Upon entering a room, a skull appears over a random enemy's head. Killing the marked enemy will cause the skull to move to a different enemy.
HaemolacriaID 531 · Quality 4 · PassivePlayable
Drop poolsItem Room
No direct change.
  • With Haemolacria, Isaac's tears become bloody and now fire by in the air in an arc
  • Upon hitting the floor, an obstacle or enemy, the bloody tear will burst and fire lots of smaller tears at random directions around the impact point
  • Tears Down - (Tear delay * 2) + 10
  • Your damage stat is unaffected by this item, however the large bloody tear does +31% of your tear damage and the smaller scattering tears deal 50-80% of your tear damage
  • Added as part of the Afterbirth+ Booster Pack #4. Based on the Steam Workshop mod (originally called Water Balloon) created by HiHowAreYou
  • Fire-delay frames multiplied by 2, then 10 frames added.
  • This build: Arcing blood tears deal 131% damage and scatter smaller tears.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
LachryphagyID 532 · Quality 2 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Isaac's tears slow down over time while moving across the room, and upon stopping completely or hitting an object will burst into 8 smaller tears which fire in all directions
  • This item will also allow you to 'feed' a tear with other tears. Doing so will cause it to increase in size, and also increase their damage and the damage of the burst tears
  • Once a tear is fed 5 times, it will immediately burst
  • Tears in the burst will deal half the damage the main tear would have
  • Tears which hit an enemy do not burst
  • Added as part of the Afterbirth+ Booster Pack #4. Based on the Steam Workshop mod (originally called Hungry Tears) created by Echo
  • This build: Tears absorb others and burst into eight half-damage tears.
TrisagionID 533 · Quality 3 · PassivePlayable
Drop poolsAngel Room
No direct change.
  • Isaac's tears are replaced with piercing holy flashes of light, which travel across the room in a similar speed to regular tears
  • Trisagion tears deal roughly 33% of your usual tear damage, however due to the size of the holy flash it is likely to hit enemies multiple times
  • Trisagion tears cause no knockback on enemies and simply travel through them (piercing tears)
  • Added as part of the Afterbirth+ Booster Pack #4. Based on the Steam Workshop mod (originally called Lightshot) created by Wyvern and TRPG
  • Piercing
  • This build: Tears pass through enemies. Piercing light deals one-third damage repeatedly.
SchoolbagID 534 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop, Gold/Stone Chest
No direct change.
  • Gives you an extra active item slot
  • Pressing the CTRL key (R2 on PS4, RT on XB1, ZR on Switch) allows you to switch active items
  • Some items that give temporary effects like The Nail might deactivate if switched to the other slot
  • Added as part of the Afterbirth+ Booster Pack #4
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you an extra active item slot. Pressing the CTRL key (R2 on PS4, RT on XB1, ZR on Switch) allows you to switch active items.
BlanketID 535 · Quality 2 · PassivePlayable
Drop poolsShop
  • +1 Soul hearts
  • +1 Soul Heart
  • Heals 1 red heart when picked up
  • Grants you a shield when entering the Boss Room, which prevents damage from 1 hit, then disappears. This shield stacks with Holy Mantle, giving you 2 free hits
  • Added as part of the Afterbirth+ Booster Pack #5. Based on the Steam Workshop mod created by Ratlah
  • This build: +1 soul hearts. blanket.
Sacrificial AltarID 536 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room
No direct change.
  • When used, this item will sacrifice up to 2 of your familiars (chosen at random), and spawn a random Devil Room item for each familar sacrificed this way
  • In addition to the familiars, any blue flies or spiders will be converted to 1 coin each
  • If Guardian Angel, Sworn Protector, or Seraphim is sacrificed, Satan will be extra happy and reward you with 2 black hearts
  • Incubus won't be sacrificed if you're playing as Lilith
  • If used while you have no familiar, this item will do nothing and won't consume the item
  • Added as part of the Afterbirth+ Booster Pack #5. Based on the Steam Workshop mod created by Niro
  • Recharge Time: Single use
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: once; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Sacrificial Altar
  • This build: When used, this item will sacrifice up to 2 of your familiars (chosen at random), and spawn a random Devil Room item for each familar sacrificed this way.
Lil SpewerID 537 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • A familiar with a charged attack, that spawns a line of creep on the floor which damages enemies that walk over it
  • Spawns 1 random pill when picked up
  • The familiar and its creep will change randomly when Isaac uses a pill
  • Possible creep types include green (deals damage), black (slows enemies), red (deals damage, forms a line with a larger puddle), yellow (deals damage, forms a short-range cone) and white (slows enemies, forms a ring)
  • Added as part of the Afterbirth+ Booster Pack #5. Based on the Steam Workshop mod created by Strawrat and Aczom
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar with a charged attack, that spawns a line of creep on the floor which damages enemies that walk over it. Spawns 1 random pill when picked up.
MarblesID 538 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsBoss Room
No direct change.
  • Spawns 3 random trinkets when picked up
  • Upon taking damage, you have a random chance to consume one of your currently held trinkets, gaining its effect permanently
  • Added as part of the Afterbirth+ Booster Pack #5. Based on the Steam Workshop mod created by Amethyst
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns 3 random trinkets when picked up. Upon taking damage, you have a random chance to consume one of your currently held trinkets, gaining its effect permanently.
Mystery EggID 539 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar which follows Isaac and, upon taking damage, will spawn a charmed enemy that will fight for you
  • When the charmed enemy is spawned the egg will crack, but regenerate in the next room
  • Added as part of the Afterbirth+ Booster Pack #5. Based on the Steam Workshop mod created by Strawrat and Aczom
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar which follows Isaac and, upon taking damage, will spawn a charmed enemy that will fight for you. When the charmed enemy is spawned the egg will crack, but regenerate in the next room.
Flat StoneID 540 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Flat Stone causes your tears to bounce across the room
  • Whenever a tear bounces, it deals splash damage to nearby enemies for 25% of your tear damage
  • Added as part of the Afterbirth+ Booster Pack #5. Based on the Steam Workshop mod created by Maddogs
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Flat Stone causes your tears to bounce across the room. Whenever a tear bounces, it deals splash damage to nearby enemies for 25% of your tear damage.
MarrowID 541 · Quality 1 · PassivePlayable
Drop poolsBoss Room
No direct change.
  • +1 Bone Heart
  • Spawns 3 red hearts on the ground when picked up
  • Added as part of the Afterbirth+ Booster Pack #5
  • This build: +1 Bone Heart. Spawns 3 red hearts on the ground when picked up. Added as part of the Afterbirth+ Booster Pack #5.
Slipped RibID 542 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • This item gives you an orbital, which will reflect projectiles back at enemies
  • Unlike some other orbitals, Slipped Rib doesn't deal contact damage to enemies
  • Added as part of the Afterbirth+ Booster Pack #5
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item gives you an orbital, which will reflect projectiles back at enemies. Unlike some other orbitals, Slipped Rib doesn't deal contact damage to enemies.
Hallowed GroundID 543 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Angel Room
No direct change.
  • A familiar which follows Isaac and spawns a white poop when you take damage
  • The white poop gives an aura that cuts your tear delay in half (Tears up) and has a chance to block damage
  • The aura disappears if the poop is destroyed
  • Added as part of the Afterbirth+ Booster Pack #5
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation.
  • Can cause white poops through other item effects such as A Card Against Humanity or Re-Lax pills.
  • REPENTANCE - White poop from Hallowed Ground is now more durable, similar to golden poop. While standing in the aura, Isaac's damage is now also increased by 25%, and his tears gain a homing effect
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar which follows Isaac and spawns a white poop when you take damage. The white poop gives an aura that cuts your tear delay in half (Tears up) and has a chance to block damage.
  • Reference transformation families: Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
Pointy RibID 544 · Quality 2 · PassivePlayable
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • A familiar that can be aimed with the fire buttons similar to the Finger item, dealing contact damage to enemies equal to your tear damage
  • Added as part of the Afterbirth+ Booster Pack #5
  • This build: pointyRib.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: poke
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Book of the DeadID 545 · Quality 3 · ActivePlayable
Drop poolsItem Room, Library, Devil Room
No direct change.
  • When used, this item will spawn a bone orbital or charmed Bony for each enemy killed in the current room
  • The orbitals and charmed enemies persist when travelling between rooms
  • Bone orbitals break after dealing enough damage or blocking too many shots
  • Added as part of the Afterbirth+ Booster Pack #5
  • Counts as 1 of 3 book items needed towards the Bookworm transformation.
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Book of the Dead
  • This build: When used, this item will spawn a bone orbital or charmed Bony for each enemy killed in the current room. The orbitals and charmed enemies persist when travelling between rooms.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
Dad's RingID 546 · Quality 3 · PassivePlayable
Drop poolsSecret Room
No direct change.
  • A passive item that puts a yellow ring around Isaac. Enemies are frozen in place while touching the yellow ring
  • Enemies touching the ring will stay permanently frozen until you move away, except for bosses which only get a temporary freeze effect after touching it
  • Added as part of the Afterbirth+ Booster Pack #5
  • This build: dadsRing.
Divorce PapersID 547 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsBoss Room
  • +0.7 Tears per second
  • +1 Bone Heart
  • +0.7 Tears Up
  • When you pick this item up, the Mysterious Paper trinket is spawned on the ground
  • Added as part of the Afterbirth+ Booster Pack #5
  • Not in random drops: Mysterious Paper pickup/effect is not implemented.
  • This build: +0.7 tears/s. divorcePapers.
Jaw BoneID 548 · Quality 1 · PassivePlayable
Drop poolsItem Room, Greed Mode item Room
No direct change.
  • A familiar that flies across the room every few seconds while firing and damages enemies (2x your tear damage)
  • Can also be used like the Boomerang to pick up consumables on the ground
  • Added as part of the Afterbirth+ Booster Pack #5
  • This build: A familiar that flies across the room every few seconds while firing and damages enemies (2x your tear damage). Can also be used like the Boomerang to pick up consumables on the ground.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: jawbone
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
Brittle BonesID 549 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • When picked up, this item replaces all of your red heart containers with 6 Bone Hearts
  • Every time you lose a bone heart, lots of bones fire in all directions damaging any enemies hit and you gain a permanent +0.5 Tears Up
  • For the Lost and Keeper characters, this item simply gives a permanent Tears Up
  • Added as part of the Afterbirth+ Booster Pack #5
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When picked up, this item replaces all of your red heart containers with 6 Bone Hearts.
Broken ShovelID 550 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Obtained by beating the Basement 1 boss within 1 minute, then bombing the large shadow that appears in the middle of the starting room
  • While held, Mom's Foot will stomp on you from above twice every few seconds, and she will continue to stomp for as long as you hold this item
  • Using the Broken Shovel will stop Mom stomping you for the rest of the current room (or current wave if you're in the boss rush or challenge room)
  • Beating the Boss Rush while holding this item will drop the second half of the Broken Shovel, which combine to create Mom's Shovel, which is used to unlock The Forgotten character
  • Dropping the Broken Shovel will cause it to disappear if you leave the room
  • NOTE: This item will not drop unless you have beaten The Lamb at least once
  • Added as part of the Afterbirth+ Booster Pack #5 and used in the quest to unlock The Forgotten character
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Broken Shovel
  • This build: Obtained by beating the Basement 1 boss within 1 minute, then bombing the large shadow that appears in the middle of the starting room.
Broken ShovelID 551 · Quality 4 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Drops after beating the Boss Rush while holding the other half of the Broken Shovel (see previous item for more details)
  • Combines with the first Broken Shovel piece to create Mom's Shovel (see next item for more details)
  • Added as part of the Afterbirth+ Booster Pack #5 and used in the quest to unlock The Forgotten character
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Drops after beating the Boss Rush while holding the other half of the Broken Shovel (see previous item for more details).
Mom's ShovelID 552 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, spawns a trapdoor that leads to the next floor
  • Digging in certain spots with objects or markings on the floor will guarantee a crawlspace once per floor
  • Unlocks The Forgotten character when used on a mound of dirt that appears in a room in The Dark Room floor
  • Obtained by combining the two Broken Shovel pieces. The first piece drops by beating the first floor boss within 1 minute then bombing the shadow in the first room. The second piece drops after beating the Boss Rush as long as you are holding the first Broken Shovel piece (see previous 2 items for full details)
  • After The Forgotten is unlocked, using it on the mound of dirt again just spawns a random type of chest
  • Added as part of the Afterbirth+ Booster Pack #5 and used in the quest to unlock The Forgotten character
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mom's Shovel
  • This build: When used, spawns a trapdoor that leads to the next floor. Digging in certain spots with objects or markings on the floor will guarantee a crawlspace once per floor.
MucormycosisID 553 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Tears have a chance to fire a fungus tear that sticks to enemies. It grows rapidly in size then explodes into a gas cloud that damages nearby enemies
  • When the explosion happens, more homing fungus tears fire out in random directions. Those tears will cause the same effect if they happen to hit other enemies
  • Effects that replace your tears such as Brimstone simply have a chance to apply this effect
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears have a chance to fire a fungus tear that sticks to enemies. It grows rapidly in size then explodes into a gas cloud that damages nearby enemies.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
2SpookyID 554 · Quality 1 · PassivePlayable
Drop poolsDevil Room
No direct change.
  • Any enemies that come within close range of Isaac will become feared, which causes them to flee
  • This build: twoSpooky.
Golden RazorID 555 · Quality 1 · ActivePlayable
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • +5 coins when picked up
  • When used, this item takes away 5 of your coins and gives a +1.2 Damage Up that lasts for the current room
  • Can stack as many times as you want. Using it with less than 5 coins does nothing
  • Recharge Time: Instant
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Golden Razor
  • This build: +5 coins when picked up. When used, this item takes away 5 of your coins and gives a +1.2 Damage Up that lasts for the current room.
SulfurID 556 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Upon use, grants use of Brimstone for the current room
  • If used twice in the same room, the brimstone laser becomes massive and deals +1.8 more damage
  • Using it more than twice in the same room will give a damage increase each time
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation.
  • Recharge Time: 3 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Sulfur
  • This build: Upon use, grants use of Brimstone for the current room. If used twice in the same room, the brimstone laser becomes massive and deals +1.8 more damage.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
Fortune CookieID 557 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Upon use, displays a random fortune and has a chance to drop either a soul heart, a card (including dice shards), rune/soul stone or a trinket
  • Soul hearts and tarot cards are much more common than trinkets
  • Recharge Time: 2 rooms
  • Not in random drops: Trinket payouts are not implemented.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Fortune Cookie
  • This build: Upon use, displays a random fortune and has a chance to drop either a soul heart, a card (including dice shards), rune/soul stone or a trinket.
Eye SoreID 558 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • With each tear fired, you have a chance to fire 1-3 extra tears in random directions
  • The extra tears scale with your other damage increasing items
  • Synergises with other items that replace your tears, like Brimstone or Technology
  • The chance to fire extra tears is not affected by luck
  • Not in random drops: Its original ability is not implemented yet.
  • This build: With each tear fired, you have a chance to fire 1-3 extra tears in random directions. The extra tears scale with your other damage increasing items.
120 VoltID 559 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • This item will fire electricity at nearby enemies, dealing roughly x0.75 of your tear damage rapidly
  • The electricity can chain up to 4 enemies if they are close enough
  • On floors with water on the ground (Downpour, Flooded Caves, Dross) this effect chain onto enemies further away than it normally would
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item will fire electricity at nearby enemies, dealing roughly x0.75 of your tear damage rapidly. The electricity can chain up to 4 enemies if they are close enough.
It HurtsID 560 · Quality 1 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Taking damage causes Isaac to fire a circle of 10 tears around him, each dealing 10 damage
  • After taking damage, you also gain a +1.2 Tears Up for the rest of the current room. Any subsequent hits give +0.4 Tears Up and will ignore the normal fire rate cap
  • This build: On damage: ten 10-damage tears; +1.2 fire rate then +0.4 per further hit this room, exceeding the normal cap.
  • The first hit gives +1.2 fire rate; subsequent hits give +0.4. Added after normal tear-stat caps/modifiers; removed on room/floor change or item removal.
Almond MilkID 561 · Quality 1 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Greatly increases tears (x4 fire rate)
  • Greatly decreases damage (x0.33 damage multiplier)
  • Individual tears gain random worm effects (e.g. Hook Worm, Wiggle Worm etc.)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Greatly increases tears (x4 fire rate). Greatly decreases damage (x0.33 damage multiplier). Individual tears gain random worm effects (e.g. Hook Worm, Wiggle Worm etc.).
Rock BottomID 562 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Prevents your stats from being reduced any more for the rest of the run
  • e.g. Stat Down pills do nothing, and items like Experimental Treatment increase stats but don't reduce any
  • This effect works on items that apply negative stat modifiers, such as Soy Milk
  • This effect works for anything that gives temporary buffs, like Devil/Strength cards, or kill bonuses like Bloody Lust
  • If you somehow lose Rock Bottom, your stats will go back to normal
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Prevents your stats from being reduced any more for the rest of the run. E.g. Stat Down pills do nothing, and items like Experimental Treatment increase stats but don't reduce any.
Nancy BombsID 563 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +5 Bombs
  • Bombs now explode with a random effect (e.g. Poison, Homing, Prize Bombs)
  • In Antibirth this was called Enigma Bombs
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. Bombs now explode with a random effect (e.g. Poison, Homing, Prize Bombs). In Antibirth this was called Enigma Bombs.
A Bar of SoapID 564 · Quality 3 · PassivePlayable
Drop poolsBoss Room
  • +0.5 Tears per second
  • +0.2 Shot speed
  • +0.5 Tears Up
  • +0.2 Shot Speed Up
  • This build: +0.5 tears/s. +0.2 shot speed.
Blood PuppyID 565 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Red Chest, Curse Room
No direct change.
  • Spawns a red worm familiar that chases enemies nearby around the room and deals 2 contact damage per tick
  • After killing a 15 enemies, Blood Puppy transforms into an aggressive version that will also attack Isaac by charging at him. Damaging the aggressive Blood Puppy will eventually return it to its normal state.
  • While aggressive, Blood Puppy deals 7.5 damage and drops half a red heart for every 10 enemies it kills.
  • After killing a 25 more enemies, it transforms again dealing 15 damage and destroying obstacles it charges into. Isaac takes a full heart if hurt by Blood Puppy and it drops a full red heart for every 10 enemies it kills.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a red worm familiar that chases enemies nearby around the room and deals 2 contact damage per tick.
Dream CatcherID 566 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • During the transition between floors, this item shows you a preview of the item that will spawn in the item room, and the boss that will appear
  • This effect will work even if you have Curse of the Blind, but the item will still appear as a ? when entering the item room
  • Gives +1 Soul Heart when starting each new floor after picking this up
  • On XL floors both items are shown
  • Currently this effect doesn't work in Greed Mode - It will show 2 items but the item rooms will have different items in them
  • Not in random drops: Its original ability is not implemented yet.
  • This build: During the transition between floors, this item shows you a preview of the item that will spawn in the item room, and the boss that will appear.
Paschal CandleID 567 · Quality 3 · PassivePlayable
Drop poolsAngel Room
No direct change.
  • Gives +0.4 Tears Up for each room completed without taking damage, up to a maximum of +2.0 Tears Up
  • When you take damage, the tears bonus is reset
  • Picking this item up counts and gives you a temporary +0.4 Tears Up as well
  • This build: paschalCandle.
Divine InterventionID 568 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Allows you to double-tap the shoot button to create a holy shield for 1 second that pushes enemies back and deals 10 damage to them if they touch it
  • The shield also reflects enemy shots and beams back at them for some extra damage
  • Can only be activated every 3 seconds (Shown by a white glow and a ticking noise)
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Allows you to double-tap the shoot button to create a holy shield for 1 second that pushes enemies back and deals 10 damage to them if they touch it.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Blood OathID 569 · Quality 1 · PassivePlayable
Drop poolsDevil Room, Curse Room
No direct change.
  • At the beginning of each new floor, this item will stab Isaac and reduce your red health down as much as it can without killing you. In exchange it gives you +0.05 Speed Up and Damage Up for every half a heart this item removes
  • The amount of Damage Up is (0.15 * FullHeartsRemoved ^ 2)
  • If Isaac is already at half a red heart when stabbed, no damage or speed increases are given
  • The damage from being stabbed can be avoided with invincibility, however no damage or speed stat increases are gained if you do
  • This build: bloodOath.
Playdough CookieID 570 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Your individual tears each gain a random effect from either: Poison, Fear, Slow, Freeze, Charm, Burning, Homing, Bleeding, x2 Damage or Reduced damage
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Your individual tears each gain a random effect from either: Poison, Fear, Slow, Freeze, Charm, Burning, Homing, Bleeding, x2 Damage or Reduced damage.
Orphan SocksID 571 · Quality 2 · PassivePlayable
Drop poolsSecret Room
  • +2 Soul hearts
  • +0.3 Movement speed
  • +2 Soul Hearts
  • +0.3 Speed Up
  • Allows you to walk on harmful floor effects without taking damage (e.g. spikes, creep). Doesn't include Curse Room doors or spiked rocks
  • This build: +2 soul hearts. +0.3 speed. orphanSocks.
Eye of the OccultID 572 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Tears can be controlled mid-flight using the directional keys
  • +1 Damage Up
  • +2.0 Range Up
  • -0.16 Shot Speed Down
  • Counts as 1 of 3 evil items needed towards the Leviathan transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears can be controlled mid-flight using the directional keys. +1 Damage Up. +2.0 Range Up. -0.16 Shot Speed Down.
  • Reference transformation families: Leviathan. Set bonuses and costumes remain a separate unfinished overhaul.
Immaculate HeartID 573 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsAngel Room
  • +1 Red heart containers
  • Damage ×1.2
  • In addition to regular tears, Isaac will sometimes fire extra spectral tears that orbit around him
  • +1 HP Up
  • +20% damage multiplier (x1.2)
  • Fully heals all your red heart containers
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • Not in random drops: Orbiting spectral tears are not implemented.
  • This build: +1 heart containers. damage x1.2. immaculateHeart.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
MonstranceID 574 · Quality 2 · PassivePlayable
Drop poolsAngel Room
No direct change.
  • Isaac now emits a large light aura that damages nearby enemies 5 times per second while touching it
  • The visual effect is similar to the effect given to tears by the GodHead item
  • The aura deals more damage towards the center, ranging from 0.75 at max range to 4 damage when touching Isaac
  • This build: monstrance.
The IntruderID 575 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • In addition to normal tears, Isaac now also fires a set of 4 quadshot tears with a slowing effect
  • The quadshot tears deal 1.5 damage each and do not scale with your damage upgrades
  • Upon taking damage, you have a chance to dislodge the spider from your face. It leaps at enemies, dealing contact damage and firing quad shots at them for the rest of the room
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: In addition to normal tears, Isaac now also fires a set of 4 quadshot tears with a slowing effect. The quadshot tears deal 1.5 damage each and do not scale with your damage upgrades.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Dirty MindID 576 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Each time you destroy a poop, this item will spawn 1-4 friendly Dip familiars that follow you, block shots and attack nearby enemies
  • Different poop types will spawn different types of Dip, each with their own effect
  • Golden poop dips can petrify enemies, turning them to gold for a few seconds. If the enemy dies while in this state they will drop 1-4 coins
  • Corn poop dips spawn 1 blue fly on death
  • Rainbow poop Dips charm enemies and have a chance to spawn 1/2 a red heart on death
  • Black poop Dips leave a trail of creep
  • White poop Dips have a small Hallowed Ground aura effect, increasing your damage and fire rate while standing in it.
  • Poops spawned by Tainted ??? and IBS also have special effects: Stone Dips deal 3.5 more damage and can take 6 hits before they die. Toxic Dips release a poison cloud when they move/die. Fire Dips burn enemies and leave a fire behind on death
  • All enemy dips become friendly.
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Each time you destroy a poop, this item will spawn 1-4 friendly Dip familiars that follow you, block shots and attack nearby enemies.
  • Reference transformation families: Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
DamoclesID 577 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • When used, places a sword directly above Isaac's head and while active, will spawn an extra item for every item pedestal spawned
  • After getting hit once with the item activated, at any time without warning, the sword may fall, instantly killing Isaac regardless of his health
  • After being hit the sword has a 1/10000 chance every 4 frames to fall. This chance doesnt change if you take further damage
  • You effectively have a 4.4% chance for every minute that passes after taking damage to die
  • Self-inflicted damage i.e. Curse Rooms and Blood Donation Machines don't trigger this effect
  • Items with a price will spawn the extra item free of charge (i.e. in shops or devil rooms)
  • The only way to survive the falling sword is either through extra lives, by using items that would make you invincible, such as Gnawed Leaf or playing as The Lost. After the sword falls, extra items will no longer spawn
  • Recharge Time: One time use
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: once; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Damocles
  • This build: When used, places a sword directly above Isaac's head and while active, will spawn an extra item for every item pedestal spawned.
Free LemonadeID 578 · Quality 1 · ActivePlayable
Drop poolsItem Room
No direct change.
  • Upon use, spawns a giant puddle of lemonade that deals 8 damage per tick to any enemies which come in contact with it
  • Lasts for about 19 seconds
  • A similar effect to the Lemon Party pill
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Free Lemonade
  • This build: Upon use, spawns a giant puddle of lemonade that deals 8 damage per tick to any enemies which come in contact with it. Lasts for about 19 seconds. A similar effect to the Lemon Party pill.
Spirit SwordID 579 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Your tears are replaced with a sword which can be swung to deal damage (Damage * 3 + Base Damage)
  • Holding the fire button charges a spin attack (Damage * 8 + 10). The charge time is based on your tears stat.
  • While at full red health you also shoot a projectile across the room with each swing, dealing your current Damage + 2 (similar to the Master Sword in Zelda)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Your tears are replaced with a sword which can be swung to deal damage (Damage * 3 + Base Damage).
Red KeyID 580 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsSecret Room, Red Chest, Curse Room, Key Beggar, Mom's Chest
No direct change.
  • While held, a red outline of a door will appear on certain walls. Using the Red Key near it will spawn a red room
  • This room will randomly choose from many types, including (but not limited to) any regular room from that floor, treasure rooms, curse rooms, devil rooms, angel rooms, I AM ERROR rooms and more
  • In rooms with multiple door outlines, the closest one will be opened
  • Attempting to create a room outside the maximum boundary (13 x 13 rooms) of the map will take you to an I AM ERROR room. You can't use the Red Key to leave this room
  • The Red Key can be used to open the secret room in the Home floor, which is the method for unlocking alternative 'Tainted' characters
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Red Key
  • This build: While held, a red outline of a door will appear on certain walls. Using the Red Key near it will spawn a red room.
Psy FlyID 581 · Quality 4 · Passive, FamiliarPlayable
Drop poolsItem Room, Key Beggar
No direct change.
  • Gives Isaac an orbital fly, that will rapidly charge around and deflect any incoming tears that would hit Isaac.
  • It isn't 100% effective but the effect is very strong and will deflect most shots under a bullet hell situation.
  • Deflected tears turn into homing tears and fire back at enemies, dealing 2 damage.
  • After reflecting a certain number of projectiles, Psy Fly enters a brief cooldown period
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation.
  • This build: Gives Isaac an orbital fly, that will rapidly charge around and deflect any incoming tears that would hit Isaac.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 0
  • Familiar Radius: 60
  • Familiar Speed: 6
  • Familiar Block: true
  • Familiar Reflect: [object Object]
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Wavy CapID 582 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Every time you use Wavy Cap, it gives +0.75 Tears Up and -0.03 Speed Down
  • Also when used, this item will distort the screen and sound slightly, stacking every time you use it
  • All of these effects stack for the rest of the floor, meaning if used too many times the screen will be distorted so much it becomes unplayable
  • Each room you clear removes one use worth of effect - reducing the screen distortion slightly and giving +0.06 Speed Up and -0.3 Tears Down
  • This item was called Black Mushroom in Antibirth
  • Counts as 1 of 3 mushroom items needed towards the Fun Guy transformation.
  • Recharge Time: Starts at 1 second, increasing by every time you use it. After 10 uses it stops auto recharging.
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 1
  • Name: Wavy Cap
  • This build: Every time you use Wavy Cap, it gives +0.75 Tears Up and -0.03 Speed Down. Also when used, this item will distort the screen and sound slightly, stacking every time you use it.
  • Reference transformation families: Fun Guy. Set bonuses and costumes remain a separate unfinished overhaul.
Rocket in a JarID 583 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Bomb Beggar
No direct change.
  • +5 Bombs
  • Placing a bomb while pressing a fire button will fire an explosive rocket in that direction
  • Placing a bomb while standing still will place a regular bomb
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. Placing a bomb while pressing a fire button will fire an explosive rocket in that direction. Placing a bomb while standing still will place a regular bomb.
Book of VirtuesID 584 · Quality 3 · Active/Passive ItemNot ready — excluded from drops
Drop poolsAngel Room, Library
No direct change.
  • Upon use, spawns a flame familiar that fires spectral tears and deals contact damage to enemies. After taking two hits, the fire will be extinguished
  • The Book can be held at the same time as another active item. When used, this will combine with your other active item, creating a unique flame and possibly giving special effects
  • The recharge time of this item is based on your 2nd active item, otherwise it's 4 rooms
  • While held, guarantees the first Devil/Angel Room encountered to be an Angel Room, and increases the overall chance of getting one
  • A maximum of 16 flames can be active at one time around Isaac
  • Counts as 1 of 3 book items needed towards the Bookworm transformation
  • Recharge Time: Varies
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Variable Pending: true
  • Name: Book of Virtues
  • This build: Upon use, spawns a flame familiar that fires spectral tears and deals contact damage to enemies. After taking two hits, the fire will be extinguished.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
Alabaster BoxID 585 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • A single use active item that will spawn 3 soul hearts and 2 items from the Angel Room pool
  • Starts fully uncharged and gains charges only through picking up soul and black. (6 full hearts to fully charge)
  • Unless fully charged, hearts picked up are consumed by the Alabaster Box, instead of being added to your life total
  • If a devil deal was already taken this run, it spawns 2 soul hearts and 1 Angel Room item instead.
  • Picking up Bone Hearts while at 12 hearts will remove charges from the Box
  • Recharge Time: 12 charges (one time use)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Alabaster Box
  • This build: A single use active item that will spawn 3 soul hearts and 2 items from the Angel Room pool.
The StairwayID 586 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Spawns a ladder in the starting room of all future floors, which leads to an Angel Room
  • Angel rooms accessed by The Stairway are different - They sell angel room items and soul hearts for money, similar to the Shop
  • Pedestal items cost 15c, all other items (eternal/soul hearts, keys and holy cards) cost 5c. Sales can be randomly applied just like regular shops
  • The ladder disappears after leaving the starting room, even if you haven't used it yet
  • In Antibirth this was called Jacob's Ladder, which had to be renamed as Afterbirth+ already had an item with this name
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a ladder in the starting room of all future floors, which leads to an Angel Room.
SolID 588 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • Permanently shows the location of the boss room on the map
  • After defeating the shown boss fight, this item will activate a use of the Sun card (full heal and map reveal), fully recharge your active item, remove curses from the floor, gives +3 Damage Up and +1 Luck up for the rest of the floor
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • In The Void floor it shows a random boss room, which isn't necessarily Delirium's room
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Permanently shows the location of the boss room on the map.
LunaID 589 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • Adds one extra secret room and one extra super secret room to each floor
  • Each secret room contains a beam of light, that gives half a soul heart, and a Tears Up for the rest of the floor. These stack with multiple secret rooms - The first one gives +1.00 Tears Up, then all future ones give +0.5.
  • Reveals the location of one secret room on the minimap.
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Adds one extra secret room and one extra super secret room to each floor.
MercuriusID 590 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • +0.40 Speed Up
  • Doors remain open when entering a room with enemies in it. This means you can leave rooms before defeating the enemies inside
  • Doesn't open locked doors, or the door that leads to the Boss Room
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +0.40 Speed Up. Doors remain open when entering a room with enemies in it. This means you can leave rooms before defeating the enemies inside.
VenusID 591 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • +1 HP Up
  • Heals one red heart container when picked up
  • This item causes nearby enemies to be affected by the charm effect, causing them to attack other nearby enemies
  • The charm effect will wear off very quicky when enemies move away from Isaac
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1 HP Up. Heals one red heart container when picked up. This item causes nearby enemies to be affected by the charm effect, causing them to attack other nearby enemies.
TerraID 592 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • This item causes your tears to become rocks, which have increased knockback and can break other rocks and objects. This includes key blocks and secret room doors
  • +1.0 Damage Up, but each rock tear has a random damage modifier that can go up or down (x0.5 to x2)
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item causes your tears to become rocks, which have increased knockback and can break other rocks and objects. This includes key blocks and secret room doors.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
MarsID 593 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • Allows Isaac to charge by double tapping the same direction, dealing damage to any enemies caught
  • You are invincible while charging (doesn't include self-damage like Blood Donation machines)
  • Can be used multiple times per room
  • The dash deals x4 your current tear damage + 8
  • Doesn't have to be in a straight line, you can hold another button to curve it
  • Has a 3 second cooldown before it can be used again
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Allows Isaac to charge by double tapping the same direction, dealing damage to any enemies caught. You are invincible while charging (doesn't include self-damage like Blood Donation machines).
JupiterID 594 · Quality 2 · PassivePlayable
Drop poolsPlanetarium, Item Room
  • +2 Red heart containers
  • -0.3 Movement speed
  • +2 HP Up (only half a heart is filled)
  • -0.3 Speed Down
  • While not moving your speed rapidly increases up to a bonus of +0.5
  • While you have this +0.5 bonus, moving will cause Isaac to fart around the room, spawning poison gas clouds
  • The farts stop spawning once you reach your regular movement speed
  • Poison deals damage equal to half your tears per tick
  • Isaac is immune to Poison from enemies, such as Gasbag
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Heal: 0.5
  • This build: +2 heart containers. -0.3 speed. Heals 0.5 red hearts. jupiter.
SaturnusID 595 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • Gives you a wide circle halo which grants 7 orbital tears upon entering a new room
  • The tears orbit for 13 seconds before dropping off
  • Has a chance to absorb any enemy tears and add them to the orbiting tears. They can be used to damage enemies
  • Saturnus tears can't break objects such as poop and TNT barrels
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a wide circle halo which grants 7 orbital tears upon entering a new room. The tears orbit for 13 seconds before dropping off.
UranusID 596 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • Isaac now shoots ice tears that slow enemies. Enemies that are killed by the ice tears will become frozen
  • Frozen enemies never unfreeze and are considered dead by the game. Kicking a frozen enemy will push it into the wall, where it shatters and fires ice shards everywhere (these can then freeze other enemies)
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac now shoots ice tears that slow enemies. Enemies that are killed by the ice tears will become frozen.
  • Normal tears use this item’s specific projectile appearance. The latest acquired held item with tear art takes priority; removing it restores the previous appearance. Lasers and knives retain their own rendering.
NeptunusID 597 · Quality 3 · Passive, Tear ModifierNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
No direct change.
  • Isaac will now automatically charge up tears, allowing you to store them up and fire them rapidly for a short time
  • Any time you aren't firing tears, the charge bar will start filling up, for up to 3 seconds. Holding down the fire button again will quickly release all stored teared
  • The charge time and max tears stored scales with your current tears stat
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac will now automatically charge up tears, allowing you to store them up and fire them rapidly for a short time.
PlutoID 598 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsPlanetarium, Item Room
  • +0.7 Tears per second
  • +0.7 Tears Up
  • Greatly reduce Isaac's size, to an extent where some enemy tears will now travel straight over him without dealing damage if they are high off the ground. Tears can still hit Isaac if gravity applies for too long
  • Allows Isaac to squeeze between some objects
  • Only available inside a Planetarium - a room that has a base 1% chance to appear, which increases by +20% every time you skip an Item Room (Must not enter to count as skipped)
  • Not in random drops: Shrinking and projectile-height/hitbox interactions are not implemented.
  • This build: +0.7 tears/s. pluto.
Voodoo HeadID 599 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Crane Game
No direct change.
  • This item has a chance to spawn an additional curse room on each future floor
  • Causes a penny to spawn in all future Curse Rooms
  • Improves curse room layouts and rewards
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item has a chance to spawn an additional curse room on each future floor. Causes a penny to spawn in all future Curse Rooms. Improves curse room layouts and rewards.
Eye DropsID 600 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsBoss Room
No direct change.
  • Tears fired from your left eye gain roughly +28% fire rate increase
  • Causes your tears to be fired at staggered rates
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears fired from your left eye gain roughly +28% fire rate increase. Causes your tears to be fired at staggered rates.
Act of ContritionID 601 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • +1 Eternal Heart
  • +0.7 Tears Up
  • Allows Angel Rooms to appears even if a Devil deal has been taken before
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1 Eternal Heart. +0.7 Tears Up. Allows Angel Rooms to appears even if a Devil deal has been taken before.
Member CardID 602 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • All shops now contain a trapdoor with a ladder, which leads down to a special shop
  • The special shop contains various consumables and items at a higher price from the Devil/Angel room, Boss room and Secret room pools.
  • Items cost 15-30c, trinkets cost 15c, cards/runes cost 6-8c, black/bone hearts 8c, eternal hearts 15c, rotten hearts 5c
  • Not in random drops: Its original ability is not implemented yet.
  • This build: All shops now contain a trapdoor with a ladder, which leads down to a special shop.
Battery PackID 603 · Quality 0 · PassivePlayable
Drop poolsShop, Battery Beggar
No direct change.
  • When picked up, this item fully recharges your currently held active item and drops between 2-4 battery pickups. These can be smaller or big batteries
  • This build: batteryPack.
Mom's BraceletID 604 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsShop, Crane Game, Mom's Chest
No direct change.
  • Upon use, Mom's Bracelet allows you to grab objects in the room and throw them, damaging any enemies which are hit for 40 damage
  • Most objects can be thrown including pots, rocks, poops, tnt etc
  • Pressing the activate button again will drop the object where you stand, which doesn't consume a charge of use
  • Allows you to remove the skull on top of Host enemies, turning them into the red version
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • Recharge Time: 1 second
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mom's Bracelet
  • This build: Upon use, Mom's Bracelet allows you to grab objects in the room and throw them, damaging any enemies which are hit for 40 damage. Most objects can be thrown including pots, rocks, poops, tnt etc.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.
The ScooperID 605 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, this item spawns a Peeper familiar for the current room, which deals 12 contact damage per tick to enemies and leaves red creep in its path
  • Using this item removes Isaac's right eye, causing tears from this eye to deal x1.5 your normal tear damage
  • Using it more than once in the same room will spawn multiple Peeper familiars
  • Recharge Time: 3 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: The Scooper
  • This build: When used, this item spawns a Peeper familiar for the current room, which deals 12 contact damage per tick to enemies and leaves red creep in its path.
Ocular RiftID 606 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Fired tears now have a chance to summon a rift when they land on the ground
  • The spawned rift sucks in enemies, projectiles and pickups and deals damage to enemies caught inside for 2 seconds
  • The chance to fire the rift tear can improve based on your luck stat. At +0 Luck theres a ~2.5% chance for this effect to activate
  • The size of the rift scales with your tear damage
  • Rifts deal half your damage per tick
  • In Antibirth this item was called Oculus Rift
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Fired tears now have a chance to summon a rift when they land on the ground. The spawned rift sucks in enemies, projectiles and pickups and deals damage to enemies caught inside for 2 seconds.
Boiled BabyID 607 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar boil that randomly fires bursts of tears, similar to the Boil enemy
  • Tears either deal 5.3 or 3.5 damage
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar boil that randomly fires bursts of tears, similar to the Boil enemy. Tears either deal 5.3 or 3.5 damage.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Freezer BabyID 608 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • A familiar baby that fires tears which have a chance to freeze or petrify enemies
  • Frozen enemies never unfreeze and are considered dead by the game. Kicking a frozen enemy will push it into the wall, where it shatters and fires ice shards everywhere (these can then freeze other enemies)
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A familiar baby that fires tears which have a chance to freeze or petrify enemies.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Eternal D6ID 609 · Quality 3 · ActivePlayable
Drop poolsItem Room, Secret Room, Crane Game
No direct change.
  • When used, rerolls all items in the room into another random item from the current room's item pool, however the item also has a 30% chance to disappear
  • The chance associated with this item does NOT scale with your Luck stat - it's always 30%
  • In the game files this item is called 'Florians Dice', which is a reference to the Eternal update for the original Binding of Isaac game, which changed the D6 to act as this item does
  • Recharge Time: 2 rooms
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Eternal D6
  • This build: When used, rerolls all items in the room into another random item from the current room's item pool, however the item also has a 30% chance to disappear.
Bird CageID 610 · Quality 1 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Taking damage for the first time in a room spawns a familiar which targets an enemy and jumps on them, releasing a rock wave outwards
  • For the remainder of the room the familiar then continues to attack enemies similar to the Dead Bird item dealing 3 contact damage per tick
  • Deals 45 damage to enemies it lands on. The rock wave deals 10 damage.
  • This build: birdCage.
LarynxID 611 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • When used, this item does a shout-type attack, with its effect increasing in damage and size the more charges you have
  • Larynx can be used with any number of charges. At 1 charge it deals 48 damage to any enemies close to Isaac. At the full 12 charges Isaac does a massive shout, dealing 356 damage to all enemies on the screen
  • Larynx gains 1 charge every time you take damage (also charges as normal)
  • Recharge Time: 12 rooms (Can be used with partial charges)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 12. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Larynx
  • This build: When used, this item does a shout-type attack, with its effect increasing in damage and size the more charges you have.
Lost SoulID 612 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Secret Room
No direct change.
  • This item gives you a familiar version of The Lost character which dies instantly upon hit
  • If the familiar survives an entire floor you get one of: 3 soul hearts, 2 eternal hearts or a random item/angel room item
  • Regenerates at the start of each floor if dead
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item gives you a familiar version of The Lost character which dies instantly upon hit.
Blood BombsID 614 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • +1 HP Up
  • Restores 5 empty red heart containers
  • Bombs now spawn a puddle of red creep upon explosion, dealing 2 damage per tick to enemies touching it
  • While at 0 bombs, you can also place further bombs now at the cost of 1/2 of a heart (kills The Lost if used like this). Placing a bomb this way will not affect your devil/angel room chances
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1 HP Up. Restores 5 empty red heart containers. Bombs now spawn a puddle of red creep upon explosion, dealing 2 damage per tick to enemies touching it.
Lil DumpyID 615 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Lil Dumpy follows Isaac and produces a Butter Bean fart when a projectile or enemy is about to hit Isaac, pushing the enemy back and preventing the damage
  • After it farts, it flies away, stops following Isaac and has to be picked up again before it will follow again
  • He also has a second larger detection radius that can randomly trigger from enemy projectiles
  • The effect only works if Lil Dumpy is following and near Isaac
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Lil Dumpy follows Isaac and produces a Butter Bean fart when a projectile or enemy is about to hit Isaac, pushing the enemy back and preventing the damage.
Bird's EyeID 616 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • You have a chance alongside each tear to shoot a red flame, which deals damage to enemies that come in contact with it
  • Damage starts at x4 your current tear damage, and scales down each time an enemy touches the fire
  • The chance to create a fire scales with your Luck stat, at +11 Luck you have a 50% chance to shoot one
  • The flames from this item can destroy shopkeepers, which is handy since doing this once per floor increases your devil/angel room chances slightly
  • Not in random drops: Its original ability is not implemented yet.
  • This build: You have a chance alongside each tear to shoot a red flame, which deals damage to enemies that come in contact with it.
LodestoneID 617 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Crane Game
No direct change.
  • Tears now have a chance to cause enemies to be magnetized
  • Magnetized enemies attract other enemies, tears (including Isaac's) and enemy projectiles, causing them to be pulled in towards them
  • Enemy tears that get pulled into other enemies will hurt them
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Tears now have a chance to cause enemies to be magnetized. Magnetized enemies attract other enemies, tears (including Isaac's) and enemy projectiles, causing them to be pulled in towards them.
Rotten TomatoID 618 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Rotten Beggar
No direct change.
  • You have a chance to fire a tear that marks enemies red and slow them
  • Marked enemies will be attacked by other enemies either until it is killed or it kills all the other enemies attacking it
  • Chance to fire a marking tear scales with your luck stat
  • Not in random drops: Its original ability is not implemented yet.
  • This build: You have a chance to fire a tear that marks enemies red and slow them. Marked enemies will be attacked by other enemies either until it is killed or it kills all the other enemies attacking it.
BirthrightID 619 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • This item has a different effect for each character. See next icon for Tainted character effects
  • Isaac - All new pedestal items cycle through two options
  • Maggy - +1 HP up. Increases the maximum heart limit to 18.
  • Cain - +1 Luck. All floors guaranteed to have an Arcade except the Chest & Dark Room floors
  • Judas - Gives a passive Book of Belial item similar to Book of Virtues. Using active items gives a damage up that scales with the charge time
  • ??? - Every HP upgrade is now worth 2 soul hearts. Health down effects still only remove 1 heart
  • Eve - Whore of Babylon and Dead Bird effects are always active
  • Samson - Bloody Lust can gain 4 more damage boosts, for a new max total of +14 Damage
  • Azazel - His beam becomes much wider, no effect on damage
  • Lazarus - Every time Lazarus dies, gives +21.6 temporary Damage Up, gradually fading over 1 minute.
  • Eden - Spawns 3 items from any pools, you can only take 1
  • The Lost - Useless items like HP upgrades, spectral tears or flight are removed from the item pools
  • Lilith - Causes all your offensive familiars to stack tightly infront of Lilith for more controlled damage
  • Keeper - +1 HP up. Increases HP cap by 1
  • Apollyon - Void has a chance to spawn a previously destroyed item as well. More items consumed = more chance for this effect
  • The Forgotten - Your Soul is now unchained and free to move.
  • Bethany - Activating an item using soul charges is sometimes free
  • Jacob & Esau - The character who picks up Birthright gains copies of three of the other character's passive items
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item has a different effect for each character. See next icon for Tainted character effects. Isaac - All new pedestal items cycle through two options.
Red StewID 621 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Ultra Secret Room
No direct change.
  • Fully heals all red heart containers
  • Significantly increases damage by +21.6, however the damage boost wears off slowly over time at a rate of roughly -0.04 per second
  • Every enemy you kill adds +0.02 Damage to the timed effect of Red Stew
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Fully heals all red heart containers. Significantly increases damage by +21.6, however the damage boost wears off slowly over time at a rate of roughly -0.04 per second.
GenesisID 622 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsAngel Room, Greed Mode Angel Room
No direct change.
  • When used, removes all your passive items and teleports you to Isaac's Bedroom
  • For every passive item removed, you are given a choice of 3 random pedestal items from any item pool. Essentially you are rerolling all your items, but each new item you get to choose between 3 random options
  • The bedroom also contains a random trinket, 2 chests, 2 sacks and Isaac's bed, which can be used to full heal your red heart health
  • The only way to exit Isaac's bedroom is teleporting out or via the trapdoor, which takes you to the next floor. This will deviate you from the alt path if you are currently on it
  • Since this item resets your stats, this item can remove Broken Hearts
  • Recharge Time: One time use
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Genesis
  • This build: When used, removes all your passive items and teleports you to Isaac's Bedroom.
Sharp KeyID 623 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • +5 Keys
  • Upon use, allows you to consume 1 key and fire it at an enemy, piercing enemies and dealing significant damage
  • The damage done by the key projectile pierces through enemies and scales with your damage upgrades (x5 damage + 30)
  • Keys fired by this item can open locked doors/chests, secret rooms and destroy objects in the room, such as rocks
  • Cannot be used if you don't have any keys
  • Enemies killed by Sharp Key have a ~10% chance to spawn random items that appear in a chests. This can be anything that would normally drop from a chest including pedestal items
  • Recharge Time: Instant
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Sharp Key
  • This build: +5 Keys. Upon use, allows you to consume 1 key and fire it at an enemy, piercing enemies and dealing significant damage.
Booster PackID 624 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Shop
No direct change.
  • Spawns 5 random cards
  • This build: boosterPack.
Mega MushID 625 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, this item causes Isaac to become humongous for 30 seconds
  • While huge, Isaac is invincible and can crush objects, doors and enemies
  • For the duration of the effect this gives you a x4 Damage Multiplier and +2.0 Range Up, but your rate of fire goes way down
  • Deals significant contact damage to enemies while active (1600 dps).
  • Counts as 1 of 3 mushroom items needed towards the Fun Guy transformation.
  • Recharge Time: 12 rooms
  • Not in random drops: Giant player-body and collision-size interactions are not implemented.
  • Active charge policy: room; capacity 12. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Mega Mush
  • This build: When used, this item causes Isaac to become humongous for 30 seconds. While huge, Isaac is invincible and can crush objects, doors and enemies.
  • Reference transformation families: Fun Guy. Set bonuses and costumes remain a separate unfinished overhaul.
Knife Piece 1ID 626 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsNone (see above), Item Room
No direct change.
  • Combine with Knife Piece 2 to create a Knife which can be fired across the room, dealing 25 damage to any enemies it comes into contact with
  • In the Downpour/Dross II, you will find a white flame somewhere, and a room with a mirror in it. Touching the white flame temporarily turns you into The Lost, but allows you to walk through the mirror into a mirrored version of this floor. You have the Holy Mantle effect to prevent one hit per room, but taking another hit will kill you. The Knife Piece 1 is located in the Item Room in the mirrored area. Returning back through the mirror door returns you back to normal again
  • If you haven't unlocked Holy Mantle for The Lost yet, you won't gain the effect after touching a white fire so be careful!
  • The mirrored floor rooms have respawned enemies, and allows you to optionally fight the Boss a second time for an extra item
  • When combined with Knife Piece 2, can be used to stab the fleshy door in the Mausoleum II, which then leads to the Corpse floor and the Mother boss
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Combine with Knife Piece 2 to create a Knife which can be fired across the room, dealing 25 damage to any enemies it comes into contact with.
Knife Piece 2ID 627 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsNone (see above), Item Room
No direct change.
  • Combine with Knife Piece 1 to create a Knife which can be fired across the room, dealing 25 damage to any enemies it comes into contact with
  • In the Mines/Ashpit II, there's a room with a minecart and a broken track. Pressing 3 yellow buttons on the floor causes the minecart to be rideable. Following the path takes you to an abandoned mineshaft, which leads you to a pedestal with the Knife Piece. Taking it will cause Mom's Shadow to spawn and chase you. You must make it back through the path solving a few bomb puzzles while avoiding her, to get back to the regular floor. All your items and consumables are temporarily removed while in the abandoned mine
  • The room to access Knife Piece 2 only appears if you have Knife Piece 1 already
  • You can skip pressing the 3 yellow buttons if you have the ability to fly and have 2 bombs to force open the door
  • When combined with Knife Piece 1, can be used to stab the fleshy door in the Mausoleum II, which then leads to the Corpse floor and the Mother boss
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Combine with Knife Piece 1 to create a Knife which can be fired across the room, dealing 25 damage to any enemies it comes into contact with.
Death CertificateID 628 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • This is a one time use item that teleports you to an alternate floor, which contains every single item in the game
  • The items are spread between several different rooms all on pedestals. You may take only one of the items, before being teleported back to where you were
  • It's literally every item, that includes items not in item pools like Knife Pieces
  • Recharge Time: 1 time use
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: Death Certificate
  • This build: This is a one time use item that teleports you to an alternate floor, which contains every single item in the game.
Bot FlyID 629 · Quality 3 · Passive, FamiliarPlayable
Drop poolsItem Room, Key Beggar, Crane Game
No direct change.
  • Gives you a robot fly familar that orbits around Isaac and fires shielded tears at incoming projectiles
  • Deals contact damage to enemies it touches
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation
  • This build: Gives you a robot fly familar that orbits around Isaac and fires shielded tears at incoming projectiles. Deals contact damage to enemies it touches.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: orbit
  • Familiar Dmg: 2
  • Familiar Radius: 52
  • Familiar Speed: 2.4
  • Familiar Block: true
  • Familiar Bot Shoot: [object Object]
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Meat CleaverID 631 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, the Meat Cleaver will split all enemies in the room into 2 smaller versions with ~40% health each
  • For enemies that have multiple parts to them (e.g. Larry Jr.) it will split them into 2 smaller enemies with half the number of sections they used to have
  • If the enemy normally has a mechanic that splits it (e.g. Teratoma, Envy) then Meat Cleaver will deal a lot of damage and trigger the splitting effect
  • If the split enemy has low enough health, it will just die instead of splitting
  • Doesn't work on end-game bosses except Delirium, where it will deal a chunk of damage and spawn a 2nd Delirium to deal with
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 2. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Meat Cleaver
  • This build: When used, the Meat Cleaver will split all enemies in the room into 2 smaller versions with ~40% health each.
Evil CharmID 632 · Quality 2 · PassivePlayable
Drop poolsSecret Room
  • +2 Luck
  • +2 Luck Up
  • You no longer take damage from poison/toxic gas/burn effects, and become immune to fear/confusion
  • This build: +2 luck. evilCharm.
DogmaID 633 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsNone, Item Room
No direct change.
  • This item isn't available in any item pools - you are automatically given it after defeating Dogma, just before The Beast sequence
  • +0.1 Speed Up
  • +2.0 Damage Up
  • Grants you the ability to fly
  • Grants a one-time use of the Holy Mantle effect
  • On normal mode this grants The Wafer effect, causing all damage to do a maximum of half a heart each time
  • Sets your health to 6 hearts if you have fewer than 6. This will heal red hearts and then give soul hearts up to a total of 6. This doesn't work with The Lost characters
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +0.1 Speed Up. +2.0 Damage Up. Grants you the ability to fly. Grants a one-time use of the Holy Mantle effect.
PurgatoryID 634 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Angel Room
No direct change.
  • While in a room with enemies, red cracks will appear on the floor in random locations
  • Walking over the crack spawns a white soul familiar, that launches itself into the nearest enemy, exploding and dealing double your tear damage to everything near it
  • Cracks will keep appearing but only one can exist in the room at a time
  • Not in random drops: Its original ability is not implemented yet.
  • This build: While in a room with enemies, red cracks will appear on the floor in random locations.
StitchesID 635 · Quality 1 · Active, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • While held, this item spawns a familiar that can be moved around using the arrow keys and deals 1.5 damage per tick to any enemies it touches
  • When activated, you teleport, swapping places with wherever Stitches was positioned
  • Teleporting next to fires will extinguish them (including blue fires) and on top of shopkeepers will destroy them (gives +10% devil/angel room chance as normal)
  • If used while stitches is on top of an enemy, it can be used to telefrag enemies, dealing x3.5 your damage + 40
  • Can be used to enter/exit Curse Rooms for free by teleporting infront of the door while holding the direction key to move in immediately. Also works for opening Spiked Chests and Mimic Chests without taking damage
  • Recharge Time: 3 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Stitches
  • This build: While held, this item spawns a familiar that can be moved around using the arrow keys and deals 1.5 damage per tick to any enemies it touches.
R KeyID 636 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • When used, this item restarts the game and places you back on the first floor with all your currently collected items, similar to doing a Victory Lap
  • The game timer does not reset
  • Allows angel rooms to be found in the new run if a devil deal was taken in the first run
  • In Greed Mode and while playing as Tainted Keeper, this item costs 99 coins instead of 15
  • When used in the backwards path after picking up Dad's Note, R key will skip you to the Basement 1 version of this path, which leads directly to the Home floor. This may cause you to skip floors where you left a trinket to spawn a Cracked Key.
  • Donation machines become fixed if they were jammed before using the R Key
  • Recharge Time: Single use
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: once; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Consumed: true
  • Name: R Key
  • This build: When used, this item restarts the game and places you back on the first floor with all your currently collected items, similar to doing a Victory Lap. The game timer does not reset.
Knockout DropsID 637 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Isaac now has a chance to fire a fist instead of normal tears, which have a much higher knockback effect and confuse enemies for a few seconds
  • Enemies that are knocked back will take 10 damage and knock back any enemy they are knocked into, dealing damage to them as well
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac now has a chance to fire a fist instead of normal tears, which have a much higher knockback effect and confuse enemies for a few seconds.
EraserID 638 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsShop, Crane Game
No direct change.
  • An active item that allows you to throw an eraser at any enemy, which will kill it and prevent it from appearing for the rest of the run
  • Enemies that are erased create a puff of smoke instead of spawning
  • Works on bosses, except it doesn't kill them it just deals 15 damage
  • Can only be used once per floor - batteries also cannot be used to recharge it to bypass this restriction
  • The first use will raise it above your head, then by pressing the fire button it will be thrown in that direction
  • Recharge Time: 1 room (Can only be used once per floor)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Eraser
  • This build: An active item that allows you to throw an eraser at any enemy, which will kill it and prevent it from appearing for the rest of the run.
Yuck HeartID 639 · Quality 1 · ActivePlayable
Drop poolsItem Room, Rotten Beggar
No direct change.
  • When used, this item will give you +1 Rotten Heart
  • Rotten Hearts act as red hearts and each one you currently have spawns 2 blue flies upon successfully clearing a room
  • Recharge Time: 4 rooms
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Yuck Heart
  • This build: When used, this item will give you +1 Rotten Heart. Rotten Hearts act as red hearts and each one you currently have spawns 2 blue flies upon successfully clearing a room.
Urn of SoulsID 640 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Enemies now create a soul upon death, which is automatically sucked into the Urn giving it +1 charge. Mini-bosses and bosses create 2-3 souls
  • When activated, the urn can be fired as a high damage flamethrower in any direction
  • A charge is consumed roughly every 0.5 seconds of use
  • Multi-part enemies such as Envy or Teratoma create a soul per each part killed
  • A maximum of 20 souls can be held in the urn at one time
  • Recharge Time: None (see above)
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Urn of Souls
  • This build: Enemies now create a soul upon death, which is automatically sucked into the Urn giving it +1 charge. Mini-bosses and bosses create 2-3 souls.
AkeldamaID 641 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • With each shot fired, another bloody tear will spawn behind Isaac
  • Spawning multiple tears will form a trail of tears that follow Isaac as he moves, bursting and dealing damage upon contact with enemies
  • The effect from this item will only work while in a hostile room that contains at least 1 enemy
  • Not in random drops: Its original ability is not implemented yet.
  • This build: With each shot fired, another bloody tear will spawn behind Isaac.
Magic SkinID 642 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsShop, Red Chest, Curse Room
No direct change.
  • Upon use, this item consumes 1 heart container or 2 soul hearts and spawns one item pedestal from the current room's pool
  • Every use gives a broken heart, meaning that slot is permanently broken and the maximum health limit is reduced by 1 for the rest of the run
  • If Isaac has 12 broken hearts, he dies instantly (this also applies to The Lost despite having no health)
  • Magic Skin will continue to appear after finding it once if you are not still holding it - the chance for it to replace an item is 1 ÷ (12 - number of times used) up to a maximum of 50%
  • Broken hearts are empty heart containers that cannot be removed or refilled and will override other types of hearts when you reach 12 total. Replacing all 12 containers with broken hearts will kill you instantly. The only way to remove broken hearts is by donating to a Confessional Machine
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Magic Skin
  • This build: Upon use, this item consumes 1 heart container or 2 soul hearts and spawns one item pedestal from the current room's pool.
RevelationID 643 · Quality 4 · PassiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • +2 Soul Hearts
  • Grants you the ability to fly
  • Holding the fire button charges up a light beam attack similar to Brimstone
  • The light beam deals damage equal to your current tear damage per tick to any enemies touching it
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +2 Soul Hearts. Grants you the ability to fly. Holding the fire button charges up a light beam attack similar to Brimstone.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Consolation PrizeID 644 · Quality 1 · PassivePlayable
Drop poolsBoss Room, Golden Chest, Crane Game
No direct change.
  • When picked up, this item gives you a stat increase, based on which is currently the lowest. Stat options are: +1.0 Damage, +0.6 Tears, +0.2 Speed, +5.25 Range
  • Also drops either a bomb, a key or 3 coins on the ground. This is decided by whatever you have the least of. Keys and bombs are equal to 3 coins for deciding which to give
  • This build: consolationPrize.
TinytomaID 645 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Grants a large orbital that rotates around Isaac
  • When the orbital takes a few hits, they split into two smaller ones
  • After the smaller orbitals take another hit, they explode into 2 blue spiders
  • This item will respawn after a period of time
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Grants a large orbital that rotates around Isaac. When the orbital takes a few hits, they split into two smaller ones. After the smaller orbitals take another hit, they explode into 2 blue spiders.
Brimstone BombsID 646 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Bomb Beggar, Greed Mode Devil Room
No direct change.
  • +5 Bombs
  • Your bombs now explode and fire 4 Brimstone lasers in all cardinal directions
  • Each brimstone laser deals 8 damage per tick for 13 total hits
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. Your bombs now explode and fire 4 Brimstone lasers in all cardinal directions. Each brimstone laser deals 8 damage per tick for 13 total hits.
4.5 VoltID 647 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop, Battery Beggar
No direct change.
  • Active items no longer charge up as normal from clearing rooms
  • Enemies taking damage now charges your item instead. This includes damage you deal, and environmental damage they take e.g. from Fireplaces
  • 60 damage dealt = 1 charge
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Active items no longer charge up as normal from clearing rooms.
Fruity PlumID 649 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room, Key Beggar
No direct change.
  • Gives you a familiar which is a smaller version of the Plum boss, which sprays tears and propels itself around the room
  • Deals 2 contact damage per tick to enemies, and the tears deal 3 damage each
  • Deals contact damage to any enemies it runs into
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a familiar which is a smaller version of the Plum boss, which sprays tears and propels itself around the room. Deals 2 contact damage per tick to enemies, and the tears deal 3 damage each.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Plum FluteID 650 · Quality 1 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, this item calls a friendly version of the Plum boss to fight for you for 10 seconds
  • It will jump to the nearest enemy, slam on the ground and fire tears around it, then propel itself around the room, dealing contact damage to any enemies it touches before disappearing
  • It's possible to get a guaranteed spawn of this item by encountering the Baby Plum boss and not damaging her. After a minute or so of not hurting her she will fly away and spawn Plum Flute
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation.
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 5
  • Name: Plum Flute
  • This build: When used, this item calls a friendly version of the Plum boss to fight for you for 10 seconds.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
Star of BethlehemID 651 · Quality 3 · Passive, FamiliarNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Spawns a star with a white aura around it, that floats very slowly through each room on the floor, making its way towards the boss room
  • While standing inside the aura, you gain a big Tears Up (x2.5 fire rate), Damage Up (damage * 1.2 + 1) and homing tears
  • The star continues to make its way through the floor, even if you aren't in the same room as it, moving faster if you are a long distance ahead of it
  • On The Void floor, it will move towards the boss room containing Delirium
  • Doesn't travel into the Hush or Mega Satan boss room
  • It may travel through secret/curse rooms on its route to the boss room
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a star with a white aura around it, that floats very slowly through each room on the floor, making its way towards the boss room.
Cube BabyID 652 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives you a baby in an ice cube, which can be kicked around the room by walking into it
  • Enemies take damage from Cube Baby depending on how fast it was travelling when it hit them. Having a higher movement speed allows you to kick it harder
  • Enemies hit by the cube while moving have a high chance to become frozen. Frozen enemies never unfreeze and are considered dead by the game. Kicking a frozen enemy will push it into the wall, where it shatters and fires ice shards everywhere (these can then freeze other enemies)
  • Enemies touching the cube while it's not moving or moving slowly will become slowed for a few seconds, and take a small amount of damage
  • Cube Baby and enemies frozen will block enemy shots
  • Cube Baby can be launched across the room if you have a melee weapon
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a baby in an ice cube, which can be kicked around the room by walking into it.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Vade RetroID 653 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Enemies that die now spawn a red ghost, that floats in place of where the enemy died
  • Activating the item causes all red ghosts in the room to explode, dealing damage to any enemies near them
  • The explosion doesn't deal damage to Isaac
  • Damage dealt by each ghost is 3 + 0.04x the HP of the enemy it spawned from
  • Larger enemies such as minibosses will spawn a larger red ghost that causes 3 explosions
  • The red ghosts can be moved around slightly by firing tears through them
  • Using the item will instantly kill any enemy or boss that has the 'ghost' tag and is at 50% or less HP. Enemies include Candler, Lil' Haunt, Polty, Red Ghost, Wizoob and The Forsaken, The Haunt, The Heretic and The Rainmaker bosses. This effect also works on Delirium if it is currently transformed into The Haunt while below half health
  • Recharge Time: Instant
  • Not in random drops: Ghost-enemy instant kills are not implemented.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Vade Retro
  • This build: Enemies that die now spawn a red ghost, that floats in place of where the enemy died. Activating the item causes all red ghosts in the room to explode, dealing damage to any enemies near them.
False PHDID 654 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Identified all pills on pickup, and converts them to their worse counterparts (e.g. Stat Up becomes Stat Down)
  • Any 'Stat down' pills you take give you a permanent +0.6 Damage Up (Horse pills +1.2)
  • Most other pills spawn a black heart when used, including R U A Wizard?, Amnesia, Bad Trip, ???, Paralysis, Retro Vision, I'm Excited
  • +1 Black Heart when picked up
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Identified all pills on pickup, and converts them to their worse counterparts (e.g. Stat Up becomes Stat Down). Any 'Stat down' pills you take give you a permanent +0.6 Damage Up (Horse pills +1.2).
Spin to WinID 655 · Quality 1 · Active & Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • While held, gives you an orbital that blocks enemy shots and deals contact damage equal to 3.5 per tick
  • While the active key is held down, Isaac gains +0.5 Speed and all of your orbitals spin faster and deal more damage
  • Orbital damage is equal to 1.5 x OrbitalDamage + 6 while this effect is active
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Spin to Win
  • This build: While held, gives you an orbital that blocks enemy shots and deals contact damage equal to 3.5 per tick.
VasculitisID 657 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • On death enemies now fire tears in random directions, which can damage other enemies
  • The amount of tears created by this effect depends on the total health of the enemy killed. Smaller enemies spawn 2-3 tears, and bosses spawn a maximum of 16
  • Tears from this effect maintain tear modifiers and status effects that Isaac currently has
  • Isaac doesn't take damage from the tears created by this item
  • Not in random drops: Its original ability is not implemented yet.
  • This build: On death enemies now fire tears in random directions, which can damage other enemies.
Giant CellID 658 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Every time you take damage, a tiny Isaac familiar will spawn, which follows you and shoots tears at nearby enemies that deal 1.3 Damage
  • The mini-Isaacs stay with you between floors, but can die if they take too much damage
  • Maximum number of mini-Isaacs is 16 at one time
  • Mini-Isaac's keep some of the abilities and appearance that Isaac has - e.g. the ability to fly. As Azazel they fire brimstone and as The Forgotten they use a bone club
  • Not in random drops: Copied character abilities and destructible mini-Isaacs are not implemented.
  • This build: giantCell.
TropicamideID 659 · Quality 1 · PassivePlayable
Drop poolsBoss Room
  • +1.5 Range
  • +1.5 Range Up
  • Tear Size Up
  • Tear Size: 1.25
  • This build: +1.5 range. Tear size x1.25.
Card ReadingID 660 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • At the beginning of all future floors, two portals will appear, that can take you to either the Boss room (Red portal), Item room (Yellow portal) or Secret room (Blue portal)
  • After Chapter 3 (The Depths floors) only one portal will spawn
  • Portals disappear if you leave the starting room
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Not in random drops: Its original ability is not implemented yet.
  • This build: At the beginning of all future floors, two portals will appear, that can take you to either the Boss room (Red portal), Item room (Yellow portal) or Secret room (Blue portal).
QuintsID 661 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Greed Mode Item Room
No direct change.
  • Every time an enemy dies, a random familiar spawns where it was killed for the rest of the room
  • The familiar cannot move, but continues to do its usual abilities
  • Possible familiars include: Abel, Boiled Baby, Brother Bobby, Sister Maggy, Little Steven, Demon Baby, Multidimensional Baby, Freezer Baby, Rotten Baby, Harlequin Baby, Ghost Baby, Guardian Angel, Lil Brimstone, Robo-Baby and Seraphim
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Every time an enemy dies, a random familiar spawns where it was killed for the rest of the room. The familiar cannot move, but continues to do its usual abilities.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Tooth and NailID 663 · Quality 2 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Every 5 seconds you become spiky for a second, becoming immune and dealing 40 contact damage to any enemies that touch you
  • The effect is indicated by 4 white flashes, where the item activates on the 4th flash
  • If timed well, can be used to enter curse rooms and open spiky chests without taking damage. You still take damage however when using Blood Donation machines and Devil Beggars
  • This build: toothAndNail.
Binge EaterID 664 · Quality 4 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Causes all pedestal items to show up as rotating items, that swap every 1 second between the original spawned item and a HP up item. This allows you to choose between the item that originally spawned and a HP upgrade every time
  • This effect applies to most items, including those in the shop and devil room. Doesn't apply to progress items like The Polaroid
  • When you pick up an item that increases your maximum HP, you gain 2 permanent stat increases, and a temporary damage boost that slowly goes down over time. Starts at +3.6 damage and goes to 0 after 30 seconds
  • While this temporary damage boost is active, each enemy you kill increases your damage slightly, allowing you to quickly kill multiple enemies and chain the effect for longer
  • This item also gives a -0.03 Speed Down for every food item held
  • The 2 permanent stat increases depend on the item taken:
  • A Snack = +0.2 shot speed, +1 luck. Breakfast = +0.2 shot speed, +1.5 Range. Dessert = +1 Flat Damage, +0.2 shot speed. Dinner = +0.5 tears, +0.2 shot speed.
  • Lunch = +0.5 tears, +1.5 range. Midnight Snack = +1 flat damage, +1 luck. Rotten Meat = +1 flat damage, +1.5 range. Supper = +0.5 tears, +1 luck.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Causes all pedestal items to show up as rotating items, that swap every 1 second between the original spawned item and a HP up item. This allows you to choose between the item that originally spawned and a HP upgrade every time.
Guppy's EyeID 665 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room, Red Chest
No direct change.
  • Shows you to see the contents of chests, sacks, shopkeepers and items that will drop from fires before you destroy them
  • Doesn't work on tinted rocks and other obstacles (e.g. poop, pots)
  • Counts as 1 of 3 cat items needed towards the Guppy transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Shows you to see the contents of chests, sacks, shopkeepers and items that will drop from fires before you destroy them. Doesn't work on tinted rocks and other obstacles (e.g. poop, pots).
  • Reference transformation families: Guppy. Set bonuses and costumes remain a separate unfinished overhaul.
StrawmanID 667 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Spawns a Keeper familiar, that shoots triple tears and follows your exact movements as you walk
  • The keeper has 3 health coins and can die if it takes enough damage. He can pick up coins to restore health
  • Similar to other familiars of this kind, you can hold the drop key to cause him to stand still
  • If he dies, his corpse turns into a few blue spiders. He won't respawn even if you move to a new floor
  • Will always match your current movement speed
  • +1 Bomb
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a Keeper familiar, that shoots triple tears and follows your exact movements as you walk.
Dad's NoteID 668 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsNone (see above), Item Room
No direct change.
  • Only found in the Mausoleum/Gehenna II boss room
  • The item itself has no effect, but triggers the ascent through the backwards path towards the Home floor
  • Once you've beaten Mother once, a door will appear at the starting room in Depths II, which leads to the Mausoleum/Gehenna floors. The door can only be opened if you have The Polaroid, The Negative or Faded Polaroid (the item/trinket is taken away when it opens). This means you need a way to teleport out of the Mom's Foot boss fight. If you didn't find one before this point, there will be a tinted Skull somewhere on Depths II, which contains a Fool card when blown up.
  • Cannot be rerolled by 4-pip dice rooms and Spindown Dice
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Only found in the Mausoleum/Gehenna II boss room. The item itself has no effect, but triggers the ascent through the backwards path towards the Home floor.
SausageID 669 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • +1 HP
  • +0.2 Speed Up
  • +0.5 Tears Up
  • +0.5 Damage Up
  • +1.5 Range Up
  • +0.16 Shot Speed Up
  • +1 Luck Up
  • +6.9% Devil/Angel Room chance
  • +6.9% Planetarium chance
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +1 HP. +0.2 Speed Up. +0.5 Tears Up. +0.5 Damage Up. +1.5 Range Up. +0.16 Shot Speed Up. +1 Luck Up. +6.9% Devil/Angel Room chance. +6.9% Planetarium chance.
Options?ID 670 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsShop
No direct change.
  • Clearing a room will spawn an extra reward, however only one can be picked up - the other one will disappear
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Clearing a room will spawn an extra reward, however only one can be picked up - the other one will disappear.
Candy HeartID 671 · Quality 1 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Each half red heart actually healed by a collected pickup grants one random stat increase.
  • +0.1 Damage
  • +0.05 Tears per second
  • +0.15 Range
  • +0.02 Movement speed
  • +0.1 Luck
  • +0.02 Shot speed
  • Spawns one Red Heart when acquired.
  • This build: candyHeart.
  • The run seed and player determine the stat sequence. Only actual healing or added shield health counts, including blended and bone-heart healing; blocked pickups and replacing existing soul health with black health give no bonus. Bonus deltas are saved on the acquisition log so exact removal and rerolls subtract the owning copy’s gains.
A Pound of FleshID 672 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Demon Beggar
No direct change.
  • This item causes Devil deals to cost money instead of hearts, and shop items to cost hearts instead of money
  • Shop items cost heart containers, and pickups have spikes around them
  • The Devil deal conversion rate is 1 heart container to 15 coins
  • Devil deal items can be on discount similar to the shop, making it 1 heart container = 7 coins instead
  • Not in random drops: Its original ability is not implemented yet.
  • This build: This item causes Devil deals to cost money instead of hearts, and shop items to cost hearts instead of money. Shop items cost heart containers, and pickups have spikes around them.
RedemptionID 673 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsNone, Item Room
No direct change.
  • Every time you enter a devil room and choose not to take an item, you get +1 Damage Up upon entering the next floor
  • The effect is shown via a cross above Isaac's head. Taking a Devil deal breaks the cross and prevents the damage up next floor
  • Taking free pickups such as Black hearts in the Devil room also count
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Every time you enter a devil room and choose not to take an item, you get +1 Damage Up upon entering the next floor.
Spirit ShacklesID 674 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • When you die, you turn into a ghost with 1/2 a red heart and flying, that is chained to your body for 10 seconds. This allows you to stay alive as long as you don't get hit during this 10 second period
  • After this effect occurs, it cannot activate again until Isaac gains a half or full Soul Heart or a Black Heart. Soul Hearts that are used to charge Spirit Shackles will not be added to your health as normal
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When you die, you turn into a ghost with 1/2 a red heart and flying, that is chained to your body for 10 seconds. This allows you to stay alive as long as you don't get hit during this 10 second period.
Cracked OrbID 675 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Secret Room
No direct change.
  • Taking damage reveals a random room on the minimap, and automatically opens certain doors in the current room. Possible doors include any needing a key to open (Item Room, Shop, Alt Path doors), secret rooms and crawl spaces
  • Cracked Orb can also reveal the location of the red room that contains a pedestal item. The Red Key item is required to access it, but it shows the direction to get there
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Taking damage reveals a random room on the minimap, and automatically opens certain doors in the current room. Possible doors include any needing a key to open (Item Room, Shop, Alt Path doors), secret rooms and crawl spaces.
Empty HeartID 676 · Quality 1 · PassivePlayable
Drop poolsItem Room, Demon Beggar
No direct change.
  • Upon entering each new floor, if you have one red heart or less, another one is added
  • This effect works while moving up floors in the backwards path
  • This item has no effect for characters with non-red health i.e. ???, Keeper and The Forgotten
  • This build: emptyHeart.
Astral ProjectionID 677 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Secret Room
No direct change.
  • The first time you take damage in a room, Isaac will become a ghost and time will stop for 3 seconds
  • During this ghost effect, you gain flight, spectral tears and the damage from the next hit you take is negated
  • Isaac returns to his body if you either clear the room or take damage while in ghost form
  • Only happens once per room - taking damage a second time does not turn you into a ghost again
  • Not in random drops: Its original ability is not implemented yet.
  • This build: The first time you take damage in a room, Isaac will become a ghost and time will stop for 3 seconds.
C SectionID 678 · Quality 4 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Ultra Secret Room
No direct change.
  • Your tears are replaced with a charge attack that fires a homing, spectral fetus
  • The fetus tears deal damage equal to 75% of your current tear damage while in contact with enemies, roughly 5 times per second
  • Can't be held down like normal charge attacks, they will release automatically at full charge
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Your tears are replaced with a charge attack that fires a homing, spectral fetus.
Lil AbaddonID 679 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Gives you a familiar that can be charged up to release a black ring, that damages any enemies that touch it with rapid hits (similar to Maw of the Void / Athame effects)
  • The effect does a decent amount of damage, but doesn't scale with your damage upgrades
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you a familiar that can be charged up to release a black ring, that damages any enemies that touch it with rapid hits (similar to Maw of the Void / Athame effects).
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Montezuma's RevengeID 680 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • While firing tears, you now charge up a poop attack for 3 seconds that when released, fires from Isaac's behind
  • The poop attack deals your current tear damage to any enemies caught in the blast
  • Counts as 1 of 3 poop items needed towards the Oh Crap transformation
  • Not in random drops: Its original ability is not implemented yet.
  • This build: While firing tears, you now charge up a poop attack for 3 seconds that when released, fires from Isaac's behind. The poop attack deals your current tear damage to any enemies caught in the blast.
  • Reference transformation families: Oh Crap. Set bonuses and costumes remain a separate unfinished overhaul.
Lil PortalID 681 · Quality 1 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Gives Isaac a little portal familiar, that moves across the screen as you're firing
  • The portal will suck up any consumables and trinkets it travels over, causing it to become larger and deal more contact damage
  • When the portal sucks up 4 pickups, it turns into a portal that can be used to teleport to unexplored rooms around the floor. It can take you to rooms that require bombs/keys, e.g. the Secret Room or the Shop
  • Every time the portal sucks up an item, it spawns a blue attack fly for you
  • Once every room has been explored, the portal does nothing
  • Cannot take you to rooms that aren't a part of the floor structure e.g. Devil Rooms / I AM ERROR rooms
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives Isaac a little portal familiar, that moves across the screen as you're firing.
Worm FriendID 682 · Quality 3 · Passive, FamiliarNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • You gain a familiar that lives under the floor. Every so often it will come up and attempt to grab onto a random enemy in the room, holding them in place and dealing damage
  • The Worm Friend deals 4 damage for 8 ticks total
  • If the enemy moves quickly enough it can miss its attack
  • Not in random drops: Its original ability is not implemented yet.
  • This build: You gain a familiar that lives under the floor. Every so often it will come up and attempt to grab onto a random enemy in the room, holding them in place and dealing damage.
Bone SpursID 683 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Enemies that die will leave behind 1-2 floating bone shards where they die, until you leave the room
  • Other enemies that touch the bone shards will take 3.5 damage, with a chance to either bounce off them or cause it to break and disappear
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Enemies that die will leave behind 1-2 floating bone shards where they die, until you leave the room.
Hungry SoulID 684 · Quality 2 · PassivePlayable
Drop poolsDevil Room
No direct change.
  • Each time an enemy dies, a friendly red soul appears. It will hunt down other enemies, dealing contact damage which scales with your tear damage
  • After 5 seconds the red soul explodes (Isaac doesn't take damage from this effect)
  • This build: hungrySoul.
Jar of WispsID 685 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • When used, gives you number of blue flame orbitals based on the number shown over this item
  • It starts at 1, and increments each activation, giving you more familiars each time you use it
  • The flames fire tears at the same time Isaac does, that deal a flat 3 damage
  • If a flame touches an enemy, it deals contact damage equal to double your current tear damage and then disappears
  • You can have a maximum of 24 flame orbitals at once
  • Each flame has a chance to spawn as one of many variants, such as green flames that poison enemies, or a crucifix flame that spawns a random horseman familiar + Locusts when it is extinguished
  • Recharge Time: 12 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 12. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Jar of Wisps
  • This build: When used, gives you number of blue flame orbitals based on the number shown over this item. It starts at 1, and increments each activation, giving you more familiars each time you use it.
Soul LocketID 686 · Quality 1 · PassivePlayable
Drop poolsAngel Room
No direct change.
  • Each half soul or black heart actually gained from a collected pickup grants one random stat increase.
  • +0.2 Damage
  • +0.1 Tears per second
  • +0.5 Range
  • +0.04 Movement speed
  • +0.04 Shot speed
  • +0.2 Luck
  • Spawns one Soul Heart when acquired.
  • This build: soulLocket.
  • The run seed and player determine the stat sequence. Only actual healing or added shield health counts, including blended and bone-heart healing; blocked pickups and replacing existing soul health with black health give no bonus. Bonus deltas are saved on the acquisition log so exact removal and rerolls subtract the owning copy’s gains.
Friend FinderID 687 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Crane Game
No direct change.
  • Spawns a random charmed enemy which fights by your side and copies your exact movements, similar to how Jacob & Esau work
  • The familiars fire tears at the same time as Isaac, and have a visible health bar showing how much damage they can take before dying
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Friend Finder
  • This build: Spawns a random charmed enemy which fights by your side and copies your exact movements, similar to how Jacob & Esau work.
Inner ChildID 688 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Gives you an extra life
  • You respawn as a tiny version of Isaac, with a greatly reduced hitbox and +0.2 Speed Up
  • When the effect activates you deal 35 damage to nearby enemies
  • Once unlocked, if you have already unlocked the tainted version of the character you're playing as, Inner Child is guaranteed to spawn in the hidden closet on the Home floor
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Gives you an extra life. You respawn as a tiny version of Isaac, with a greatly reduced hitbox and +0.2 Speed Up. When the effect activates you deal 35 damage to nearby enemies.
Glitched CrownID 689 · Quality 4 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Item pedestals now cycle between 5 random items
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Item pedestals now cycle between 5 random items.
Belly JellyID 690 · Quality 3 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Enemies that touch Isaac will now bounce off him and fly off in the opposite direction
  • Bounced enemies will take 10 damage if they slam into the wall
  • This item also gives a random chance for enemy shots to bounce off you without taking damage
  • This build: bellyJelly.
Sacred OrbID 691 · Quality 4 · PassiveNot ready — excluded from drops
Drop poolsAngel Room, Secret Room
No direct change.
  • Increases the quality of generated items
  • Rerolls items with a quality of 0 or 1
  • 33% chance to reroll items with a quality of 2
  • Quality is a hidden mechanic in Repetance for all items and ranges from 0-4. Certain items consider Quality for picking what item to spawn, allowing better items to spawn under certain conditions
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Increases the quality of generated items. Rerolls items with a quality of 0 or 1. 33% chance to reroll items with a quality of 2.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Sanguine BondID 692 · Quality 1 · PassiveNot ready — excluded from drops
Drop poolsDevil Room, Curse Room
No direct change.
  • Spawns a special set of spikes in the Devil Room
  • Taking damage from the spikes has a chance to spawn a reward
  • Nothing - 37.5% chance
  • 6 Pennies - 17% chance
  • +0.5 Damage Up - 27.5% chance
  • 2 Black Hearts - 9.5% chance
  • Random Item - 5.5% chance
  • Leviathan trasformation - 3% chance
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns a special set of spikes in the Devil Room. Taking damage from the spikes has a chance to spawn a reward. Nothing - 37.5% chance. 6 Pennies - 17% chance. +0.5 Damage Up - 27.5% chance.
The SwarmID 693 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Key Beggar
No direct change.
  • When picked up, this gives you 9 orbital flies
  • Each time a fly blocks an enemy shot, it will turn into a blue fly and attack nearby enemies, leaving you with one less orbital
  • Every room clear gives you +1 orbital fly, up to a maximum of 9
  • Counts as 1 of 3 fly items needed towards the Beelzebub transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When picked up, this gives you 9 orbital flies. Each time a fly blocks an enemy shot, it will turn into a blue fly and attack nearby enemies, leaving you with one less orbital.
  • Reference transformation families: Beelzebub. Set bonuses and costumes remain a separate unfinished overhaul.
HeartbreakID 694 · Quality 3 · PassivePlayable
Drop poolsDevil Room, Curse Room
No direct change.
  • Gives you +0.25 Damage Up for every broken heart you have
  • Gives 3 broken hearts when picked up
  • Every hit of damage that would kill you, instead adds 2 more broken hearts and deal 40 damage to all enemies in the room
  • Heartbreak cannot kill you on pickup
  • Broken hearts are empty heart containers that cannot be removed or refilled and will override other types of hearts when you reach 12 total. Replacing all 12 containers with broken hearts will kill you instantly. The only way to remove broken hearts is by donating to a Confessional Machine
  • This build: heartbreak.
Bloody GustID 695 · Quality 2 · PassivePlayable
Drop poolsItem Room, Devil Room
No direct change.
  • Every time you take damage, you gain a Speed Up and a Tears Up
  • The stat increases start small, and scale up each time you take damage (+0.25 Tears Up for the first hit, +0.75 Tears Up for the 6th hit)
  • The effect maxes out at +3 Tears Up and +1 Speed Up after taking damage 6 times. This brings you to the maximum possible speed
  • The effect lasts for the rest of the current floor
  • This build: Damage raises speed and uncapped fire rate for this floor; six hits give +1.02 speed and +3 fire rate.
  • Per-floor shared rage: six hits maximum, cumulative +0.25 / 0.6 / 1.05 / 1.6 / 2.25 / 3 fire rate added after normal tear-stat caps/modifiers. Speed gains total +1.02. Resets next floor or on item removal.
SalvationID 696 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsAngel Room
No direct change.
  • Isaac gains a halo of light around him. When an enemy touches the halo for couple of seconds, a beam of light will come down and deal a burst of damage to it
  • The triggered beam also fires in all 4 cardinal directions, dealing damage to anything it touches
  • Every time Isaac takes damage, the halo grows slightly bigger up to a maximum of 10 times. The size resets when leaving the floor
  • Counts as 1 of 3 angel items needed towards the Seraphim transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac gains a halo of light around him. When an enemy touches the halo for couple of seconds, a beam of light will come down and deal a burst of damage to it.
  • Reference transformation families: Seraphim. Set bonuses and costumes remain a separate unfinished overhaul.
Vanishing TwinID 697 · Quality 2 · Passive, FamiliarNot ready — excluded from drops
Drop poolsSecret Room, Curse Room
No direct change.
  • A fetus familiar follows Isaac, and upon entering the Boss room on each floor, it will transform into a copy of the boss
  • This makes bosses a lot harder, however you now get 2 boss item drops
  • Not in random drops: Its original ability is not implemented yet.
  • This build: A fetus familiar follows Isaac, and upon entering the Boss room on each floor, it will transform into a copy of the boss. This makes bosses a lot harder, however you now get 2 boss item drops.
Twisted PairID 698 · Quality 4 · Passive, FamiliarPlayable
Drop poolsDevil Room
No direct change.
  • You gain two familiar demons, that stay by Isaac's side and fire shots in the same direction as you
  • The familiars deal roughly 40% of Isaac's damage, scaling with damage upgrades you get
  • They sit near and rotate around Isaac depending on which way you're firing tears. They do not block enemy shots
  • Counts as 1 of 3 familiar items needed towards the Conjoined transformation.
  • This build: You gain two familiar demons, that stay by Isaac's side and fire shots in the same direction as you. The familiars deal roughly 40% of Isaac's damage, scaling with damage upgrades you get.
  • One familiar per held copy; removing or rerolling the item updates its count.
  • Familiar Kind: shooter
  • Familiar Copy: true
  • Familiar Dmg Mult: 0.4
  • Familiar Copies: 2
  • Familiar Cd: 0.4
  • Contact-tick implementation: 10 ticks per second; custom-world radii are pixel estimates.
  • Reference transformation families: Conjoined. Set bonuses and costumes remain a separate unfinished overhaul.
Azazel's RageID 699 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • Isaac builds rage each time you clear a new room. This is shown by the Azazel skin spreading on Isaac's face
  • After 4 rooms, Isaac's face will flash red. The next room you enter he will automatically fire a massive red brimstone laser for 4 seconds, dealing huge damage
  • The rage resets back to zero, and the cycle continues every 5 rooms cleared
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Isaac builds rage each time you clear a new room. This is shown by the Azazel skin spreading on Isaac's face.
Echo ChamberID 700 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • When using a card, pill, or rune, you also use a copy of the last 3 cards/pills/runes you used after picking up Echo Chamber
  • Counts as 1 of 3 astrology items needed in the same run to unlock Planetariums
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When using a card, pill, or rune, you also use a copy of the last 3 cards/pills/runes you used after picking up Echo Chamber.
Isaac's TombID 701 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • Spawns an Old chest at the start of all future floors
  • Old Chests work the same as Golden Chests, requiring a key to open but contain different items
  • The Old chest can contain: 3 trinkets (42% chance), 1-3 soul hearts (43% chance), a random item from the Old Chest pool (10% chance) or an angel room item (5% chance)
  • Spawns a second chest in the mirrored floor of Downpour II or Dross II, but only if you had this item before entering the floor
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns an Old chest at the start of all future floors. Old Chests work the same as Golden Chests, requiring a key to open but contain different items.
Vengeful SpiritID 702 · Quality 1 · PassivePlayable
Drop poolsDevil Room, Curse Room
No direct change.
  • Each time you take damage, a red flame orbital will appear around Isaac for the remainder of the floor, up to a maximum of 6
  • The flames deal contact damage which scales with your tear damage
  • Upon reaching 6 flames, they will also start to fire tears along with Isaac, dealing a flat 3.2 damage per tear
  • When entering a new floor, all the flames disappear
  • This build: vengefulSpirit.
Esau JrID 703 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Secret Room
No direct change.
  • Using this item swaps you between the character you started as, and Esau, which has 3 black hearts, +2 base damage and the ability to fly
  • This character keeps its own separate health and items. Items picked up are not shared between the two characters
  • If either character dies it's game over
  • Recharge Time: 1 room
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Esau Jr
  • This build: Using this item swaps you between the character you started as, and Esau, which has 3 black hearts, +2 base damage and the ability to fly.
Berserk!ID 704 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • When activated, Isaac's tears are replaced by a bone sword and he goes on a killing rampage, gaining +0.4 Speed, +3 Flat Damage Up for 5 seconds
  • The sword deals x3 damage if used at close range, or x1.5 damage if charged up and thrown
  • Clearing rooms doesn't charge this item - charge is added equal to damage taken by enemies. This includes all sources of damage, including environmental damage to enemies
  • Killing an enemy while berserk will increase the duration of the effect by 1 second
  • You don't die while in Berserk mode, but taking lethal damage will kill you after the effect wears off
  • The bone sword from this item is similar to Donkey Jawbone from Antibirth
  • Tainted Samson starts with a passive version of this item
  • Recharge Time: Enemy damage taken = charge
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Berserk!
  • This build: When activated, Isaac's tears are replaced by a bone sword and he goes on a killing rampage, gaining +0.4 Speed, +3 Flat Damage Up for 5 seconds.
Dark ArtsID 705 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • When used, Isaac turns into a ghost for 1 second and his speed goes up to maximum (2.0). During this time he can walk over enemies to mark them for death. When the effect wears off, Isaac quickly runs between each marked enemy, dealing high damage to each one rapidly (roughly x2.5 your tear damage)
  • The damage caused by this effect scales up with every target it hits in a row
  • Tainted Judas starts with this item
  • Recharge Time: 7 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 7
  • Name: Dark Arts
  • This build: When used, Isaac turns into a ghost for 1 second and his speed goes up to maximum (2.0). During this time he can walk over enemies to mark them for death. When the effect wears off, Isaac quickly runs between each marked enemy, dealing high damage to each one rapidly (roughly x2.5 your tear damage).
AbyssID 706 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsDevil Room
No direct change.
  • When used, Abyss consumes all pedestal items in the current room and converts them into Red attack flies
  • Red attack flies will charge across the room in the same direction Isaac is shooting, dealing contact damage to enemies equal to Isaac's tear damage
  • The flies don't block enemy shots, but this also means they never die and stay with Isaac forever
  • Tainted Apollyon starts with this item
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Abyss
  • This build: When used, Abyss consumes all pedestal items in the current room and converts them into Red attack flies.
SupperID 707 · Quality 1 · PassivePlayable
Drop poolsBoss Room
  • +1 Red heart containers
  • +1 HP Up
  • This build: +1 heart containers.
StaplerID 708 · Quality 3 · PassivePlayable
Drop poolsBoss Room
  • +1 Damage
  • +1 damage per copy.
  • Fires tears from the right eye; 20/20 retains both eyes.
  • This build: +1 damage; fires tears from the right eye. Blood Clot and Chemical Peel roll together at 50% per tear; 20/20 retains both eyes.
  • Blood Clot and Chemical Peel share a 50% roll per tear, even though the tear comes from the right eye.
  • R U a Wizard? fires the right diagonal consistently; 20/20 keeps its alternating diagonals.
  • Other multishot fans keep all their tears. Lasers retain their native origins.
  • Removing the last copy restores normal eye selection and removes its damage bonus.
Suplex!ID 709 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Crane Game
No direct change.
  • When used, you charge forwards for a second. If you touch an enemy in that time, Isaac will pick it up and slam it on the ground, killing it and sending a shockwave around the impact
  • In the brief period while holding the enemy you can move a target to decide where it lands
  • Actually does work on bosses! However after the attack you end up near the boss, which puts you in danger of taking damage too
  • Scales in damage and area of effect with the player's size
  • Recharge Time: 8 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 8
  • Name: Suplex!
  • This build: When used, you charge forwards for a second. If you touch an enemy in that time, Isaac will pick it up and slam it on the ground, killing it and sending a shockwave around the impact.
Bag of CraftingID 710 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used will do a swipe attack in any direction. Can be used to store up to 8 consumables in, such as hearts, coins, keys, bombs, cards etc
  • When the bag has 8 items you can hold down the activate button for 2 seconds to craft yourself a brand new random item
  • Bag of Crafting's recipes are based on your current seed, but there are some fixed recipes that exist in every run, e.g. 8 coins = Slot Machine
  • While playing as Tainted Cain you get a visual interface to see what items are in the bag, allowing you to see what item will be created and swap out specific consumables
  • Has other uses - Will deal 3 damage to enemies it hits, and can be used to quickly push bombs and objects across rooms
  • Tainted Cain starts with this item, but can be used by any character after unlocking it and finding it in the item room
  • Cannot be used to craft another Bag of Crafting!
  • Recharge Time: Instant
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Bag of Crafting
  • This build: When used will do a swipe attack in any direction. Can be used to store up to 8 consumables in, such as hearts, coins, keys, bombs, cards etc.
FlipID 711 · Quality 4 · ActiveNot ready — excluded from drops
Drop poolsCurse Room, Secret Room, Shop
No direct change.
  • While holding flip, a ghost item will appear behind item pedestals upon entering Item Rooms and Shop that cannot be interacted with
  • When activated, all real items in the room will be swapped with the ghost items behind them
  • The ghost item stays there even if you take the regular item, allowing you to use Flip to get both of them
  • Does nothing with item pedestals that don't have a ghost item behind them
  • When playing as Tainted Lazarus, activating Flip also changes you between Lazarus and Dead Lazarus
  • Tainted Lazarus starts with this item, but can be used by any character after unlocking it and finding it in the item room
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Flip
  • This build: While holding flip, a ghost item will appear behind item pedestals upon entering Item Rooms and Shop that cannot be interacted with.
LemegetonID 712 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsDevil Room, Library
No direct change.
  • When used, gives you an orbital flame which represents another random passive item in the game. While you have this flame you also have that item's effect
  • The flame deals double your tear damage to any enemies that touch it, but if it takes too much damage the flame will disappear and you lose the item's effect
  • Tainted Bethany starts with this item
  • Wisps are randomly chosen from Item Room, Boss Room and Shop item pools, with a 25% chance to pick the same pool as the current room
  • Counts as 1 of 3 book items needed towards the Bookworm transformation.
  • Recharge Time: 6 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Lemegeton
  • This build: When used, gives you an orbital flame which represents another random passive item in the game. While you have this flame you also have that item's effect.
  • Reference transformation families: Bookworm. Set bonuses and costumes remain a separate unfinished overhaul.
SumptoriumID 713 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, removes half a heart of health and creates a clot familiar
  • Clot familiars follow Isaac's exact movements including flight, firing tears and tear effects
  • Holding down the swap button will cause all your clots to stay in place
  • Works differently as Tainted Eve - instead clots are created by firing for 2 seconds, down to a minimum of half a red heart. Using Sumptorium as her will then cause all Clots to be consumed and return your hearts back to you. Clots returning back to Eve deal 3x damage as they suck back in
  • The type of heart consumed to create a clot will give it different abilities: Soul Hearts = More health, Black Hearts = Dark Matter effect, Eternal Hearts = Sacred Heart effect, Gold Hearts = Midas Touch effect, Bone Hearts = Compound Fracture effect, Rotten Hearts = Less health
  • Tainted Eve starts with this item, but can be used by any character after unlocking it and finding it in the item room
  • Recharge Time: 10 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 10
  • Name: Sumptorium
  • This build: When used, removes half a heart of health and creates a clot familiar. Clot familiars follow Isaac's exact movements including flight, firing tears and tear effects.
RecallID 714 · Quality 0 · ActiveNot ready — excluded from drops
Drop poolsNone, Item Room
No direct change.
  • When used, this will retreive the Tainted Forgotten's skeleton back to its owner's hands from any distance
  • Tainted Forgotten's Birthright effect. Cannot be obtained and has no use for any other character
  • Birthright is a Shop item that has unique effects depending on what character you're playing as
  • Recharge Time: 3 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 3
  • Name: Recall
  • This build: When used, this will retreive the Tainted Forgotten's skeleton back to its owner's hands from any distance.
HoldID 715 · Quality 0 · ActiveNot ready — excluded from drops
Drop poolsNone, Item Room
No direct change.
  • This is the item Tainted Blue Baby (???) uses as his main mechanic
  • Killing or damaging enemies spawns various poops, which add to his collection. Pressing the bomb button will put the next poop into the 'Hold' jar. Pressing it again allows you to throw it at enemies. Each poop has random effects like Butt Bombs, Fire Poops etc
  • Tainted Blue Baby starts with this item, and is the only one who can use it
  • Recharge Time: Instant
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: zero; capacity 0. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Hold
  • This build: This is the item Tainted Blue Baby (???) uses as his main mechanic.
Keeper's SackID 716 · Quality 3 · PassiveNot ready — excluded from drops
Drop poolsShop, Secret Room
No direct change.
  • Spawns 3 random coins and a key when picked up
  • Buying items from the shop gives you random stat upgrades. The more you spend the higher the stat increase
  • Possible stats include Speed, Damage and Range
  • 15c items give all 3 stats: +1 Damage Up, +0.03 or +0.06 Speed Up, +0.25 or +0.5 Range Up
  • 5c items give 1 or 2 stats: +0.5 Damage Up **OR** +0.25 Range and +0.03 Speed Up
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Spawns 3 random coins and a key when picked up. Buying items from the shop gives you random stat upgrades. The more you spend the higher the stat increase.
Keeper's KinID 717 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Secret Room
No direct change.
  • While in a room with enemies, blue spiders will randomly spawn from objects in the room (e.g. rocks, pots, stone blocks)
  • All rocks spawn 0-2 blue spiders when destroyed
  • Counts as 1 of 3 spider items needed towards the Spider Baby transformation.
  • Not in random drops: Its original ability is not implemented yet.
  • This build: While in a room with enemies, blue spiders will randomly spawn from objects in the room (e.g. rocks, pots, stone blocks). All rocks spawn 0-2 blue spiders when destroyed.
  • Reference transformation families: Spider Baby. Set bonuses and costumes remain a separate unfinished overhaul.
Keeper's BoxID 719 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsShop, Secret Room, Wooden Chest
No direct change.
  • When used, spawns a random shop item or consumable, however you have to pay the relevant cost to pick it up
  • Can include anything that would appear in the shop
  • Recharge Time: 4 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Keeper's Box
  • This build: When used, spawns a random shop item or consumable, however you have to pay the relevant cost to pick it up. Can include anything that would appear in the shop.
Everything JarID 720 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Crane Game
No direct change.
  • With every bar of charge this item has, a different consumable is shown inside the Jar. 1 = poop, 2 = penny, 3 = bomb, 4 = key, 5 = red heart, 6 = pill, 7 = card, 8 = soul heart, 9 = gold heart, 10 = gold key, 11 = gold bomb
  • At the full 12 charges, a completely random effect will happen. It can be anything including spawning a bunch of consumables, spawning a glitched pedestal item, creating a bunch of light beams, spawning troll bombs or nothing at all
  • Recharge Time: 12 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Everything Jar
  • This build: With every bar of charge this item has, a different consumable is shown inside the Jar. 1 = poop, 2 = penny, 3 = bomb, 4 = key, 5 = red heart, 6 = pill, 7 = card, 8 = soul heart, 9 = gold heart, 10 = gold key, 11 = gold bomb.
TMTRAINERID 721 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsSecret Room
No direct change.
  • When picked up, all future items become 'glitched', causing them to become random combinations of 2-3 effects based on other items
  • Glitched items can be passive or active and are completely randomly generated with infinite possibilities (similar to other 'Randomizer' games)
  • The ratio of active to passive item effects given is 1/4
  • Random effects combine effects that exist on other items, and assign them to a random event (e.g. on enemy death, on room clear, on damage taken etc.)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: When picked up, all future items become 'glitched', causing them to become random combinations of 2-3 effects based on other items.
Anima SolaID 722 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, it puts the closes enemy in chains for 5 seconds, preventing it from moving. You can release the enemy early by using it again
  • Tainted Jacob starts with this item. While playing as him Anima Sola will always target Dark Esau. Releasing Dark Esau will cause him to charge directly at Jacob and deal damage to anything in his path. If used in a room with no enemies, Dark Esau will instantly spawn
  • Will chain up to two targets if you have Car Battery, if only one valid target is present it will be chained for twice the duration
  • Recharge Time: 15 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: timed; capacity 1. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Seconds: 15
  • Name: Anima Sola
  • This build: When used, it puts the closes enemy in chains for 5 seconds, preventing it from moving. You can release the enemy early by using it again.
Spindown DiceID 723 · Quality 4 · ActivePlayable
Drop poolsItem Room, Secret Room, Crane Game
No direct change.
  • Rerolls all pedestal items, lowering all their internal item IDs by 1
  • For example: Brimstone's ID = 118, so it would be rerolled into Dead Bird (ID = 117)
  • Sad Onion (ID = 1) will reroll into nothing
  • There are some gaps in item IDs which are skipped if no item exists, or will reroll into unexpected items if hidden items are present at that ID. For example rerolling Plan C (ID = 475) changes it into the Broken Glass Cannon, which is a hidden item with ID = 474
  • Items that are yet to be unlocked will also be skipped over, preventing you from getting items you don't have access to yet
  • Recharge Time: 6 rooms
  • Active charge policy: room; capacity 6. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Spindown Dice
  • This build: Rerolls all pedestal items, lowering all their internal item IDs by 1. For example: Brimstone's ID = 118, so it would be rerolled into Dead Bird (ID = 117).
HypercoagulationID 724 · Quality 2 · PassivePlayable
Drop poolsItem Room
No direct change.
  • Upon taking damage you have a chance to drop the heart that you just lost. It gives you 2 seconds to pick it up again to re-heal, before it disappears
  • This build: hypercoagulation.
IBSID 725 · Quality 0 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Whenever you deal damage to an enemy, has a chance to give the effect of one of Tainted ???'s unique poops
  • Corn poop - Spawns a blue fly every 2 seconds
  • Flaming poop - Leaves behind fire that damages enemies
  • Stinky poop - Emits a toxic cloud
  • Black poop - Creates slowing black creep. Confuses all enemies briefly when destroyed
  • White poop - Same effect as Hallowed Ground
  • Stone poop - Deals extra thrown damage, can hit multiple enemies. Takes more shots before breaking
  • Bomb poop - Throws a butt bomb that explodes after 2 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Whenever you deal damage to an enemy, has a chance to give the effect of one of Tainted ???'s unique poops. Corn poop - Spawns a blue fly every 2 seconds.
HemoptysisID 726 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • Allows you to quickly double tap a shoot button to sneeze on nearby enemies, dealing x1.5 your tear damage and pushing them back slightly
  • If an enemy is pushed into a wall or object it takes 10 damage
  • Not in random drops: Its original ability is not implemented yet.
  • This build: Allows you to quickly double tap a shoot button to sneeze on nearby enemies, dealing x1.5 your tear damage and pushing them back slightly.
Ghost BombsID 727 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsItem Room, Bomb Beggar
No direct change.
  • +5 Bombs
  • Bombs become spectral and can now pass through objects
  • Bombs spawn a friendly white soul, which will hunt down other enemies, dealing contact damage which scales with your tear damage
  • After 10 seconds the white soul explodes dealing 7 damage to nearby enemies. Isaac doesn't take damage from this effect
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +5 Bombs. Bombs become spectral and can now pass through objects. Bombs spawn a friendly white soul, which will hunt down other enemies, dealing contact damage which scales with your tear damage.
GelloID 728 · Quality 3 · ActiveNot ready — excluded from drops
Drop poolsItem Room, Devil Room
No direct change.
  • Spawns a familiar that's attached via an Umbilical Cord, but will move and shoot in the same direction Isaac is shooting
  • When activated you first need to throw the familiar, which deals x3 your tear damage to any enemies it touches
  • Gello's tears deal x0.75 your tear damage (x1.0 if Lilith)
  • Can be used multiple times per room to spawn more familiars, however they only last for the current room
  • Recharge Time: 2 rooms
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 3. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Gello
  • This build: Spawns a familiar that's attached via an Umbilical Cord, but will move and shoot in the same direction Isaac is shooting.
Decap AttackID 729 · Quality 2 · ActiveNot ready — excluded from drops
Drop poolsItem Room
No direct change.
  • When used, this item allows you to throw your head where it will sit as a stationary sentry firing bullets until you walk over and pick it up again
  • Throwing Isaac's head deals 24 damage to anything it hits while being thrown
  • Your hitbox remains with the body. Enemies touching the head don't hurt Isaac
  • Recharge Time: 4 seconds
  • Not in random drops: Its original ability is not implemented yet.
  • Active charge policy: room; capacity 4. One charge per cleared normal room; large rooms give two. Battery pickups follow their own charge rules.
  • Name: Decap Attack
  • This build: When used, this item allows you to throw your head where it will sit as a stationary sentry firing bullets until you walk over and pick it up again.
Glass EyeID 730 · Quality 3 · PassivePlayable
Drop poolsBoss Room, Crane Game, Golden Chest
  • +0.75 Damage
  • +1 Luck
  • +0.75 Damage Up
  • +1 Luck Up
  • This build: +0.75 damage. +1 luck.
StyeID 731 · Quality 2 · PassiveNot ready — excluded from drops
Drop poolsBoss Room
No direct change.
  • +28% Damage Up (right eye only)
  • +7 Range Up (right eye only)
  • -0.3 Shot Speed Down (right eye only)
  • Not in random drops: Its original ability is not implemented yet.
  • This build: +28% Damage Up (right eye only). +7 Range Up (right eye only). -0.3 Shot Speed Down (right eye only).
Mom's RingID 732 · Quality 3 · PassivePlayable
Drop poolsShop, Golden Chest, Mom's Chest, Old Chest
  • +1 Damage
  • +1 Damage Up
  • Drops 1 random rune or soul stone when picked up
  • Counts as 1 of 3 mom items needed towards the Mom transformation
  • This build: +1 damage; spawns a Rune or Soul Stone. Counts toward Yes Mother?: three Mom item copies grant a trailing contact knife dealing 2x tear damage.
  • Reference transformation families: Mom. Yes Mother? is implemented: three qualifying Mom item copies grant a trailing knife for 2× current tear damage at 20 contact ticks per second. Duplicate passive copies count; dropping below three removes it. The knife follows movement rather than aim. Room changes reset contact history; the host owns damage and clients display the synchronized knife. Unfinished item abilities, unrelated knife-item synergies and other transformation families remain separate.

Pickups

PickupWhat it does
Red HeartRestore one red heart. Does not add capacity.
Soul HeartGain one protective blue heart. Lost soul health cannot be refilled.
Eternal HeartCarry this half to the next floor, or collect two, for a red heart container.
Black HeartOne protective black heart. Losing its last half damages every enemy in the room.
Rotten HeartOne fragile red heart. Each room cleared spawns two blue flies.
Bone HeartA refillable bone container. The empty shell absorbs one hit before breaking.
Golden HeartCoats your rightmost heart. When lost, drops coins and damages nearby enemies.
Broken HeartPermanently consumes one health slot. Twelve broken hearts are fatal.
Blended HeartRefill up to one red heart; any remaining half becomes soul health.
Half Soul HeartGain half a soul heart. Can complete a half black heart.
CoinOne coin.
BombOne bomb.
KeyOpens a locked chest.
BatteryRestore one active-item charge.
PillCarry one pill. C / PILL to use.

Bible tokens (Angel Room rewards)

TokenNote
Genesis SproutA token of creation. An Angel Room victory reward.
Exodus TabletsA token of deliverance. An Angel Room victory reward.
Psalms HarpA token of praise. An Angel Room victory reward.
Gospel CrossA token of faith. An Angel Room victory reward.
Revelation SealA token of revelation. An Angel Room victory reward.

You can carry up to 12 heart slots. Red hearts are containers, soul and black hearts are protective, bone hearts absorb one hit, rotten hearts spawn blue flies, golden hearts pay out, and broken hearts permanently shrink your health.

Pills

40 supported effects out of 50 catalogued effects. Every design has a permanent effect across all runs, floors, rooms, saves and multiplayer sessions. Using a pill identifies it for the current run; its effect never shuffles. Existing saved custom pills retain their original design and equivalent effect.

Unsupported effects do not enter drops. Horse pills and golden pills are not available yet. Health amounts below use full hearts; gameplay stores two half-heart units per heart. Isaac pill reference.

Pill & fixed designEffectDetailsAvailability
Bad GasEffect 0 · Design 1
5 nearby damage plus poison.Nearby radius: 100 game pixels. Poison: 3.6 seconds.Supported
Bad TripEffect 1 · Design 2
Lose one heart; at critical health, refill red health instead.—Supported
Balls of SteelEffect 2 · Design 3
Gain two soul hearts.—Supported
Bombs Are KeyEffect 3 · Design 4
Swap bomb and key counts.—Supported
Explosive DiarrheaEffect 4 · Design 5
Drop five lit bombs, one each second.Five lit bombs at one-second intervals. Does not spend carried bombs.Supported
Full HealthEffect 5 · Design 6
Refill red heart containers.—Supported
Health DownEffect 6 · Design 7
Lose one heart container; becomes Health Up at one container or less.—Supported
Health UpEffect 7 · Design 8
Gain one empty heart container.—Supported
I Found PillsEffect 8 · Design 9
Changes facial expression.—Supported
PubertyEffect 9 · Design 10
Three uses grant Adult and one full heart container.Adult health bonus triggers once after three uses; hair/zit costume artwork is pending.Supported
Pretty FlyEffect 10 · Design 11
Gain a projectile-blocking fly orbital, maximum three.One defensive orbital per use, maximum three. Blocks ordinary enemy bullets, not beams or rolling boulders. Does not replace allied blue attack flies.Supported
Range DownEffect 11 · Design 12
-1 range.—Supported
Range UpEffect 12 · Design 13
+1.25 range.—Supported
Speed DownEffect 13 · Design 14
-0.12 movement speed.—Supported
Speed UpEffect 14 · Design 15
+0.15 movement speed.—Supported
Tears DownEffect 15 · Design 16
-0.28 tears per second.—Supported
Tears UpEffect 16 · Design 17
+0.35 tears per second.—Supported
Luck DownEffect 17 · Design 18
-1 luck.—Supported
Luck UpEffect 18 · Design 19
+1 luck.—Supported
TelepillsEffect 19 · Design 20
Teleport to a random room, with special destination chances.—Required mechanic is unfinished; excluded from random drops.
48 Hour EnergyEffect 20 · Design 21
Recharge active item; spawn 2-3 batteries.Charges the equipped active to its real capacity and creates 2–3 batteries.Supported
HematemesisEffect 21 · Design 22
Reduce red health to one heart; spawn 1-4 red hearts.—Supported
ParalysisEffect 22 · Design 23
Prevent moving and shooting for two seconds.—Supported
I Can See Forever!Effect 23 · Design 24
Open secret and super-secret entrances for this floor.—Supported
PheromonesEffect 24 · Design 25
Charm enemies in this room.—Required mechanic is unfinished; excluded from random drops.
AmnesiaEffect 25 · Design 26
Hide the map for this floor.—Supported
Lemon PartyEffect 26 · Design 27
Create yellow creep dealing 22 damage three times per second.Eight seconds; 22 damage per tick, three ticks per second. Radius: 110 game pixels.Supported
R U a Wizard?Effect 27 · Design 28
Fire diagonally for 30 seconds.Alternates +45° / −45° once per volley. Lasts 30 gameplay seconds across room changes; preserves multishot.Supported
Percs!Effect 28 · Design 29
Damage capped at half a heart for this room.Half a heart maximum per hit in this room. Addicted overrides this; The Wafer takes priority.Supported
Addicted!Effect 29 · Design 30
Damage is a full heart for this room; The Wafer prevents this.At least one full heart per hit in this room. The Wafer takes priority.Supported
Re-LaxEffect 30 · Design 31
Drop poop while moving for a short time.Drops ordinary 12-HP poop behind a moving player for one second. Placement skips pits, occupied cells, players, chests and door clear zones.Supported
???Effect 31 · Design 32
Curse of the Maze for this floor.—Required mechanic is unfinished; excluded from random drops.
One Makes You LargerEffect 32 · Design 33
Increase visual size without increasing the hitbox.—Required mechanic is unfinished; excluded from random drops.
One Makes You SmallEffect 33 · Design 34
Reduce visual and collision size.—Required mechanic is unfinished; excluded from random drops.
Infested!Effect 34 · Design 35
Destroy poop and spawn allied spiders.Destroys every intact poop and creates one blue spider per poop. Spiders hop on the floor, respect rocks and pits, deal twice current tear damage once, then disappear. Maximum 64 allied spiders.Supported
Infested?Effect 35 · Design 36
Spawn allied spiders based on enemy count.One blue spider per living enemy; 1?3 spiders in an empty room. Same ground movement and damage as Infested!.Supported
Power Pill!Effect 36 · Design 37
Temporary invulnerability, fear and damaging contact.—Required mechanic is unfinished; excluded from random drops.
Retro VisionEffect 37 · Design 38
Pixelation and reduced colors for 30 seconds.Three pixelation and color-reduction pulses over 30 gameplay seconds. The HUD remains readable.Supported
Friends Till the End!Effect 38 · Design 39
Spawn three allied blue flies.Three attacking blue flies. Each deals twice the current tear damage, then disappears.Supported
X-LaxEffect 39 · Design 40
Create slippery brown creep.Five-second slippery brown pool. Reduced ground traction affects players touching it; flyers are immune. Radius: 60 game pixels.Supported
Something's Wrong...Effect 40 · Design 41
Create slowing black creep.Five-second black pool slows grounded enemies touching it without dealing damage. Flyers are immune. Radius: 60 game pixels.Supported
I'm Drowsy...Effect 41 · Design 42
Slow the room, including enemies, player and music.—Required mechanic is unfinished; excluded from random drops.
I'm Excited!!!Effect 42 · Design 43
Speed the room, with three later reactivations.—Required mechanic is unfinished; excluded from random drops.
Gulp!Effect 43 · Design 44
Absorb held trinkets permanently.—Required mechanic is unfinished; excluded from random drops.
Horf!Effect 44 · Design 45
Fire one explosive Ipecac tear dealing 200 damage.—Required mechanic is unfinished; excluded from random drops.
Feels Like I'm Walking on Sunshine!Effect 45 · Design 46
+0.28 speed and invulnerability for six seconds; cannot fire tears. Ends on room exit.Invulnerable and +0.28 movement speed, capped at 2.00, for six seconds. Normal tear firing disabled. Reuse refreshes duration, without stacking speed. Room exit removes only this bonus and leaves other protection intact.Supported
Vurp!Effect 46 · Design 47
Drop the previously used pill.Preserves the previous pill’s fixed design. With no previous pill, creates Vurp itself.Supported
Shot Speed DownEffect 47 · Design 48
-0.15 shot speed.—Supported
Shot Speed UpEffect 48 · Design 49
+0.15 shot speed.—Supported
Experimental PillEffect 49 · Design 50
Raise one random stat and lower a different random stat.Chooses health, range, movement speed, tears, luck, or shot speed; increases one and decreases a different one using the normal stat-pill amounts.Supported

Cards

97 cards have gameplay handlers. Cards and pills share one pocket slot; another pickup drops the previous pocket item. Use C, R3 or the touch pocket button. Ground cards use the shared card sprite; held cards use their matching front artwork. Current room-clear card chance is 4% after earlier rewards; chest weight is 1.5. Room and enemy counterparts are used where applicable.

CardIDEffectNumbersStatus
0 - The Fool
1Teleports the party to the starting room of the floor.
  • Destination: start room
Gameplay effect
I - The Magician
2Homing tears and +3 range until you leave the room.
  • Homing tears
  • Range +3.0
  • Lasts: current room
Gameplay effect
II - The High Priestess
3Mom's foot stomps the highest-health enemy for 300 damage and smashes nearby obstacles. With no enemies it stomps you instead; move away to dodge.
  • Foot damage 300
  • Self stomp: 1 heart (2 half hearts) when no enemy
  • Landing delay 1.0 s
  • Blast radius 70 px
Gameplay effect
III - The Empress
4Whore of Babylon boost until you leave the room, whatever your health.
  • Damage +1.5
  • Speed +0.3
  • Lasts: current room
Gameplay effect
IV - The Emperor
5Teleports the party into the floor's Boss Room.
  • Destination: Boss Room
Gameplay effect
V - The Hierophant
6Drops two Soul Hearts.
  • 2 Soul Hearts
Gameplay effect
VI - The Lovers
7Drops two Red Hearts.
  • 2 full Red Hearts
Gameplay effect
VII - The Chariot
8Invulnerable and faster for six seconds. You cannot shoot; touching enemies hurts them.
  • Duration 6 s
  • Speed +0.28
  • Contact damage 20 twice per second
  • Enemies at 40 HP or less take 40
  • Cannot shoot
Gameplay effect
VIII - Justice
9Drops one Heart, one Key, one Bomb and one Coin.
  • 1 Heart + 1 Key + 1 Bomb + 1 Coin
Gameplay effect
IX - The Hermit
10Teleports the party to the Shop.
  • Destination: Shop
Gameplay effect
X - Wheel of Fortune
11Spawns a Slot Machine (75%) or a Fortune Telling Machine (25%) next to you, with a 1% chance of a Crane Game. Bump into it to pay.
  • Slot: 1 coin, wiki coin-gamble table
  • Fortune: 1 coin, fortune / Soul Heart / card / explosion
  • Crane: 5 coins, 25% item, breaks after 3 prizes
  • Bombs break them for pickups
Gameplay effect
XI - Strength
12Magic Mushroom boost for one room, without the heal.
  • Damage +0.3 and x1.5
  • Speed +0.3
  • Range +2.5
  • +1 Red Heart container (kept if removing it would kill you)
  • Lasts: current room
Gameplay effect
XII - The Hanged Man
13Flight until you leave the room.
  • Flying
  • Lasts: current room
Gameplay effect
XIII - Death
14Necronomicon blast: damages every enemy in the room.
  • 40 damage to every enemy
Gameplay effect
XIV - Temperance
15Spawns a Blood Donation Machine next to you. Bump into it to give blood for coins.
  • Half a heart per donation (a heart from floor 7)
  • 1-2 coins back
  • Algiz makes it free
Gameplay effect
XV - The Devil
16Book of Belial boost until you leave the room.
  • Damage +2.0
  • Lasts: current room
Gameplay effect
XVI - The Tower
17Spawns six Troll Bombs around the room. Their fuses are random.
  • 6 Troll Bombs
  • Fuse 0.6-1.8 s (random)
  • 1 heart damage to anyone caught
Gameplay effect
XVII - The Stars
18Teleports the party to the Treasure Room.
  • Destination: Treasure Room (no Planetarium in this game)
Gameplay effect
XVIII - The Moon
19Teleports the party to a Secret Room, opening its wall.
  • Destination: Secret Room
Gameplay effect
XIX - The Sun
20Full health, 100 damage to every enemy in the room, and the floor map is revealed.
  • Heal all Red Hearts
  • 100 damage to every enemy
  • Reveals the map except Super Secret rooms
Gameplay effect
XX - Judgement
21Spawns a beggar: Beggar 61.5%, Devil Beggar 33.33%, Battery Bum 1.33%, Rotten Beggar 1.31%, Key Master 1.28%, Bomb Bum 1.24%.
  • Pays out pickups, cards or an item pedestal
  • Item payout makes the beggar leave
  • Payout timing: odds rise each donation, guaranteed by the 8th (wiki-documented for the Devil Beggar)
Gameplay effect
XXI - The World
22Reveals the whole floor map except Super Secret rooms.
  • Reveals map, Super Secret excluded
Gameplay effect
2 of Clubs
23Doubles your bombs; gives 2 if you have none.
  • Bombs x2, or +2 from zero
  • Cap 99
Gameplay effect
2 of Diamonds
24Doubles your coins; gives 2 if you have none.
  • Coins x2, or +2 from zero
  • Cap 99
Gameplay effect
2 of Spades
25Doubles your keys; gives 2 if you have none.
  • Keys x2, or +2 from zero
  • Cap 99
Gameplay effect
2 of Hearts
26Doubles your Red Hearts; with only empty containers it heals one heart.
  • Red hearts x2 up to your containers
  • Empty containers: +1 heart
Gameplay effect
Ace of Clubs
27Every pickup and chest in the room turns into a Bomb.
  • Room pickups and chests become Bombs
  • Non-boss enemies also become pickups
Gameplay effect
Ace of Diamonds
28Every pickup and chest in the room turns into a Coin.
  • Room pickups and chests become Coins
  • Non-boss enemies also become pickups
Gameplay effect
Ace of Spades
29Every pickup and chest in the room turns into a Key.
  • Room pickups and chests become Keys
  • Non-boss enemies also become pickups
Gameplay effect
Ace of Hearts
30Every pickup and chest in the room turns into a Red Heart.
  • Room pickups and chests become Red Hearts
  • Non-boss enemies also become pickups
Gameplay effect
Joker
31Teleports the party to a Devil or Angel Room through a hatch in the Boss Room.
  • Destination: Devil or Angel Room, 50/50
  • Return hatch leads to the Boss Room
Gameplay effect
Hagalaz
32Destroys every breakable obstacle in the room (rocks, tinted rocks, poop, pots, barrels explode), reveals hidden secret-room doors, and destroys stone-themed enemies.
  • All obstacles except pits, blocks, spikes and key blocks
  • Secret doors revealed
  • Stone Golems, Stone Hoppers and Sentinels die
Gameplay effect
Jera
33Duplicates every pickup and unopened chest in the room.
  • Each pickup and closed chest copied once
Gameplay effect
Ehwaz
34Creates a trapdoor under you that leads to the next floor.
  • Trapdoor leads to the next floor
Gameplay effect
Dagaz
35Grants a Soul Heart and clears Amnesia / ??? map blindness. This game has no other floor curses to remove.
  • +1 Soul Heart (2 half hearts)
Gameplay effect
Ansuz
36Reveals the whole floor map including Secret and Super Secret rooms.
  • Secret + Super Secret rooms shown
  • Lasts for the floor
Gameplay effect
Perthro
37Rerolls every unclaimed item pedestal in the room (like the D6), keeping the room's item pool.
  • All pedestal, shop, devil/angel offer and library items rerolled
Gameplay effect
Berkano
38Summons 3 standard locusts that last for the room.
  • 3 locusts
  • Each hit deals your tear damage x1
  • Removed on leaving the room
Gameplay effect
Algiz
39Grants a shield that negates all damage for 20 seconds. Uses stack additively.
  • 20 s per use
  • Blocks every damage source including machine and beggar costs
Gameplay effect
Blank Rune
40Triggers a random rune effect (any rune except Rune Shard) and has a 25% chance to drop another Blank Rune.
  • 25% to drop another Blank Rune
Gameplay effect
Black Rune
41Deals 40 damage to every enemy, consumes every free pedestal item for two random stat boosts each, and turns every pickup into a Blue Fly or Blue Spider.
  • 40 damage to all enemies
  • Per item: 2 of +1 damage / +0.5 tears / +0.2 speed / +0.2 shot speed / +1 luck / +2.5 range
  • Pickup to fly or spider: 50/50 (split not published)
Gameplay effect
Chaos Card
42Throws the card in your moving direction; it kills any enemy it touches, breaks obstacles and opens doors, then sticks in the wall.
  • Kills anything in its path, bosses included
  • Thrown at 620 px/s
Gameplay effect
Credit Card
43Makes every shop item and devil deal in the room free.
  • All unsold offers cost 0
  • Stays free after leaving
Gameplay effect
Rules Card
44Shows one of eight cryptic hints (sometimes with an Easter-egg seed).
  • 8 messages
  • 31 possible seeds
Gameplay effect
A Card Against Humanity
45Fills the room with poop over a few seconds, in every free tile (never on existing obstacles or in doorways). Leaving early leaves the room partly filled.
  • Poop in every free tile
  • About 20 tiles per second
  • Tiles under players, enemies and obstacles are skipped
Gameplay effect
Suicide King
46Kills you and spawns 10 pickups around the spot.
  • 10 pickups
  • Another living player can still revive you with a heart
Gameplay effect
Get out of Jail Free Card
47Opens every door in the room, like Dad's Key.
  • Locked and forced-shut doors open
Gameplay effect
? Card
48Uses your active item once without spending charge.
  • Free activation of the held active item
  • No charge spent
Gameplay effect
Dice Shard
49Rerolls every pedestal item (D6) and every pickup (D20) in the room.
  • Pedestals rerolled in their pool
  • Pickups become random pickups
Gameplay effect
Emergency Contact
50Two of Mom's Hands grab two random enemies, dealing 40 damage and holding enemies with more than 40 HP, and bosses, for 5 seconds.
  • Up to 2 hands
  • 40 damage each
  • 5 s hold if HP > 40 or boss
Gameplay effect
Holy Card
51Grants a Holy Mantle shield that blocks the next hostile hit.
  • Blocks 1 hit
  • Lasts until a hit is blocked
  • Does not stack
Gameplay effect
Huge Growth
52For the room: +7 damage, +3 range, bigger Isaac who destroys obstacles by walking into them.
  • Damage +7 flat
  • Range +3.0
  • Sprite x1.6, hitbox unchanged
  • Lasts: current room
Gameplay effect
Ancient Recall
53Spawns 3 random cards (never runes or soul stones).
  • 3 cards
Gameplay effect
Era Walk
54For the room: enemies are slowed, speed +0.5 and shot speed -1.0.
  • Speed +0.5
  • Shot speed -1.0
  • Enemies at half speed
  • Lasts: current room
Gameplay effect
Rune Shard
55Activates a random weakened rune effect.
  • Algiz 3 s shield
  • Ansuz reveals rooms up to 3 doors away
  • Berkano 1 locust
  • Dagaz half Soul Heart
  • Hagalaz breaks about a third of obstacles
  • Jera duplicates one pickup
  • Perthro rerolls one item
Gameplay effect
0 - The Fool?
56Drops all your hearts, coins, keys and bombs on the floor, leaving you at half a heart. Pickups drop in their biggest denominations.
  • Coins: 25 / 10 / 5 / 2 / 1
  • Bombs: 10 / 2 / 1 (exactly 99 stays one pickup)
  • Keys: 2 / 1
  • Hearts: double / red / half; soul and black hearts drop as usual
  • Leaves 1 half heart
Gameplay effect
I - The Magician?
57A blue aura strongly pushes enemies and enemy projectiles away from you for one minute.
  • Duration 60 s
  • Aura radius 120 px (value not published)
  • Re-use refreshes the timer
Gameplay effect
II - The High Priestess?
58Mom's foot repeatedly stomps where you stand for one minute (1.5-3.5 s apart, 1-2 feet).
  • Duration 60 s
  • 1 s warning
  • 1 heart damage if you stay
  • Breaks obstacles and opens doors in the radius
Gameplay effect
III - The Empress?
59+2 temporary Red Heart containers, +1.5 tears and -0.1 speed for one minute. Does not stack.
  • +2 empty containers
  • Tears +1.5
  • Speed -0.1
  • Duration 60 s
Gameplay effect
IV - The Emperor?
60Teleports you to an extra Boss Room with a boss from two floors deeper. Beating it gives the usual boss reward and a hatch back to where you used the card.
  • Boss pool: floor + 2
  • Normal boss reward
  • Return hatch appears when the boss dies
Gameplay effect
V - The Hierophant?
61Drops two Bone Hearts.
  • 2 Bone Hearts
Gameplay effect
VI - The Lovers?
62Spawns a random item pedestal from the room's item pool and turns one Red Heart container (or two Soul Hearts) into a Broken Heart. Can kill you.
  • 1 item
  • 1 Broken Heart
Gameplay effect
VII - The Chariot?
63For 10 seconds you are an invincible statue with 4x fire rate. Machines and beggars can still hurt you.
  • Duration 10 s
  • Tears x4
  • Movement nearly stopped (speed x0.12)
Gameplay effect
VIII - Justice?
64Creates 2-4 Locked Chests near you.
  • 2-4 locked chests
Gameplay effect
IX - The Hermit?
65Sells every pickup and pedestal item in the room for coins at shop price (items 15). Drops one Penny if there is nothing to sell.
  • Item 15c, heart 3c, soul heart 5c, bomb/key/card/pill 5c, bone/black heart 6c, eternal/gold heart 10c
Gameplay effect
X - Wheel of Fortune?
66Triggers a random Dice Room effect: 1 reroll everything you hold, 2 reroll the room pickups, 3 reroll every pickup on the floor, 4 reroll every item pedestal on the floor, 5 re-roll and restart the floor, 6 = effects 1+3+4.
  • Pip chosen uniformly 1-6
  • Held passives are rerolled into the pool they came from
Gameplay effect
XI - Strength?
67Every enemy in the room, bosses included, is slowed and takes double damage for up to a minute or until you leave. Purple fog fills the room.
  • Damage taken x2
  • Enemies slowed
  • Contact damage reduced to half a heart (direct contact only)
  • Lasts up to 60 s or the current room
Gameplay effect
XII - The Hanged Man?
68For 30 seconds you fire three tears per shot with -0.1 speed and x0.51 tears; enemies you kill drop a Penny. Stacks additively.
  • Triple shot
  • Tears x0.51
  • Speed -0.1
  • +30 s per use
  • Penny per enemy killed by you
Gameplay effect
XIII - Death?
69For each enemy already killed in the room (up to 8), spawns an orbiting bone or a friendly Bony, Black Bony, Big Bony, Bone Fly or Revenant.
  • 80% orbital bone
  • 20% bone monster
  • Bony 25% Black, 25% Big if the kill was tough, 25% Bone Fly, 1% Revenant
Gameplay effect
XIV - Temperance?
70Forces you to eat 5 random pills one after another (0.45 s apart). Eaten pill colours become identified.
  • 5 pills
  • 0.45 s apart
  • Pills come from the run's pill pool
Gameplay effect
XV - The Devil?
71Flight for the room and a Seraphim familiar that shoots enemies for 30 seconds.
  • Flight: current room
  • Seraphim: 30 s
Gameplay effect
XVI - The Tower?
72Creates 7 clusters of 1-4 random obstacles. They never seal off the room; rocks have a 3% chance to be tinted.
  • 7 clusters
Gameplay effect
XVII - The Stars?
73Removes your oldest passive item picked up this run (starting items are ignored) and spawns 2 item pedestals from the current room pool. Does nothing if you have no items.
  • -1 item (exact stat undo)
  • +2 pedestals
Gameplay effect
XVIII - The Moon?
74Teleports you to the Ultra Secret Room (created if needed, linked to the map by a Red Room) that holds an Ultra Secret Room item. With nowhere legal on the floor you land in a random room.
  • Ultra Secret Room: touches only red rooms
  • Its item comes from the Ultra Secret Room pool
Gameplay effect
XIX - The Sun?
75For the whole floor: +1.5 damage, flying, spectral tears, your Red Heart containers become Bone Hearts, and the room goes dark.
  • Damage +1.5
  • Flying and spectral tears
  • Containers become Bone Hearts (revert at the end of the floor)
Gameplay effect
XX - Judgement?
76Spawns a Shop Restock Machine. Each coin rerolls every unclaimed item in the room; it can break after the fourth reroll.
  • 1 coin per use (cost not published)
  • First 4 rerolls guaranteed
  • 50% break chance afterwards
Gameplay effect
XXI - The World?
77Creates a trapdoor with a ladder under you that always leads to the Crawl Space: a side-view room with gravity, one per floor. Climb the ladder at the top to leave by the entrance you used.
  • Always the Crawl Space
  • Gravity unless on the floor, a ladder or flying
  • Layouts: item + pickups, chest + 6 coins, 3 coins, 2 items, ...
  • Ehwaz also has an 8% chance of this trapdoor
Gameplay effect
Cracked Key
78One use of the Red Key: creates a Red Room (always unlocked) through the wall nearest you, joined to every neighbouring room.
  • One Red Room
  • Legal walls follow the Secret Room placement rule
  • All its doors open
Gameplay effect
Queen of Hearts
79Drops a pile of Red Hearts.
  • 1-20 full Red Hearts
Gameplay effect
Wild Card
80Copies the most recently used card, pill or active item.
  • Copies cards (including runes and soul stones), pills and the held active item
  • Does not itself become the "last used" card
Gameplay effect
Soul of Isaac
81Rerolls every pedestal item, but each one cycles back to its original item after a second, repeating. Extra uses add one more item to the rotation.
  • 1 s per step
  • +1 item per extra use
  • Take the item that is showing
Gameplay effect
Soul of Magdalene
82Red aura for the room: every enemy that dies drops a Half Red Heart that vanishes after 2 seconds.
  • Half Red Heart per kill
  • Disappears after 2 s
  • Lasts: current room
Gameplay effect
Soul of Cain
83Opens every door in the room and creates a Red Room on every legal wall.
  • All doors open
  • Red Room on each legal wall
Gameplay effect
Soul of Judas
84Dark Arts for 3 seconds: +1 speed, walk through enemies and bullets unharmed. Touched enemies freeze, then take 2x damage + 3.5 (each next one +3.5 more), and a final blast equal to the total hits everything nearby.
  • 3 s
  • Speed +1.0
  • Per enemy: 2x damage + 3.5, +3.5 per extra target
  • Final blast = sum of the damage dealt (radius 140 px)
Gameplay effect
Soul of Blue Baby
85Over 2 seconds: 8 poison farts (5 damage, poison, reflect shots) and brown creep, then 7 Butt Bombs that blast, deal 10 to every enemy and confuse them.
  • 8 farts and 7 Butt Bombs
  • Fart 5 damage + poison
  • Creep 1.5x damage per tick
  • Butt Bomb cloud 10 damage to all, confusion 3 s
Gameplay effect
Soul of Eve
8614 Dead Birds fly in from the screen edges and attack enemies. They stay while any enemy lives (at least 10 s) and leave when you leave the room.
  • 14 birds
  • Hit for 25% tear damage every 0.2 s (value not published)
  • 10 s minimum
Gameplay effect
Soul of Samson
87Berserk for 10 seconds: your tears become a jawbone swing that deals 3x damage in a 160-degree arc, with +0.4 speed, +3 damage and tears halved then +2.
  • 10 s
  • Swing 3x damage (reach about 78 px)
  • Speed +0.4
  • Damage +3
  • Tears x0.5 then +2
Gameplay effect
Soul of Azazel
88Fires Mega Blast for 7.5 seconds: a huge freely aimed laser dealing 5x your damage every tick, pushing you backwards. Lasts across rooms. Aim with the fire keys.
  • 7.5 s
  • 5x damage per tick (10 ticks/s assumed)
  • Beam width 44 px
  • Recoil 90 px/s
  • You cannot shoot tears while it fires
Gameplay effect
Soul of Lazarus
89Used on purpose you die and revive at half a heart with 1.5 s of invincibility. While held it triggers automatically on a fatal hit as an extra life.
  • Revive at half a heart
  • 1.5 s invincibility
  • Held: automatic extra life
Gameplay effect
Soul of Eden
90Rerolls every pedestal item (from any item pool) and every pickup in the room.
  • Items from random pools
  • Pickups rerolled like the D20
Gameplay effect
Soul of The Lost
91Ghost form for the current room: flying, spectral tears and a stackable Holy Mantle. Any hit that gets past the mantle kills you.
  • Flying
  • Spectral tears
  • +1 mantle per use
  • Lasts: current room
Gameplay effect
Soul of Lilith
92Grants one permanent familiar from the Item Room pool (any familiar item that has real behaviour in this game). Duplicates are possible.
  • 1 familiar
  • Counts as an owned item (Stars? / rerolls can remove it)
  • Pool: familiar items implemented in ItemFamiliars.js
Gameplay effect
Soul of Keeper
93Drops 1-25 coins.
  • 1-25 coins
  • Penny / double penny / nickel / dime (odds approximate)
Gameplay effect
Soul of Apollyon
94Spawns 15 random locusts (War, Pestilence, Famine, Death, Conquest) that stay with you.
  • 15 locusts
  • All hit for 2x tear damage
  • War: 60 explosion
  • Pestilence: poison
  • Famine: slow
  • Death: hits twice
Gameplay effect
Soul of The Forgotten
95Spawns the Forgotten as a second body you control at the same time: it moves with you, swings a bone club when you fire (3x damage, reflects shots), has 2 bone hearts, dies harmlessly and vanishes when you leave the room.
  • 2 bone hearts (4 half hearts)
  • Club 3x damage (factor not published)
  • Takes contact and shot damage instead of you
  • Refilled by Bone Heart pickups
Gameplay effect
Soul of Bethany
96Spawns 6 blue wisps for the room that orbit, fire tears and block shots (10% are tougher).
  • 6 wisps
  • 2 health each (3 for the random 10%)
  • Block enemy shots
Gameplay effect
Soul of Jacob and Esau
97Spawns Esau as a second body you control at the same time: it moves with you, fires a tear whenever you do, has 3 red hearts, shares coins/bombs/keys, dies harmlessly and vanishes when you leave the room.
  • 3 red hearts
  • Fires with you
  • Hearts heal him; coins, bombs and keys go to you
  • Gets no extra items (see discrepancies)
Gameplay effect

Curse Room layouts

41 standard-mode layouts: 31 ordinary layouts and 10 additional Voodoo Head layouts. Greed layouts are excluded. Each layout uses its listed relative weight. Voodoo Head eligibility is captured at floor entry; its layouts become available on subsequent floors. Existing Curse Room placement rolls, dead-end placement, real map connections, spiked-door damage and flight rules are preserved. Narrow layouts rotate to match an east/west entrance. Wiki illustrations show possible doors; actual rooms create only their connected doors, plus valid hidden Secret Room connections.

Enemies from the pictures always appear, using similar members of our roster: spiders → Skitter Spider, Nulls → Mourning Mask, Imps → Emberling, Black Globin heads → Rot Ghoul, Bulbs → Puffshroom and enemy Sacks → Brood Mother. Enemy-free layouts stay empty. No 10% ambush or 20% ordinary-population rolls are applied. Current chest artwork is shared by red, bomb and spiked chests; bomb chests require a nearby explosion, and spiked chests cause contact damage when opened. Runes reuse the shared card sprite. Trinket rewards currently draw from Curved Horn (+2 damage), Goat Hoof (+0.15 speed), Lucky Toe (+1 luck) and Whip Worm (+0.5 shot speed); one can be held and swapped. Reward plates, black sacks and Devil Beggars use our existing artwork and simplified supported rewards.

Layout reference

IDPoolWeightReference contents
0Standard1A Red Chest .
1Standard1Two Red Chests .
2Standard1Two Red Chests .
3Standard1An item and four Spiders .
4Standard0.25Two Black Hearts .
5Standard0.75Two Red Chests and a Bomb Chest .
6Standard1A Big Spider and four Spiders .
7Standard1A Red Chest .
8Standard1A Red Chest and four Blue Fire Places .
9Standard0.5A Black Heart and a Nulls .
10Standard1A Red Chest and two Nulls .
11Standard0.5A Reward Plate , four Fire Places , and two Nulls .
12Standard0.25A random rune .
13Standard0.5Two random cards and seven Red Fire Places .
14Standard0.5Four spiders and a Devil Beggar .
15Standard1Two Red Chests and an Imp .
16Standard1A Red Chest .
17Standard0.5A black heart and two spiders.
18Standard1Two random pickups , a Nickel , and a Big Spider .
19Standard1A Spiked Chest .
20Standard1Three Red Chests , one surrounded by spikes.
21Standard0.1A Satan statue, two Red Fire Places, and a pickup that has an equal chance to be&#160;: a random trinket, a random rune, a Black Rune , an item, a random pickup, and a red chest.
22Standard0.5Two Black Globin's Heads and a Fire Place .
23Standard0.1Three red chests and three black hearts.
24Standard0.1A Black Globin's Head , and 6 urns (4 of them have 50% chance to be a Black Globin's Head instead).
25Standard0.5An item and two Bulbs .
26Standard0.25A red chest, two Reward Plates and four Fire Places.
27Standard0.25An item and two Red Fire Places.
28Standard0.1A Reward Plate, two red chests, four urns, and two Blue Fire Places.
29Standard0.25Two Black Sacks , four urns, and a Blue Fire Place.
30Standard0.5A random rune behind three urns that each have 50% chance to be a cobweb instead, two spiders, and two Fire Places.
31Voodoo Head1A coin and two red chests.
32Voodoo Head0.5A coin, two red chests, four cobwebs, and spikes.
33Voodoo Head1A coin, three red chests, and four Fire Places.
34Voodoo Head1A coin, three red chests, and two Sacks .
35Voodoo Head0.5A coin, two black hearts, an Imp , and four Blue Fire Places.
36Voodoo Head1A coin, three red chests, and six Fire Places.
37Voodoo Head1A coin, two red chests, and four Fire Places.
38Voodoo Head1A coin, four red chests, and two Nulls.
39Voodoo Head1A coin, four red chests, and spikes.
40Voodoo Head0.1A coin, a Big Spider, and two items.

Enemies

100 regular enemies, each with a difficulty tier and an unlock floor; deeper floors shift encounters toward harder tiers. Tiers unlock at:

1 · LesserFloor 1+
2 · DangerousFloor 3+
3 · SevereFloor 5+
4 · EliteFloor 7+
Attack Fly1 · LesserDebug playground only (not in random rooms yet)5A red and black flashing fly that chases the player. Easy to be hit by from the left or right, but it struggles to hit from above or below.
Ring Fly1 · LesserDebug playground only (not in random rooms yet)5Clusters with other Ring Flies into a circle of up to 10 that orbits rapidly while moving toward the player; the formation holds as flies die.
Moter1 · LesserDebug playground only (not in random rooms yet)10Two conjoined Attack Flies. Splits into two Attack Flies, perpendicular to the player, when killed unless killed very quickly.
Dart Fly1 · LesserDebug playground only (not in random rooms yet)5Like an Attack Fly, but predicts the player's movement and cuts them off.
Swarm1 · LesserDebug playground only (not in random rooms yet)5Appears in tightly packed groups of 3-4, each attacking like an Attack Fly; a separated fly quickly rejoins its group.
Army Fly1 · LesserDebug playground only (not in random rooms yet)5Chases along the cardinal directions; every Army Fly in the room forms one single-file line behind the leader.
EnemyTierAppearsHPAbility
Blister Toad1 · LesserFloor 1+26Lobs short-lived rot patches, then threatens a close belly slam.
Candle Imp1 · LesserFloor 1+18Leaves warned wax steps and throws a short flame fan.
Glass Tadpole1 · LesserFloor 1+16Paired glass splinters alternate with a lateral dart.
Imp1 · LesserFloor 1+
bat1 · LesserFloor 1+
bleeder1 · LesserFloor 1+
boomTick1 · LesserFloor 1+
Fly1 · LesserFloor 1+3Buzzes around the room at random while slowly hovering toward the player. Harmless: it cannot damage by touch.
emberling1 · LesserFloor 1+
graveClasp1 · LesserFloor 1+
lobber1 · LesserFloor 1+
maggotCharger1 · LesserFloor 1+
mourningMask1 · LesserFloor 1+
puffshroom1 · LesserFloor 1+
skitterSpider1 · LesserFloor 1+
Ash Deacon2 · DangerousFloor 3+25Broken ember rings alternate with delayed cardinal ash cuts.
Bone Flutist2 · DangerousFloor 3+22Plays three staggered projectile rows followed by a broken sound ring.
Brass Locust2 · DangerousFloor 3+19Throws three separated gears, then lunges at its locked aim.
Coffin Skater2 · DangerousFloor 3+28Slides through a locked lane and sends a broken row along its exit.
Copper Crab2 · DangerousFloor 3+30Strafes, rolls a gear, then closes its two warned pincers.
Ember Scarab2 · DangerousFloor 3+24Plants a warned ember mine and throws three offset shell chips.
Gloom Jelly2 · DangerousFloor 3+22Pulls four ink shots toward a locked spot, then spits a curving fan.
Ink Friar2 · DangerousFloor 3+24Writes a delayed aimed volley, then fans out spiral ink strokes.
Latch Goblin2 · DangerousFloor 3+25A hook-tip lane retracts, followed by a short close slam.
Mirror Mite2 · DangerousFloor 3+16Fires reflected fans from opposite offsets and sidesteps between bursts.
Mucus Monk2 · DangerousFloor 3+26Fires a spreading slime fan and lobs a patch at a locked position.
Needle Nun2 · DangerousFloor 3+21Backs away, fires a narrow needle fan, then stitches a marked crossing cut.
Pearl Gnasher2 · DangerousFloor 3+24Orbits its target, holding pearls before releasing offset paired shots.
Root Dentist2 · DangerousFloor 3+25Lobs a tooth at a marked circle and draws a fork of dental-root cuts.
Rust Pilgrim2 · DangerousFloor 3+29Sweeps a warned rusty strip, then rolls a wall-bouncing gear.
Salt Widow2 · DangerousFloor 3+23A moving salt row leaves a gap, followed by an open web triangle.
Scab Runner2 · DangerousFloor 3+17Makes a short zigzag rush, then leaves a warned blood blister behind.
Shiver Hare2 · DangerousFloor 3+19Throws paired ice shards, then makes a short warned zigzag rush.
Soot Cherub2 · DangerousFloor 3+21Drops cardinal ash lines before firing a staggered feather fan.
Soot Siphon2 · DangerousFloor 3+26Opens its mouth before inhaling up to three nearby ordinary tears in a short forward cone, then returns a wider soot volley. Flank it while it inhales.
Spindle Snail2 · DangerousFloor 3+30Spits slow threads while rolling a single bouncing spindle disk.
Spleen Balloon2 · DangerousFloor 3+20Curving blood spirals alternate with a recoil that marks its old position.
Tallow Tumbler2 · DangerousFloor 3+22Folds its legs into a wax ball, rolls toward a locked position and bounces once, then unfolds and releases four slow wax droplets.
Vesper Bat2 · DangerousFloor 3+13A broken sonar ring precedes a locked swoop.
Wax Twins2 · DangerousFloor 3+24Two offset mouths fire successive fans, leaving three wax puddle warnings.
burrower2 · DangerousFloor 3+
casketMaw2 · DangerousFloor 3+
echoMoth2 · DangerousFloor 3+
emberGrub2 · DangerousFloor 3+
gutterJaw2 · DangerousFloor 3+
inkScribe2 · DangerousFloor 3+
lanternLeech2 · DangerousFloor 3+
maw2 · DangerousFloor 3+
mimic2 · DangerousFloor 3+
mireSlug2 · DangerousFloor 3+
moltWorm2 · DangerousFloor 3+
pallbearer2 · DangerousFloor 3+
ricochetSkull2 · DangerousFloor 3+
rotGhoul2 · DangerousFloor 3+
sentinel2 · DangerousFloor 3+
sporePriest2 · DangerousFloor 3+
stoneHopper2 · DangerousFloor 3+
sutureRam2 · DangerousFloor 3+
Bellows Worm3 · SevereFloor 5+26An inward broken ring contracts before the worm recoils and marks its old spot.
Blight Courier3 · SevereFloor 5+23Throws rot ahead of a short marked delivery dash.
Brine Oracle3 · SevereFloor 5+26Sends offset tide rows with a safe channel, then releases three pearls.
Cinder Hound3 · SevereFloor 5+28Warns a charging lane, leaving ember marks, then breathes a short fan.
Gore Pinwheel3 · SevereFloor 5+24Rotating blood spokes switch to curved spiral beads.
Iron Tick3 · SevereFloor 5+25Two curving magnetic fans converge before a close shell slam.
Ivory Compass3 · SevereFloor 5+27Four ivory beads cross inward, then its needle draws a fixed gaze line.
Jaw Harvester3 · SevereFloor 5+32Jaws close from two sides, followed by an aimed tooth fan.
Maw Pendulum3 · SevereFloor 5+31Sweeps a long marked jaw lane, then spits pairs from opposite sides.
Moss Cantor3 · SevereFloor 5+28Holds seeds in orbit, then sings staggered seed rows through a moving gap.
Pale Ferryman3 · SevereFloor 5+29Sweeps a long oar strip and releases held pale pearls.
Red Surveyor3 · SevereFloor 5+25A gaze line stops tracking before firing; crossed cuts mark its next position.
Scarlet Nautilus3 · SevereFloor 5+28Spiral blood beads precede an inward broken ring.
Tallow Husk3 · SevereFloor 5+32A close slam opens three delayed wax patches along its path.
Thorn Hermit3 · SevereFloor 5+28A forked root lash leaves a center lane; seeds orbit before scattering.
Vesicle Witch3 · SevereFloor 5+27Marks a blister beneath a locked target, then fires mirrored offset fans.
Wisp Tailor3 · SevereFloor 5+20Crossing scissor cuts make space for a narrow needle volley.
Wound Spinner3 · SevereFloor 5+23Draws a three-sided web snare, then shoots a slow thread fan through it.
boneKnight3 · SevereFloor 5+
broodMother3 · SevereFloor 5+
chalkWeaver3 · SevereFloor 5+
cinderSeam3 · SevereFloor 5+
gloomBell3 · SevereFloor 5+
hexWitch3 · SevereFloor 5+
orbitUrn3 · SevereFloor 5+
pendulumWretch3 · SevereFloor 5+
rivetWidow3 · SevereFloor 5+
shadeWraith3 · SevereFloor 5+
shadowStalker3 · SevereFloor 5+
shieldBearer3 · SevereFloor 5+
spiralWisp3 · SevereFloor 5+
thornChoir3 · SevereFloor 5+
threadling3 · SevereFloor 5+
waxCantor3 · SevereFloor 5+
Blood Astrolabe4 · EliteFloor 7+30Four orbiting beads cross through its center, then converge on a locked target.
Halo Eater4 · EliteFloor 7+33Bites through a broken projectile ring, then extends a warned hooked tongue.
Sable Mantis4 · EliteFloor 7+29Crossing claw cuts alternate with a staggered thin feather fan.
Shard Shepherd4 · EliteFloor 7+29Refracted fans cross at a distance before a broken crystal wall advances.
brimstoneEye4 · EliteFloor 7+
hushIdol4 · EliteFloor 7+
reaper4 · EliteFloor 7+
stoneGolem4 · EliteFloor 7+

Champions

Regular enemies can spawn as a champion with an added behaviour (99 types). The chance per enemy and the maximum champions per room grow with depth:

DepthChanceMax per room
Floor 1+6%1
Floor 3+9%1
Floor 5+12%3
Floor 8+16.5%3
Floor 12+22.5%3
Floor 20+34.5%3
ChampionBehaviour
GraveboundThree delayed grave marks pursue a locked trail.
CoalbedPlants three staggered ember beds around its target.
Last SparkLeaves a delayed hot afterimage on its old position.
FaultbreakerZips three staggered fault lines across a locked landing.
Twin ShadowFollows its native dash with a marked flanking dash.
Rooted ElderFour spores converge on a locked position.
Ossuary GuardBriefly hardens its bones while marking a close counterstrike.
Brood RegentMarks three staggered brood eruptions instead of merely spawning faster.
PrismaticRefracts two crossing marked sight lines.
CounterwoundFires opposed curved fans that reverse the safe side.
GravediggerMarks its old burrow with a delayed collapse.
TripwireDraws three short tripwire cuts before detonating normally.
SiegehandAdds four small converging shots from warned offsets.
Coven MatronCalls four fixed curse origins around the target.
Blind PrismSplits its gaze into two delayed crossing beams.
BonewheelAdds opposed curving bone fans to its ricochets.
ClotkeeperPlants three delayed clot pools.
UndertowA contracting broken ring forces a sideways escape.
JawbreakerTwo closing jaw lines threaten a locked target.
BastionA timed body brace ends in a close counterstrike; its normal shield remains breakable.
NeedlelegsAdds two staggered crossing leg cuts.
Night EchoTwo broken sonar waves follow its normal flight.
Grave EchoThree delayed grave circles punish standing still.
CrookedFollows its charge with a short perpendicular rebound.
LockjawMarks two closing latch jaws beyond its chest bite.
RampartA short damage-reducing brace warns a broad close slam.
AfterveilLeaves collapsing afterimages on a three-point trail.
SporebedGrows a three-patch spore bed around its target.
Twin ScytheTwo offset scythe cuts close from different directions.
Echo RegentAdds broken sound rings with a visible escape wedge.
CounterchimeIts additional chime sends opposing curved shards.
Iron CasketA brief brace ends with a close coffin-lid crush.
ZipperlingSews three parallel cuts in sequence.
Tallow ChoirAlternates two expanding broken wax rings.
Cross-ClaspA second perpendicular clasp follows the normal jaws.
SwitchbackA perpendicular rebound follows its original bent rush.
ClockbreakerFour timed floor spokes supplement its flail.
Ghost LanternA collapsing lantern afterimage marks the takeoff trail.
Chalk PrisonThree staggered chalk cuts supplement its open corral.
Sewer UndertowA shrinking ring precedes its tongue attack.
Mourning EchoThree delayed mirrored grave marks supplement its reflected movement.
CinderbedThree small delayed fire beds flank its branching fissure.
Grave MarshalFour warned coffin splinters converge before the next slam.
Briar MatronFour root seeds converge through its existing thorn lanes.
Ghost MoltIts recent path collapses after a warning; molted offspring stay ordinary.
Ruby PrismTwo fixed ruby sight lines supplement its hit-count retaliation.
Rivet ScissorsDiagonal leg cuts follow opposite-pair stomps.
PalimpsestOpposing curved ink fans supplement its accelerating beads.
Ossuary OrbitFour delayed teeth launch from a rotating pattern.
Needle Nun AscendantThree staggered parallel floor cuts.
Pearl Gnasher AscendantFour warned origins converge on a locked target.
Ash Deacon AscendantThree delayed marks follow a fixed trail.
Copper Crab AscendantTwo crossing melee cuts.
Vesper Bat AscendantTwo separately warned lunges.
Blister Toad AscendantThree small delayed ground beds.
Mirror Mite AscendantFour small converging shots.
Wound Spinner AscendantThree staggered parallel floor cuts.
Candle Imp AscendantCollapsing images of its recent path.
Spleen Balloon AscendantA two-part perpendicular rebound.
Rust Pilgrim AscendantA timed damage-reducing brace with a warned counter.
Bone Flutist AscendantTwo expanding rings with visible escape gaps.
Gloom Jelly AscendantA contracting ring with an escape gap.
Scab Runner AscendantTwo separately warned lunges.
Iron Tick AscendantA two-part perpendicular rebound.
Mucus Monk AscendantThree small delayed ground beds.
Wisp Tailor AscendantTwo crossing melee cuts.
Brass Locust AscendantFour delayed rotating spokes.
Salt Widow AscendantFour warned origins converge on a locked target.
Ink Friar AscendantThree delayed marks follow a fixed trail.
Gore Pinwheel AscendantOpposed curving fans.
Cinder Hound AscendantCollapsing images of its recent path.
Glass Tadpole AscendantTwo fixed crossing beam cuts.
Thorn Hermit AscendantThree small delayed ground beds.
Pale Ferryman AscendantA contracting ring with an escape gap.
Jaw Harvester AscendantTwo crossing melee cuts.
Bellows Worm AscendantA contracting ring with an escape gap.
Blood Astrolabe AscendantOpposed curving fans.
Coffin Skater AscendantA two-part perpendicular rebound.
Root Dentist AscendantThree staggered parallel floor cuts.
Soot Cherub AscendantFour small converging shots.
Brine Oracle AscendantTwo expanding rings with visible escape gaps.
Red Surveyor AscendantTwo fixed crossing beam cuts.
Wax Twins AscendantThree delayed marks follow a fixed trail.
Spindle Snail AscendantA timed damage-reducing brace with a warned counter.
Shiver Hare AscendantTwo separately warned lunges.
Ember Scarab AscendantCollapsing images of its recent path.
Moss Cantor AscendantTwo expanding rings with visible escape gaps.
Latch Goblin AscendantTwo crossing melee cuts.
Ivory Compass AscendantTwo fixed crossing beam cuts.
Scarlet Nautilus AscendantOpposed curving fans.
Tallow Husk AscendantThree small delayed ground beds.
Vesicle Witch AscendantFour warned origins converge on a locked target.
Shard Shepherd AscendantTwo fixed crossing beam cuts.
Maw Pendulum AscendantFour delayed rotating spokes.
Blight Courier AscendantThree small delayed ground beds.
Sable Mantis AscendantTwo crossing melee cuts.
Halo Eater AscendantOpposed curving fans.
Soot Siphon AscendantOpposed curving fans.
Tallow Tumbler AscendantCollapsing images of its recent path.

Bosses

25 bosses with multiple phases, telegraphed attacks and real damage windows. Each floor ends with one, chosen by depth and never repeating the previous floor's. Bosses can roll as champion bosses (3 item rewards instead of 2).

BossAppearsHPDescription
Plague BellFloor 1+260Tolls arena-wide plague waves with safe openings, strikes your last position with its clapper, and launches pestilent mortars. Summons diseased minions.
Riven SeraphFloor 1+240At half health splits into two linked halves, alternating crossing feather cuts and offset volleys.
The HeelFloor 1+330A towering swollen leg stomps at locked positions while heavy hands alternate bongo slaps. Blue phase gains attached eyes and flesh; red phase retains them and attacks faster for more damage. Strike planted limbs during recovery.
Tithe CollectorFloor 1+230Sweeps a counting hook, rolls coin volleys and lunges along a marked collection lane.
Glass OracleFloor 2+280Three refracting facets aim sequential beams; a rotating prism leaves one safe wedge.
Hollow InfantFloor 2+280Orbiting spirits, staggered tear fans and delayed cross marks leave deliberate escape gaps.
Ivory AnnunciantFloor 2+290Flaps around the arena, locks crossing rays of light, then releases feather fans and expanding halo rings with an escape gap.
Marrow ExpressFloor 2+360A long bone snake slithers after you. Damage body vertebrae to cut it into smaller snakes; exposed marrow tails take double damage. Skull volleys, tail shots and a warned speed surge punish standing still.
Seamstress QueenFloor 2+300Pins a marked rectangle with one open corner, then draws diagonal sewing cuts before a lunging stitch.
Cathedral WidowFloor 3+510Stalks on long legs, crouches before lunging at a locked position, then spits spreading web volleys and lays staggered cross-web cuts.
Choir EngineFloor 3+340Three mouths breathe in sequence; the silent mouth marks the safe lane, followed by a staggered chord slam.
Drowned AbbotFloor 3+320Alternating tidal walls leave a visible channel; a contracting undertow ring tests positioning.
Eclipse TwinsFloor 3+330Sun and moon separate and trade aimed charges. One casts a cross while the other leaves a safe ring gap.
Gilded TyrantFloor 3+350Alternating fist slams and a coin press. Its shell loses armor at half health, replacing its press with long rushing shockwaves.
Grave ArchitectFloor 3+310Raises marked coffin strips into a shifting maze, then collapses the oldest strip while opening an escape route.
Ossuary LambFloor 3+310Its skull detaches at half health; body root slams and independently orbiting skull bites share one life bar.
Scarlet CantorFloor 3+340Sings staggered expanding sound rings, sweeps close with a feather volley, and alternates offset light lanes. Dodge through the visible gaps.
Abyss RegentFloor 4+370A sealed statue wakes into claw and beam attacks, then becomes alternating giant hooves at low health.
Carrion MatriarchFloor 4+340Alternates cleaver arcs and staggered splinter rows, then chains two warned charges below half health.
Crucible HeartFloor 4+360Vents three locked heat circles, then an expanding pressure wave. Below half health pressure waves gain a delayed flame fan.
Rot-Crowned KingFloor 4+370Baits a tongue slam into lingering rot, then lunges between locked targets. Below half health its second lunge flanks the first.
Weeping CongregationFloor 4+660Heaves across the room, spews alternating tear waves, lobs clots at locked positions and contracts around expanding shock rings. Adds crawl from its folds.
Furnace BeastFloor 5+420Inhales broken fire rings, sweeps a warned furnace breath, then charges through a safe shifting lane.
Obsidian PatriarchFloor 5+840Opens its enormous jaw before a sweeping mouth beam, splits the floor with staggered fissures, and bellows expanding rings between heavy charges.
The Witness BelowFloor 5+400Marks a gaze line that stops tracking before firing. At half health its hands add mirror cuts and an open blind wedge.

Enemy / Boss Studio

Open the dedicated enemy and boss editor. Author behavior trees, movement, attacks and phases; edit sprite layers, particles, and hitboxes or hurtboxes on a frame timeline. Rewind, step and fast-forward the deterministic preview. Test authored enemies in the solo playground, save browser drafts, or export and import JSON. Authored overrides do not automatically replace native JavaScript AI in normal play.