Passively gives flight and increases speed to 1.5. Upon use, Isaac charges in the direction the pony is facing, giving invincibility during the charge and dealing 40 damage.

Spawns six Troll Bombs around the room.

Spawns a decoy Isaac that eventually explodes with an increased blast radius.

Has the same effect as the card or rune currently held by Isaac. Has the same effect as the card currently held by Isaac.

Upon use, takes a full heart of health and deals 40 damage to all enemies in the room.

Upon use, Isaac holds a poison bomb which can be thrown in the cardinal directions and explodes on impact.

Gives one Soul Heart, increases the chance for a Devil or Angel Room, and changes the boss of the current floor to a Harbinger if possible.

Gives the effect of Treasure Map, The Compass, or Blue Map for the duration of the current floor.

Creates a protective shield, nullifying all types of damage for 10 seconds.

Spawns 1-4 Blue Spiders that deal 2.5x damage to enemies. Spawns 4-8 Blue Spiders that deal 2x damage to enemies.

Grants a brief moment of invincibility when the charge bar hits zero. If the spacebar is held for an additional second after hitting zero, Isaac will take damage.

Upon use, Isaac farts and knocks back nearby enemies and projectiles. Enemies pushed into walls or obstacles take 12 damage.

Upon use, Converts two Soul Hearts into one full Heart Container. Upon use, converts one Soul or Black Heart into one full Heart Container.

Summons 5 beams of light in random locations on the ground, dealing large amounts of damage to any enemies that touch them.

Upon use, reveals the map (except the Super Secret Room) and drops a Soul Heart or random card/rune.

Rerolls the monsters in the room. Only rerolls monsters that are still alive (does not spawn new enemies).

Combines the effects of D4, The D6, and D20. Combines the effects of D1, D4, The D6, D7, D8, D10, D12, and D20.

Rerolls all pickups in the current room.

Rerolls all of Isaac's passive items.

Opens all doors in the current room when activated, including doors which require a key to open and entrances to Secret Rooms. Opens the big doors in the first room of both The Chest and the Dark Room.

Triggers the effect of a random activated item from a list of possible options (not every activated item is included).

Gives Isaac a random card.

Creates a crosshair on the ground that can be aimed with tear controls. A missile strikes the spot after 2 seconds, creating a heavy damage explosion.

Turns all non-boss monsters in the room into poop. Instantly kills poop-themed bosses.

On use, re-generates the current floor with a new layout. Isaac loses Forget Me Now, but keeps other items and consumables picked up on the original floor.

Spawns 2-4 friendly Blue Flies that damage enemies.

Upon use, converts one Heart Container into three Soul Hearts.

Fires a powerful Brimstone beam in four cardinal directions, much like Krampus shoots. Fires a powerful Brimstone beam in four cardinal directions, much like Krampus shoots with a 50% chance to rotate all beams around Isaac 90 degrees.

Upon use, Isaac jumps in the direction he is currently moving, allowing travel over obstacles and enemies.

Fires 8 tears around Isaac, which retain the damage, range, shot speed, and special tear effects. Each tear shot by Isaac increases item charge by one.

Upon use, Isaac loses half a heart of health (one in The Womb onward) for a random amount of coins, similar to a Blood Donation Machine.

Upon use, creates an explosion in the same place as Isaac, damaging him for half a heart and dealing 40 damage to all enemies caught in the blast.

Creates a tiny pool of yellow creep, damaging enemies that cross it.

Uses 1 coin to deal twice Isaac's damage to all enemies in the room.

Gives Isaac a random pill.

Petrifies all enemies in the current room for around 4 seconds.

Inflicts fear to all enemies in the room for 5 seconds.

Spawns a familiar from a list of of familiars for the current room. Spawns a familiar from a list of of familiars for the current floor.

A friendly Monstro jumps on a random enemy, dealing 120 area damage. Lands on Isaac if used in a room without enemies.

Places a Mr. Mega bomb that deals 110 damage.

Gives invulnerability and +0.28 speed for six seconds, removing the ability to shoot tears and replacing it with the ability to deal 40 contact damage to enemies.

Isaac destroys obstacles and opens Secret Rooms by walking into them, but cannot shoot or pick up items until it's cancelledToggles between tears and the pickaxe, which can be swung to attack and break obstacles. Using it depletes the charge, and it can't be used until next floor once the charge runs out.

Upon use, spawns specific pickups or items depending on the floor it is used on. Disappears after use.

Upon use, consumes 1 coin and has a chance to drop a random pickup, like a slot machine.

Gives an Eternal Heart per use.

On use, takes one heart of health and grants +1.2 damage for the current room.

Throws a flame that that can pass over gaps (but not through obstacles). The flame damages everything in its path, diminishing in size as it hits enemies or blocks shots.

Bombs placed by Isaac only explode when Remote Detonator is used. Gives 5 bombs.

Gives one Black Heart. Replaces the boss room item on the current floor with a Devil deal.

Turns Isaac's head into a stationary familiar for the current room which fires tears automatically. Turns Isaac's head into a stationary familiar for the current room which fires tears automatically, while causing Isaac to shoot a controllable fountain of blood shots.

Fires a laser from Isaac's mouth.

Deals 10 damage to all enemies in the room and slows them for 4 seconds.

Shoots 10 tears in a circle around Isaac, which retain the damage, shot speed, and special effects (such as poison) of Isaac's tears.

Gives homing tears for the current room.

Teleports Isaac to a random room on the current floor.

Isaac farts, poisoning any enemy in close range.

On use, Isaac gains flight for the current room. Instantly kills Mom, Mom's Heart, and It Lives when activated, but kills Isaac when used on Satan.

+2 damage for the current room. Guarantees a Devil Room or Angel Room will be open after beating a boss while holding it. Increases the chance by 12.5%.

Spawns a random pickup, pill, card, or trinket.

Throws a boomerang which retrieves pickups, as well as damages and petrifies enemies hit for 2 seconds.

Throws out a temporary flame that can pass over gaps (but not through rocks). The flame damages anything in its path.

Re-rolls all items in the current room into other items, depending on the current room's Item Pool.

Turns Isaac into a into a Pac-Man-like creature for 6 seconds, granting invulnerability, inflicting fear on all enemies, and replenishing a Half Red Heart for every two enemies killed.

All enemies in the room are slowed for 8 seconds.

When at full health, up to 4 extra Red Hearts can be stored in The Jar.

Gives one Soul Heart half a Black Heart. For the current room; +0.7 damage, -0.18 speed, allows Isaac to break rocks and damage enemies by walking over them.

Deals 40 damage to every enemy in the room.

Gives flight for the current room, while turning Isaac's body into a fast, high damage familiar.

Spawns a pile of poop where the Isaac is standing and knocks back nearby enemies. May yield pickups like regular poop.

Teleports Isaac to the Secret Room, Super Secret Room, Treasure Room, or I AM ERROR.

Gives invulnerability and increased speed for five seconds, but removes the ability to shoot tears.

Creates a trapdoor to go to the next floor. If used in The Womb, it will create a trapdoor to Sheol, even if the player hasn't unlocked it.

Passively gives flight and increases speed to 1.5. Upon use, Isaac charges in the direction the pony is facing, giving invulnerability during the charge and dealing 40 damage while also casting the effect of Crack the Sky.

Restores one Red Heart of Isaac's health.

Duplicates all of Isaac's familiars for the current room. If Isaac has no familiars, spawns a Demon Baby for the room instead.

Re-rolls all rocks in the current room into other random objects, such as bomb rocks, metal blocks, TNT, or poops.

Restarts the current room and brings back all enemies, allowing more rewards to be acquired by completing the room.

Re-rolls Isaac's damage, tears, range, and speed.

Duplicates all pickups and item pedestals in the room.

Throwing the ball at a monster instantly kills and captures it. The captured enemy can later be released and will be friendly, fighting for Isaac and persisting between rooms.

Fires a high-damage piercing spectral tear, but lowers Isaac's health to half a heart. Fires a high-damage piercing spectral tear. If Isaac takes damage while holding Glass Cannon, he takes extra damage and it becomes Broken Glass Cannon.

When used, this item will rewind time, put Isaac back in the previous room, and undo anything that happened in the current room. Any health, pickups, or items gained or lost will be reset back to the previous state.

Killing an enemy adds a fly to the jar, up to a maximum of 20. On use, releases Blue Flies equal to the number of flies in the jar.

Isaac farts, charming all nearby enemies.

Petrifies all enemies in the current room for a couple of seconds, poisons any enemies near Isaac, and sends a rock wave across the room in the direction Isaac is facing.

Upon use, Isaac fires a laser similar to the one used by Mega Satan. This laser deals massive damage, lasts for approximately 15 seconds, and persists between rooms. Isaac is pushed backwards by the force of the laser while it is active.

Places an explosive TNT barrel that can be pushed and used to destroy rocks or damage enemies when used. If used a second time in the same room while the previous TNT barrel is still intact, it will remotely explode the TNT.

When used, Mom's Box will drop a random trinket on the ground. While held, increases luck by 1 and doubles the effects of trinkets.

When used, copies the effect of the pill Isaac is currently holding without consuming it. Does not copy the effects of cards or runes.

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.

Teleports Isaac to a random room that has not been explored yet when used. If all rooms are explored, including secret rooms, it will teleport Isaac to the Devil or Angel room. If all rooms are explored, including the Devil or Angel room, it will teleport Isaac to the I AM ERROR room. If used in a room with enemies, it will teleport Isaac out and back into the same room.

Can be used to place an orange portal and a blue portal. Upon entering a portal, Isaac is teleported to the other portal.

When used, has a 50% chance to drop one random type of coin (Penny, Nickel, or Dime).

Throws a black hole on the ground which sucks in and damages enemies.

Upon use, spawns a friendly Bony or an orbital bone for each enemy killed in the current room.

While held, causes multiple Mom's Foots to come down and stomp on Isaac. One of two parts necessary to create Mom's Shovel.

Spawns a stationary fly turret that fires tears at nearby enemies.

Transforms Isaac into a random character and removes the last item collected.

Doubles Isaac's Blue Flies and Blue Spiders, or spawns one if Isaac has none. Converts pickups in the current room into Blue Flies or Blue Spiders.

Upon use, makes a random item from a Shop, Devil deal, or Black Market free.

Spawns a penny and has a 50% chance to double all items and pickups in the room. If the effect fails, the items and pickups disappear.

Grants a random dice item that changes each use. Acts as any dice item, and can by cycled by pressing the drop key.

Duplicates a random pickup in the room.

Displaces enemy sprites for the current room, randomly increases one stat and decreases another.

Spawns Delirium as a random friendly boss that fights for Isaac.

Hurts Isaac without depleting health, activating any items that trigger upon taking damage.

Spawns two item pedestals then is consumed. Begins with no charges.

Damages all enemies and destroys all obstacles. The effect occurs every time a new room is entered for the rest of the floor. Opens doors to the floor's Secret and Super Secret Rooms.

Grants a random item effect for the current room.

Spawns a trapdoor that leads to the next floor upon activation. Unlocks The Forgotten when used on a mound of dirt that appears in Dark Room.

If the box is empty, picks up all items and pickups in a room and stores them. If the box is not empty, places all stored items and pickups in the current room.

Summons a controllable ghost that can perform various tasks depending on what it targets.

Upon use, spawns a random item from the current room's item pool, with a chance to spawn A Lump of Coal or The Poop instead.

Freezes all enemies until a fire button is pressed.

Kills all enemies in the room, then kills Isaac three seconds later.

Removes a heart container, increases damage and range, and grants a Cube of Meat.

Sacrifices up to 2 familiars and spawns an item from the Devil Room pool for each familiar sacrificed. Converts all friendly spiders and flies into coins.

Damages all enemies in the room. Has a chance to drop a half red heart or half soul heart if an enemy is hit.

Consumes Isaac's currently held trinket and applies its effect permanently.

Upon use, spawns a sprinkler that rotates and fires tears.

Upon use, for the next two seconds, any enemy shots that come near Isaac are held in place. After the charge is depleted, they are fired back as tears.

Consumes all pedestal items in the room. Active items will have their effects added to Void, and passive items will grant stat upgrades.

Isaac farts, sending out rock waves.

Destroys all items in the room and gives Isaac a unique attack fly familiar for each item destroyed.

Spawns three soul hearts and two Angel room items and is consumed. Starts with no charges, and can only be charged by picking up 6 soul hearts.

Chains down the nearest enemy for 5 seconds, preventing them from acting.

Collects and holds up to 8 pickups. Holding the activate button crafts them into a passive item, with the power level based on the quality of pickups used.

Causes Isaac to go berserk for 5 seconds, greatly increasing his speed, tears, and damage, but restricting him to using a melee weapon instead of his tears. This item charges by dealing damage to enemies instead of clearing rooms.

On use, spawns an orbital Wisp familiar that fires spectral tears but can be destroyed. Also becomes a passive item that causes other active items to spawn themed Wisps.

Begins with no charges and turns into Glass Cannon when used. Only acquired by taking damage while holding Glass Cannon.

Has the same effect as the rune or soul stone currently held by Isaac.

Spawns a sword above Isaac's head, which doubles all item pedestals. After Isaac takes damage, the sword can randomly fall at any point, instantly killing him.

Makes Isaac invulnerable and intangible for one second. When the effect ends, all enemies Isaac ran through take damage and Isaac temporarily gains +1 damage for each one.

Takes Isaac to an abandoned and expanded version of Home, which has one copy of every item in the game. After taking an item, Isaac returns to the room he used Death Certificate in.

Throws Isaac's head, which is still able to fire tears at the spot it lands. Reactivating the item or stepping on the head reattaches it.

Throws an eraser that instantly kills the first monster it hits, and prevents that monster from spawning for the rest of the run. Can only be used once per floor.

Swaps between the current character and Esau Jr., who has +2 flat damage and flight. Characters have independent items and health. Dying as either character ends the run.

Rerolls all items in the room. Each item has a chance to disappear instead.

Spawns certain pickups based on how many charges it has. If fully charged, instead has one of many unique effects.

Switch characters between Tainted Lazarus and Dead Tainted Lazarus.

Gives Isaac a fortune, soul heart, tarot card, or trinket.

Creates a large pool of yellow creep beneath Isaac.

Spawns a random friendly monster that mimics Isaac's movements and attacks.

Spawns a demon familiar that's attached to Isaac and moves and fires in the direction Isaac shoots, using Isaac's damage, tears, range, shotspeed, and special tear effects.

Removes all of Isaac's items and pickups and takes him to a unique bedroom with some pickups and chests and a trapdoor to the next floor. For every item Isaac lost, he gets to take an item from a set of three.

Spends five coins to increase Isaac's damage by 1.2 for the current room.

Exclusive to Tainted ???. Allows him to save one poop bomb for later, allowing him to gather more over time.

Spawns random wisps that shoot various tears, block shots, and deal contact damage. The number of wisps spawned increases every time the jar is used.

Spawns a random shop item/pickup.

Makes Isaac shout, damaging and pushing nearby enemies. The shout gets stronger the more charges the item has. Can also be charged by taking damage.

Spawns the ghost of a random passive item, which orbits Isaac but can be destroyed. While the ghost is alive, Isaac gains that item's effects.

Consumes one heart container or two soul hearts to spawn an item and give Isaac a broken heart container that can never be filled. If Magic Skin isn't being held after being used, it is very likely to replace any future items.

Splits all enemies in the room into two smaller versions of themselves with much less health.

Gigantifies Isaac for 30 seconds, increasing damage and range while lowering tears, granting invulnerability, and allowing Isaac to crush enemies and obstacles he walks on. The effect persists between rooms.

Lets Isaac pick up and throw rocks, TNT, poops, and other obstacles.

Summons the boss Baby Plum to fight for Isaac in the current room.

Brings Isaac back to the first floor of a new run, retaining all of his items.

Retrieves the Forgotten's body from any distance. Only available as the Birthright effect for Tainted Forgotten.

Creates a new room adjacent to a viable wall, indicated by the outline of a door. These rooms have a chance to be various special rooms.

Adds 5 keys on pickup. Allows Isaac to throw his keys to deal damage to enemies, destroy obstacles, and open doors.

When used, gives Isaac +0.5 speed and greatly increases the rotation speed of Isaac's orbitals for 3 seconds. Gives Isaac a spinning top orbital that blocks enemy shots and deals contact damage to enemies while held.

Transforms all items in the room by decreasing their internal ID number.

Passively spawns a familiar that moves in the direction Isaac shoots. On use, Isaac swaps places with the familiar.

Grants Brimstone for the current room.

Holding down the fire button converts hearts into familiars that fire tears but can be destroyed. Activating converts the familiars back into hearts.

Allows Isaac to dash into and pick up enemies, then slam them into the ground to deal damage and create rock waves that damage nearby enemies and destroy obstacles.

Summons a Peeper familiar for the current room, which leaves a trail of red creep.

Spews a stream of damaging flame. Gains Soul Charges each time an enemy dies, which are used to fuel the urn.

While held, non-ghost enemies leave behind small, red ghosts on death; using the item causes the ghosts to explode, dealing damage to nearby enemies. Stronger enemies leave behind stronger ghosts that create more powerful explosions.

Increases fire rate, decreases speed, and distorts the screen. All effects become more pronounced with repeated use, and wear off by clearing rooms.

Gives Isaac a Rotten Heart.

Spawns a controllable familiar that deals 37.5 damage per second on touch. It can be moved using the shooting directional keys

Grants Isaac one Red Heart container and fully restores Isaac's health.

Gives Isaac an extra life. Upon death, he will respawn in the previous room with full health and lose the 1up!.

Isaac fires two tears at once, one from each eye.

Gives Isaac a random tear effect every room. Gives Isaac a random tear effect every few seconds.

Reduces the charge of any activated item by 1. Any 1 charge items instead have timed recharges.

Gives Isaac 99 coins.

The more distance tears travel, the more damage they will do.

Adds 25 to Isaac's coin count, capping at 99.

Grants one full Red Heart container. Heals 1 additional heart of health.

+1.5 damage, +0.2 speed. Removes all Red Heart containers, grants six Black Hearts, and adds a chance to shoot fear tears.+1.5 damage, +0.2 speed. Grants two Black Hearts, converts all Red Heart containers into Black Hearts, and adds a chance to shoot fear tears.

Spawns a familiar that mirrors Isaac's movements and shoots in the opposite direction.

Increases range. After Isaac is damaged, a trail of red creep will be left behind him until he leaves the current room.

Upon death, the player will respawn as ??? with 3 Soul Hearts.

-2 Tear Delay. Tears float in position until firing ceases, after which they will fly off in the direction they were shot in.

A trail of blue creep is left behind Isaac, which damages enemies.

+0.25 Speed. Running into enemies while at a high speed will deal damage. Does not prevent contact damage.

Spawns an orbital familiar that blocks enemy shots, dealing 105 damage per second. Collecting additional copies gives it the ability to shoot charm tears, then chase enemies, then increases the damage.

Adds a chance to shoot slowing tears. Isaac leaves a trail of slowing creep behind as he moves, impeding enemies' speed.

Spawns a familiar that flies around the room in a zig-zag pattern and explodes on contact with an enemy. Respawns after ten seconds.

When hit, spawns a quickly orbiting attack fly similar to Forever Alone for the current room dealing 75 damage per second.

Increases the size and effectiveness of most familiars.

Spawns a large orbital familiar that blocks enemy shots and deals 30 damage per second to enemies.

Prevents curses. Grants one Black Heart. Increases the chance for a Devil or Angel Room to appear.

Grants one Red Heart, one Soul Heart, and one Black Heart.

Grants one Red Heart container, restores 5 Red Hearts, and increases speed by 0.3.

Tears fired from the left eye have +1 flat damage, +5 range, and +0.5 tear height.

Increases Damage by 1, and turns Isaac's tears into blood tears.

Increases Isaac's damage whenever he takes damage, up to six times. The bonus resets when entering a new floor.

Gives one full Red Heart container, +0.7 tears and -0.16 shot speed. Gives one Red Heart container, 2 Hearts of health, +0.7 tears and -0.16 shot speed.

Shows Secret and Super Secret Room locations on the map.

Spawns a familiar that charges forward when shooting tears and explodes upon contact with an enemy, damaging and poisoning them. The familiar respawns after a few seconds.

Gives 5 bombs and grants Isaac's bombs a poison effect.

+5 bombs. Bombs gain a homing effect, slowly moving towards the nearest enemy.

All Bomb pickups become Double Bombs.

Spawns a familiar that drops a bomb every 3 rooms.

Grants 10 bombs.

Spawns various pickups: 1 coin, 1 key, 1 bomb, 1 Red Heart, 1 card/rune, 1 pill and 1 trinket.

Grants one full Red Heart container. Heals 1 additional heart of health.

Tears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.

Chance upon entering a room to slow down or speed up every enemy and their attacks. The chance to slow enemies is quite higher than the chance to speed them up.

A familiar that follows Isaac around shooting normal tears.

Grants two empty Red Heart containers and heals Isaac by half a Red Heart, but decreases speed by 0.2.

Spawns a familiar that picks up coins for himself, giving random pickups in return. Does not spawn collectibles.

+5 bombs. Bombs now cloud up the screen, briefly damaging and confusing all enemies.

Grants +0.3 speed, reduces character size and gives a random pill.

Spawns a familiar that floats slowly around the room on a zig-zag pattern similar to The Peeper and shoots normal tears in the same direction as Isaac.

Adds 3 Soul Hearts. Grants The Wafer effect for the current room upon taking damage.

Increases health, damage, speed, and range, lowers tear delay, and gives one coin, bomb, and key.

+1 damage, +0.23 shot speed.

Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 7 seconds.

Grants 3 Black Hearts, and +1 damage.

Increases damage, but also increases the chance of champion enemies appearing.

Heals Isaac for half of a Red Heart for every 13 enemies killed.

Tears fired from the left eye have +2 flat damage.

Grants charged tears that deal greater damage when fully charged.

Doubles the number of most room clear awards, but reduces the overall chance of getting one by 1/3.

Grants -1 tear delay and reduces range. When tears hit an object or deplete their range, they spawn 4 smaller tears, whose range and damage scale with Isaac's.

Increases damage by 0.5, and multiplies it by 1.5x.

Spawns an orbital familiar that blocks enemy shots, dealing 105 damage per second. Collecting additional copies grants it the ability to shoot, then chase enemies, then increases the damage.

Grants Isaac piercing tears that travel through enemies (but not obstacles) instead of breaking on impact with them.

Grants charged tears that can be fired in a tight burst. Getting hit while charging will teleport Isaac to another room.

Daddy Long Legs' shadow follows Isaac and occasionally stomps enemies for 40 damage total.

Spawns a familiar that follows Isaac around and collects Red Hearts for himself. For every 1½ Red Hearts collected, Dark Bum will give a Soul Heart, a hostile Spider, a friendly Blue Spider, or a random card, rune or pill.

+1 damage, adds a chance to shoot fear tears.

After Isaac takes damage, spawns a flying familiar that chases enemies for the current room, dealing ~5 damage per second.

Sets Isaac's Red Heart containers to 1, but grants 9 extra lives. After dying, Isaac respawns with 1 Red Heart Container.

Grants spectral tears and flight.

Grants piercing and spectral tears. Increases tear size (without increasing damage) while greatly reducing range and shot speed.

+1.5 damage, -0.3 tears. Tears are replaced with large piercing scythes.

Spawns a familiar that follows Isaac and automatically fires at enemies in its reach.

Grants one full Red Heart container. Heals 1 additional heart of health.

Grants one full Red Heart container. Heals 1 additional heart of health.

Spawns an attack fly that circles further out than Halo of Flies, but closer than Forever Alone, dealing 75 damage per second.

Tears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired.

Spawns a familiar that follows Isaac around and blocks enemy projectiles. Upon blocking a shot, it has a chance of triggering The Necronomicon effect.

Enemies that touch Isaac are changed into poop.

Isaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.

Doubles damage, halves tears stat, and greatly reduces shot speed.

Randomly increases and decreases some of the character's stats.

Has a chance to drop a random pickup when Isaac takes damage.

Grants flight and one Eternal Heart.

Grants flaming tears that deal burning damage over time. Tears have a chance to explode on impact with an enemy, which creates a fire at the location of the explosion.

Spawns an attack fly that orbits a long distance from Isaac, dealing 30 damage per second.

Spawns a conjoined familiar which chases enemies close to Isaac, dealing ~8 damage per second.

Spawns a familiar that follows Isaac around and fires spectral tears.

Gives chance of spawning a Soul Heart when taking damage. Enemies have a chance to drop a Half Red Heart after being killed.

After standing still and not shooting for a short time, Isaac turns invincible until he moves or shoots.

A Devil Room / Angel Room will always spawn after every boss fight, excluding the first floor and floors after Chapter 4.

Grants homing tears with a damaging halo. +0.5 damage, -0.3 tears, +1.2 range, -0.3 shot speed, +0.8 tear height.

+1 damage, +0.4 speed.

Spawns an orbital familiar that blocks enemy shots, deals 105 damage per second to enemies, and increases the speed of all orbital familiars.

Isaac's head is removed from his body and floats around him as an orbital. Gives +1 damage and grants -1 tear delay.

Grants a permanent 50% chance to respawn with 1/2 of a Red Heart after death.

Spawns a familiar that loosely follows behind Isaac, which blocks shots can be swung like a flail to damage enemies. Grows bigger by killing enemies.

Room clear awards have a 1/3 chance of being replaced with a chest and a 1/3 chance being replaced with nothing.

When Isaac is hit, his active item gains 1 room's worth of charge.

Spawns two Pretty Flies that block enemy shots and deal contact damage to flies.

Spawns a familiar that follows Isaac around and fires two tears at once in a V-pattern.

Spawns a familiar that follows Isaac, leaving blood creep on the ground.

Increases the size of Blue Spiders and Blue Flies and doubles the amount of damage they deal. Also increases the effectiveness of fly and spider familiars.

Grants flight and one Red Heart container.

Upon entering a room, grants a shield that negates the first damage taken.

Spawns a bottle familiar that breaks when Isaac takes damage, leaving a puddle of blue creep. The bottle respawns upon entering a different room. A bottle familiar that flies forward when Isaac shoots. It breaks upon hitting an enemy, leaving a puddle of blue creep that petrifies enemies. The bottle respawns after a few seconds.

Grants 5 bombs. Isaac's bombs leave behind fire that damages enemies upon contact.

Replaces all regular red hearts, pennies, keys, and bombs with double versions worth twice as much. Regular red hearts, pennies, keys, and bombs have a chance to be replaced with double versions worth twice as much.

Chance to block projectiles coming from any direction.

1-3 Blue Flies randomly spawn every time Isaac gets hit.

Spawns allied Blue Spiders from killed enemies.

Replaces tears with explosive and poisoning projectiles fired in an arc from the mouth.

Increases damage by 0.3 and adds a chance to shoot concussive tears, causing enemies to walk around randomly.

Isaac himself is now immune to all damage, and a heart familiar appears and follows Isaac. If the heart is hurt, Isaac is hurt.

+0.5 damage, +0.25 range, +0.5 tear height.

Adds an extra life; upon death, it respawns Isaac as Dark Judas with two Black Hearts.

Spawns a familiar that follows Isaac and drips a trail of slow creep, spawning 1-2 Blue Spiders after each room.

Combined with Key Piece 2, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.

Combined with Key Piece 1, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.

Grants 1 Soul Heart and +1 luck. Spawns 2 Keys.

Upon dying, resurrect as Lazarus Risen with one heart container and Anemic.

Spawns a leech familiar that chases enemies, dealing ~3 damage per second. Heals a Half Red Heart whenever Leech kills an enemy.

Isaac can destroy rocks by walking into them.

Gives 6 coins, 6 bombs, and 6 keys and balances out all attributes.

Grants a familiar that charges a thin Brimstone laser while Isaac is shooting shooting.

Spawns a familiar that chases down enemies, dealing 4 damage per second and inflicting fear.

Isaac can hold 2 pills at once and all cards are replaced by pills.

Spawns a familiar who drops a Half Red Heart every 3 rooms.

Spawns a charger familiar that charges forward and deals contact damage to any enemies in its path.

Spawns a familiar that follows Isaac around and fires slowing tears, impeding enemies' speed.

Spawns a familiar who follows Isaac around and fires homing tears.

Gives a random chance for projectiles to fire in all 4 cardinal directions.

Grants flight and +0.3 speed.

Isaac's tears can hit and destroy enemy projectiles. -0.16 shot speed.

+1 luck. Increases chance of winning Shell Games and Fortune Tellers (independent from the luck stat). Converts all bad pills into good pills, without identifying them.

Grants one full Red Heart container. Heals 1 additional heart of health.

Gives one Red Heart container and doubles the healing provided by Red Hearts.

+0.16 shot speed, spawns a random tarot card.

Makes Isaac bigger. Adds one Red Heart container, +0.3 damage, x1.5 damage multiplier, +5.25 range, and +0.3 speed. Restores all health on pickup.

Grants one full Red Heart container, +1 luck.

Pulls pickups towards Isaac.

Grants Isaac one Black Heart, Spawns two or three Bombs.

Grants one full Red Heart container, +0.3 damage.

Enemies that touch Isaac are temporarily petrified and turn to gold. Any enemy killed while in this state will drop coins.

Decreases Isaac's size, making him less likely to be hit. +0.3 speed, +1.5 tear height, -4.25 range (effective range is increased).

Randomizes all passive items and stats upon pickup and at the start of each succeeding floor.

Grants one Black Heart. Upon taking damage that reduces Isaac's health to one heart or less, deals damage to all enemies in the room. Increases the damage of Black Hearts and The Necronomicon from 40 to 80.

Grants a chance of converting any Red Heart pickups into Soul Hearts instead.

Spawns 4 random pills near Isaac.

+0.25 range. Adds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking.

Allows Isaac to fire tears from the back of his head.

Tears have a chance to charm enemies.

+5.25 range, +0.5 tear height. Enemies that touch Isaac take 12 damage.

Adds 2 keys. Chests will drop additional pickups.

Isaac's tears are replaced by a knife that pierces enemies, can travel through obstacles and can hurt enemies while Isaac is holding it. Holding down the fire button before firing increases its range and power.

+5.25 range, +0.5 tear height. Spawns one random heart.

Adds a chance to shoot fear tears and decreases tear delay by 1.

Allows Isaac to hold 1 additional trinket.

+5.25 range, +0.5 tear height. Spawns 3-6 Blue Flies on pickup.

Adds a chance to spawn Blue Spiders when firing tears. Restores 1 red heart.

Increases damage by 0.04 for every coin Isaac has, up to +3.96 damage at 99 coins.

Spawns a familiar that copies the tears of Isaac's other familiars.

Increases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.

Grants 5 bombs, and makes all dropped bombs larger, which have an increased blast radius and increased damage.

Grants quadruple shot but decreases tears.

Gives Isaac's tears a boomerang effect. +1.5 range, +1 tear height, x1.6 shot speed multiplier.

Tears leave a small, short lasting pool of creep on impact or when their range is depleted.

Spawns a familiar that drops a Heart, coin, bomb, or key every 5-6 rooms.

+1.5 tears, -17.62 range

Grants one empty Heart container, +0.3 damage, +0.25 range, +0.5 tear height, and -0.1 speed.

+1.7 tears, +0.3 speed, slightly reduces damage.

Grants an empty Red Heart container. Adds a chance of dropping a Red Heart after taking damage.

Grants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them.

Spawns seven random coins around Isaac.

+1 damage, increases Devil Room / Angel Room chance by 10%.

Converts all bad pills into good pills, spawns one pill pickup, and identifies all pills. Restores two Red Hearts and increases the payout of Blood Donation Machines.

Gives 3 pennies on pick-up. Every time Isaac is damaged, he will drop one additional penny.

-1 Tear Delay, adds knock-back shots and increases tear size.

Grants one full Red Heart container, and a chance to regenerate a Half Red Heart of health every minute of gameplay.

Isaac fires huge tears that deal massive damage but fire rate is greatly decreased. If a tear kills an enemy, the tear travels on with any leftover damage.

Tears start out massive with high damage, and then shrink down and become weaker over a short range.

Spawns a Mulligan familiar that wanders randomly. Enemies will attack the Mulligan if it's closer.

Grants 99 bombs.

+5 bombs. Grants immunity to explosion damage and causes explosions to heal Isaac. Also grants immunity to fire.

Spawns a familiar that follows Isaac around and fires tears with random effects.

Grants 2 Red Heart containers and completely restores health.

Spawns a familiar that shoots Technology lasers.

Spawns a familiar that fires lasers at any enemy in its line of sight and moves based on the direction Isaac is firing tears.

+0.6 speed, +5.25 range, +0.5 tear height.

Adds 3 Soul Hearts. The Bible will appear in any item pool.Also a +0.5 tears up.

Spawns a familiar that spawns a Blue Fly when Isaac shoots. It can only have one Fly at a time.

Grants one full Red Heart container. Heals 1 additional heart of health.

Tears bounce off walls, enemies, and environmental objects.

Spawns a familiar that drops a coin every 2 rooms.

Grants homing tears, x2.3 damage multiplier, +1 flat damage, +4.125 range, +0.75 tear height, -0.4 tears, -0.25 shot speed, a red Heart Container and replenishes all Red Hearts.

Spawns a dagger orbital familiar, dealing 225 damage per second and blocking enemy shots.

+5 Bombs. Upon exploding, bombs shoot 10 tears around them, affected by tear modifiers.

Grants one Black Heart, +5.25 range, +0.5 tear height, +0.16 shot speed.

Increases speed by +0.2 and grants piercing tears.

Attaches a ball and chain to Isaac that pulls behind him that damages enemies, blocks shots, and destroys most obstacles.

Once per room, when Isaac is reduced to his last half heart, he is granted one Soul Heart.

Grants poison tears, which deal damage over time when inflicted.

+0.5 tears, +0.2 shot speed.

Damages Isaac in exchange for fully recharging Isaac's current activated item.

Spawns a familiar that wanders randomly, occasionally spawning Blue Spiders.

Spawns a familiar that follows Isaac around shooting normal tears.

Flies become harmless or less dangerous depending on the type.

Gives Isaac 99 keys.

Spawns an orbital familiar that blocks enemy shots. Upon taking damage, the familiar will pursue enemies for the rest of the room, dealing 22.5 damage per second.

+1 Red Heart container, +0.3 damage, +0.2 tears, +0.2 speed, +0.5 range, +1 tear height. Fully restores all red hearts.

Tears are smaller and do much less damage, but fire in very rapid succession.

+0.3 speed, +0.2 shot speed.

Reveals type of adjacent rooms, including location for Secret Rooms and Super Secret Rooms.

Adds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them.

When hit, spawns up to 2 Blue Spiders.

Grants spectral tears and flight.

Grants Isaac homing tears.

Increases tears by 0.4, spawns 2 Soul Hearts.

Isaac can hold 2 cards at once and all pills are replaced by cards.

Reduces all Shop prices by 50%, rounded down to 7 coins for an item, rounded up to 2-3 coins for a pickup.

Grants one full Red Heart container and +0.16 shot speed.

Increases damage by 1.

Increases damage, and adds 1 heart container.

Automatically inflicts slow to all enemies in every room. Upon taking damage, inflicts slow to all enemies for the current room. Slows all enemies in every room to roughly half speed.

Pickups, trinkets, and monsters are magnetically attracted to Isaac's tears.

Grants one full Red Heart container and 2 Soul Hearts.

+1 damage, +5.25 range, +0.5 tear height.

-0.3 Speed. Isaac builds speed while in a room with enemies. At max speed, he gains the My Little Unicorn effect for 5 seconds.

Isaac occasionally fires an unlimited range piercing laser alongside his normal tears. The laser can glitch, mimicking the effects of certain items and trinkets.

Replaces tears with a piercing laser with unlimited range.

Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously.

Activated collectibles can be "overcharged" to allow for an additional use.

Increases speed by 0.3.

When taking damage, Isaac farts, causing poison damage to all enemies in range.

Adds 3 Red Heart containers.

Adds a chance to shoot poison tears, dealing damage over time when inflicted.

Reveals all special rooms (except secret rooms of any kind).

Grants one full Red Heart container, +0.3 damage, +0.2 tears, +0.25 range, +0.3 speed, and +0.5 tear height.

Grants triple shot but decreases tears.

Allows Isaac to walk across gaps one square across by automatically placing a ladder between the two walkable sections.

Instead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.

Grants one Soul Heart, +1 damage, and +0.2 speed.

Reveals the entire map, including all special rooms and Secret Rooms.

Tears have a 1/6 chance of spawning allied Blue Flies when they hit an enemy.

If Isaac has half a red heart or no red hearts after taking damage, all enemies in the room take significant damage. Allows entrance into the Dark Room. Also allows access to Home.

Grants two Soul Hearts Black Hearts, +0.5 damage, and +0.7 tears.

Isaac's tears split in two when they hit something.

Spawns a familiar that floats slowly around the room on a zig-zag pattern, damaging enemies it passes through.

If Isaac has half a red heart or no red hearts after taking damage, he gains a shield that nullifies all types of damage for 5 seconds. Allows entrance into The Chest. Also allows access to Home.

Spawns a cross familiar that drops a Soul Heart every 5-6 rooms.

Increases tears by 0.7.

Increases damage by 1, increases tears by 0.2, and decreases speed by 0.2.

Grants two Soul Hearts. Isaac gains a pulsing aura that repels enemies and projectiles.

Inflicts poison to enemies who make contact with Isaac. Speed down. Poisoned enemies have a chance to drop a black heart when killed.

All sources of damage that would cause more than one-half heart of damage are reduced to one-half heart instead.

Two items spawn after defeating a boss. Only one can be taken; the other will disappear.

Destroys rocks upon contact with Isaac. Adds one Red Heart container and lowers Speed.

Range up and makes shot tears revolve around Isaac until they drop.

+0.7 tears, +0.16 shot speed.

+0.7 tears, +0.16 shot speed.

Adds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears.

Grants flight.

Reveals all rooms for every floor. However, it does not reveal icons or secret rooms.

Isaac gains a shield that protects him from enemy shots. It aims in the direction Isaac fires from.

Adds a chance to give a shield that nullifies all incoming damage for 10 seconds upon taking damage. Also converts bad pills into good pills.

Grants +1.5 damage and +0.3 speed whenever Isaac has half a red heart or less (one red heart for Eve), ignoring any Soul or Black Hearts.

Increases tears by 0.7.

Increases speed by 0.3.

Reveals and opens all Secret Room and Super Secret Room entrances.

+1.5 Damage Up. Replaces Isaac's tears with nails, which have increased knockback.

When Isaac takes damage, a black ring briefly appears around him, dealing damage to all nearby enemies.

Every time Isaac takes damage, a charm effect is applied to every enemy in the room, causing them to attack each other rather than Isaac.

Grants one Soul Heart, +0.75 tears and decreases Isaac's size.

Isaac leaves a trail of black powder on the floor. Walking in a circle will spawn a pentagram symbol on the floor, which deals 10 damage per tick to any enemies inside it.

+5 bombs. Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide). This also affects player-spawned Troll Bombs.

Spawns a beggar familiar which picks up any nearby coins, leveling up after collecting several coins. At level 2, Bumbo gains a body. At level 3, it begins to fire tears. At level 4, Bumbo follows enemies and gains contact damage.

Spider enemies no longer target or deal contact damage to Isaac.

After taking damage a certain amount of times, a permanent demonic familiar spawns.

Causes Isaac's activated item to activate twice on each use.

Spawns a familiar which creates a circular aura that slows down enemies and enemy shots inside.

Drops 1-6 random pickups on the floor. Causes items to be chosen from random item pools.

Spawns a familiar that occasionally drops a Lil' Battery, gives an activate item charge, or petrifies all enemies in the room.

Surrounds Isaac with a large white halo that occasionally deals Isaac's tear damage to enemies inside it, and can convert enemy shots into friendly homing tears.

Grants spectral tears and increases range. Tears travel through walls and appear at the opposite side of the room.

Grants one full Red Heart container and drops a random trinket.

+2 soul hearts. While Isaac has no empty red hearts, grants 2x damage, +5.25 range, and -0.3 shot speed. Regardless of health, the crown deactivates for the current room when Isaac takes damage.

Upon taking damage, spawns six Troll Bombs around the room similar to the XVI - The Tower.

Isaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.

Allows Isaac to carry two cards or pills (or a combination of both) at the same time. Increases the coin cap to 999. If a room would otherwise yield no reward, 1-3 pennies will spawn.

+0.7 tears up. Grants a random item at the start of the next run.

Grants two Black Hearts. While Isaac has no red hearts, grants flight and periodically grants an invincibility shield for a few seconds.

Shooting in one direction increases Isaac's rate of fire until the cap is reached. As soon as Isaac changes direction or stops shooting, rate of fire is reset to its normal amount.

While firing tears, Isaac has a chance to fire an eye across the screen with a very slow shot speed, which will fire tears of its own in the same direction as Isaac. The eye will be destroyed if it comes into contact with an enemy or obstacle.

Isaac's tears have a chance to stick to enemies and explode.

Spawns a familiar that follows Isaac and blocks enemy shots. If a shot hits Farting Baby, it has a chance to fart, which Charms, Poisons, or knocks back nearby enemies.

A blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.

Spawns a white attack fly that orbits somewhere between Distant Admiration and Forever Alone, dealing 45 damage per second.

Isaac's tears gain a random effect that changes every shot.

Spawns a familiar that bounces diagonally around the room, applying a random status effect to enemies it hits and has a chance to re-roll pickups it passes over. Spawns a familiar that follows Isaac. Double tapping the fire button launches it forward, causing it to reroll the first monster or pickup it hits. It respawns after clearing a room.

+5 bombs. Bombs have a chance to drop random pickups or charm enemies when they explode.

Tears have a chance to shrink enemies, making them run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.

Isaac's tears become coins and now have a chance to drop Pennies on the floor upon successfully hitting an enemy.

Adds a chance to fire holy tears, which will create a damaging light beam in the area if they hit an enemy.

A host familiar that sits on Isaac's head and has a random chance to block enemy shots and retaliate with 3 tears. Grants immunity to explosions.

Upon picking up a certain amount of health, spawn a permanent angelic familiar.

Spawns a demonic familiar that shoots tears identical to Isaac's in terms of damage, tears, and tear effects.

Spawns a familiar that follows Isaac and collects Keys for himself, giving random Chests in return.

Randomly while firing tears, Isaac will stop firing and turn red, where he will charge and release a lot of 'tears' in one go. The burst of tears also includes a kidney stone, which deals a lot of damage.

Spawns a chest familiar that spawns a random pickup (25% chance) or trinket (10% chance) upon clearing a room.

A Gurdy Jr. familiar that charges up while Isaac is firing, bouncing around the room when released and dealing contact damage based on its speed.

Spawns a Loki familiar that follows Isaac and fires 4 tears in a cross pattern.

Spawns fly familiar that moves in a straight line and circles around the first wall or obstacle it hits, dealing 105 damage per second on contact.

Isaac's damage increases for the current room each time he kills an enemy.

Isaac will automatically fire tears directed at a red target on the ground. The target can be moved with tear controls. +0.7 tears, +3.15 range.

Charged by firing for 2.5 seconds and when released, creates a black ring around Isaac that rapidly deals damage. +1 damage, the ring can cause enemies to drop Black Hearts.

Spawns a glass familiar that spills on the floor upon taking damage. After the milk spills, Isaac's tear delay is decreased by 2 for the current room.

+1.25 range, +0.5 tear height, +1 luck.

Two items spawn in every Treasure Room. Only one can be taken; the other will disappear.

+0.7 tears, +5.25 range, +0.5 tear height, spawns 3 random types of Hearts on the floor when picked up.

Spawns a familiar that will follow Isaac's movements on a 2.5-second delay. Tears that pass through the baby will be doubled and increase in speed.

Each time Isaac takes damage, inflicts fear on all enemies in the room and spawns a black friendly Charger that will attack enemies. The Charger will be killed if it is damaged too much.

A cone of light shines in the direction Isaac is moving that slows enemies and enemy shots.

Continuously firing tears for three seconds causes Isaac to drop a Butt Bomb, which damages and confuses all enemies in the room when it explodes.

Spawns a familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.

Spawns a familiar that follows Isaac's movements on a 3 second delay, firing tears at nearby enemies.

+5 coins. Turns doors that require a single key into doors which need a coin to enter instead.

Grants 4 Soul Hearts and fully restores Isaac's health.

Gives Isaac spectral tears and gives his tears a wide arc shape, increasing their size.

Boosts one of Isaac's stats depending on the color of the aura around him. The aura disappears upon taking damage and reappears with a random color upon entering a new room. Red boosts damage, blue boosts tears, yellow boosts speed, and orange boosts range.

Causes shops to instantly restock their items when they are bought. Granted by default for every character in Greed Mode.

Spawns a familiar that drops a random rune every 5-6 rooms.

Coins, bombs, keys, cards, runes and batteries have a chance to become sacks.

Adds 5 bombs. Isaac's bombs explode into 2-4 tiny bombs.

Spawns an angel familiar which follows Isaac and fires homing tears which deal 10 damage and have 75% shot speed.

Tears have a chance to apply a poison effect to enemies. Isaac poisons enemies on contact. Poisoned enemies have a chance to drop a black heart when killed.

In addition to tears, Isaac holds a spear in front of him which deals contact damage equal to 2x his tear damage, and occasionally inflicts fear.

Displays Isaac's tear damage and enemy health bars. Spawns a familiar that wanders around and inflicts random status effects on enemies it touches. Can spawn a Lil' Battery/Blue spider upon clearing a room.

+5 bombs. Bombs stick to enemies and spawn 2-4 Blue Spiders if they kill an enemy.

Spawns a flying familiar that bounces around the room with a black aura, dealing rapid damage to any enemies inside it. While standing in the aura, Isaac gains a 1.5x tear damage multiplier.

Spawns an orbital familiar which does 105 damage per second and attracts and blocks enemy shots. Upon blocking 10 shots in a room it drops an Eternal Heart.

Tears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.

Tears simultaneously fire out of both eyes diagonally, similar to the effect of the R U a Wizard? pill. Isaac's tears also travel above all obstacles.

Upon entering a room, poisons all enemies, dealing double Isaac's tear damage. Killing enemies leaves a small, short lasting pool of green creep on the ground.

Increases tears, range, and shot speed. Isaac emits a beam from his face that his tears follow along.

Gives Isaac a random zodiac item effect that changes every floor.

Spawns a random Harbinger familiar that changes every 10 seconds. Harbingers have different behaviors and spawn themed Locusts.

Spawns a familiar that drops a random pill every 3 rooms. Upon using a pill, all enemies in the room are poisoned.

Increases damage based on how many empty Red Heart containers Isaac has.

+0.35 tears up. Allows Isaac to fire tears diagonally.

Spawns an orbital familiar with a large orbital radius. Tears that pass through the prism split into four multi-colored tears.

Spawns a fly familiar that orbits around a random enemy and deals 30 damage per second to enemies it comes in contact with.

Increases tears. Adds a chance to fire a high-damage razor blade.

Isaac's tears deal double damage and inflict bleeding on enemies if they're facing away from Isaac.

Drops a random trinket. Grants a second trinket slot.

Spawns a familiar that follows Isaac and charges across the room when Isaac fires, blocking shots and dealing 40.5 damage per second on contact.

Grants one Soul Heart. Upon entering a boss room, grants a shield that blocks one hit, then disappears.

Spawns an orbital familiar that deals 30 damage per second and fires a randomly angled tear every 2 seconds.

Increases damage by a flat 0.1 and grants a Soul Heart. Enemies can randomly become briefly charmed or feared. Taking damage has a chance to spawn a rainbow poop.

Replaces all Red Hearts with 6 empty Bone Hearts. Upon losing a Bone Heart, Isaac fires bones in 8 directions and permanently gains a tears up.

Enemies, enemy shots, tears, and pickups will briefly freeze in place at random intervals.

One of two parts necessary to create Mom's Shovel.

Spawns a familiar with a random tear effect. The familiar is randomized at the start of each floor.

Isaac becomes camouflaged at the beginning of each room. Until he shoots, all non-boss enemies will be confused.

Increases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.

Grants a Soul Heart. Gives Isaac a chance to ignore any damage taken.

The first enemy killed in a room explodes and poisons nearby enemies. Poisoned enemies will also explode upon death.

+1.5 range, Drops a Lucky Penny.

Creates a ring of light around Isaac that petrifies enemies in contact.

When at exactly one Red Heart, grants +0.75 tears, +1.5 range, +1 tear height, +0.2 shot speed.

While firing, Isaac gains a green aura that poisons nearby enemies.

Grants a pickup or stat upgrade if all enemies in a room are killed in the order they are marked.

Spawns a familiar that leaves a trail of creep that damages enemies at 6 damage per second. Has a chance to spawn damaging beams of light onto enemies that touch the cloud.

Grants one Bone Heart, +0.7 tears, spawns a Mysterious Paper.

+0.3 damage, +0.1 speed. Plays a howl or bark sound when entering a room with undiscovered Secret Rooms or Crawl Spaces.

Whenever a Devil or Angel Room would spawn after defeating a boss, both rooms spawn. Only one can be entered.

An Angel Room door will always spawn after every boss fight, excluding the first floor and floors after The Womb II/ Utero II.

Adds a chance to fire needles that instantly kill basic enemies and deal triple damage to bosses. If a needle kills an enemy, it bursts into more tears/needles.

Grants piercing tears. After piercing one enemy, tears start homing and deal double damage.

Every 20 tears, Isaac loses 1 coin and shoots an additional gold tear that petrifies enemies and turns them into gold. Any enemy killed while in this state will drop coins.

Grants 7 bombs and allows bombs to be placed rapidly.

Spawns a finger familiar that points at enemies, dealing scaling damage.

Tears bounce off the floor, creating splashes. Splashes deal 25% of Isaac's tear damage to all enemies in a small area.

Gives a chance to shoot fires alongside tears that block enemy shots and deal damage to enemies that touch them.Gives a chance to shoot blue fires alongside tears that become smaller as they travel.

Adds a chance to shoot tears that confuse enemies for an extremely long time.

Grants 2 Soul Hearts and modifies drops from Champion monsters based on certain conditions. Also modifies room clear drops.

Grants a Red Heart container for every 25 coins Isaac has.

Tears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.

Spawns a white poop familiar, which turns into a white poop when Isaac is hurt. White poop has an aura that halves tear delay and can block enemy shots.

Spawns a Hush familiar that bounces diagonally around the room and deals contact damage. While firing tears, it stops moving.

Tears fire sparks of electricity in random directions upon hitting an obstacle or enemy.

Spawns a familiar that flies through the room while firing, dealing a flat 7 contact damage to enemies retrieving pickups.

Grants an active item charge every 15 enemies killed.

Spawns a familiar that follows Isaac and makes other familiars follow it. While firing tears, other familiars stop moving.

Isaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.

Adds a chance to fire a creep shot that deals double damage and leaves a trail of slowing white creep.

After every 15 tears fired, Isaac will fire a high-damage cluster of tears.

Upon taking damage, grants a body part as an orbital, which blocks enemy shots and deals 7 damage per tick to enemies it comes in contact with. The orbitals will be destroyed if they take enough damage from enemies or enemy shots.

Grants a familiar that transforms into another random familiar every 10 seconds.

Spawns a familiar that fires clusters of tears. Must be charged before shooting.

Drops a random pill, and spawns a familiar that charges up and fires creep. Using pills changes the creep type.

Constantly shooting causes Isaac to release gas clouds that can be pushed by his tears and damage nearby enemies.

Adds a chance to fire a piercing tear that instantly kills any enemy that it touches. Adds a chance to fire a tear that summons Big Horn's hand to crush the first enemy it hits, instantly killing monsters or greatly damaging bosses.

Spawns 3 random trinkets, 5% chance to swallow held trinket after taking damage, gaining its effect permanently.

Grants one bone heart and spawns three red heart pickups.

Grants one Soul Heart. Enemy shots have a chance to be reflected at the shooter as confusing tears.

Grants one full Red Heart container. Heals 1 additional heart of health.

Spawns an orbiting razor that deals contact damage and inflicts bleeding on enemies, causing them to slowly take damage over time.

Spawns an egg familiar, which cracks into a random friendly monster when Isaac is hurt. The egg regenerates upon entering a different room.

Adds a chance to fire an egg sack which creates slowing creep and spawns a Blue Fly or Blue Spider upon hitting an enemy.

Spawns a bone familiar that hovers back and forth in front of Isaac, dealing damage equal to Isaac's damage.

Upon entering a room with enemies in it, has a chance to spawn a random friendly enemy that persists across rooms.

Allows Isaac to carry two cards, pills, or any combination of both. Spawns one random card, rune or pill.

Replaces Isaac's tears with eyeballs that can bounce off of each other. The eyeballs are not limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle.

Spawns a familiar that drops a sack every 5-6 rooms cleared.

Allows Isaac to hold two active items.

Spawns a shadow familiar that follows Isaac's movements on a 1 second delay and deals contact damage to enemies. After dealing enough damage, it is absorbed by Isaac and spawns friendly Chargers.

Upon taking damage, Isaac has a chance to drop a full red heart, gain 5 range, and leave a trail of damaging red creep for the current room. Taking damage causes Isaac to bleed, spraying a volley of blood in the direction he fires. Bleeding will eventually damage him, but it can be stopped by picking up a Red Heart.

Adds a chance to fire a booger that sticks to enemies and deals damage over time.

Spawns a bone familiar that circles around Isaac and reflects enemy shots.

+0.3 damage. Adds a chance to fire acidic tears which can destroy obstacles.

Drops a random card or rune. Doubles the effects of most cards and runes. Doubles the effects of tarot cards.

Connects Isaac's tears with electricity that can damage enemies.

Damage down. Tears are replaced with piercing white blasts of light that can damage the same enemy multiple times.

Taking damage releases a ring of 10 high damage tears.

+1 luck. Spawns a fairy familiar that points out Secret Rooms, Crawl Space entrances, and tinted rocks.

Repeatedly zaps enemies that are close to Isaac.

Enemies near Isaac are afflicted with fear.

Active items don't charge when clearing rooms. Instead, they're charged by dealing damage to enemies.

Gives Isaac +0.5 Tears and +0.2 Shot Speed.

Devil deals now cost coins, shop items now cost health, and consumables in shops are free but surrounded by spikes.

Increases tears and grants an Eternal Heart. Allows Angel Rooms to appear even if a Devil deal has been taken before. Greatly boosts Devil/Angel Deal chance if Isaac has taken Red Heart damage.

While in an uncleared room, Isaac forms a trail of bloody tears that drags behind him, bursting and dealing damage upon contact with enemies.

Quadruples fire rate, with x0.3 damage multiplier. Tears are given random worm trinket effects.

Causes Isaac to turn into a ghost if he gets hit while in a room with enemies, giving him flight and spectral tears and blocking the next hit he takes.

Isaac builds rage every time a room is cleared. After four rooms, fires a large Brimstone laser when entering the next room.

Recharges Isaac's currently held active item and drops 2-4 batteries.

Causes enemies to bounce off of Isaac, dealing damage to them if they hit and enemy or obstacle. Also gives Isaac the chance to deflect enemy shots.

+1 red heart container and fully heals Isaac. Item pedestals cycle between their normal items and food, and collecting food grants a temporary damage boost and permanent bonuses to 2 stats.

The first time Isaac takes damage in a room, a familiar leaps on an enemy, dealing damage and releasing a rock wave. For the rest of the room, it chases enemies similar to Dead Bird.

Gives a chance to shoot fires alongside tears that block enemy shots and deal damage to enemies that touch them.

Has a different effect for each character.

Grants a Red Heart container and restore 5 hearts. Bombs leave behind damaging red creep. Isaac can place bombs at the cost of half a heart if he doesn't have any.

Stabs Isaac at the beginning of each floor, draining his red hearts. Increases damage and speed for the floor based on the amount drained.

Spawns a familiar that chases enemies. After killing enough enemies, it becomes more powerful and drops red hearts after killing enemies, but will also try to hurt Isaac. Attacking it returns it to normal.

When Isaac takes damage, he gains speed and tears for the rest of the floor.

Gives Isaac a familiar that fires chaotic bursts of tears in all directions.

Enemies spawn floating bones on death, which block shots and damage/repel enemies that touch them.

Spawns 5 random cards.

Spawns an orbiting fly familiar that fires shielded tears at incoming enemy projectiles.

Gives Isaac +5 bombs and causes his bombs to fire Brimstone lasers in the cardinal directions upon exploding.

Switches control to a fetus that is attached via umbilical cord. The fetus has flight as well as all of Isaac's tear effects and stats.

Gives permanent stat boosts when Isaac heals with red heart pickups.

Spawns two portals that each lead to either the Boss Room, Secret Room, or Treasure Room at the beginning of each floor.

Increases Isaac's lowest stat and drops either 3 coins, 1 bomb, or 1 key depending on what Isaac has the least of.

Unlocks doors and reveals a random room on the map when Isaac takes damage.

Spawns an ice cube familiar that slides around when walked into. It slows and deals contact damage, freezing monsters it kills.

Begins the sequence to access Home.

Destroying poop spawns friendly Dips that follow Isaac and damage enemies. Destroying different types of poop spawns different Dips with special effects.

Double tapping a fire key creates a shield that pushes away enemies and reflects enemy projectiles and lasers.

Grants flight, +0.1 speed, +2 damage, and the Holy Mantle effect. Grants enough health to have 6 full hearts, if possible. Automatically given to Isaac after defeating Dogma.

During the transition between floors, Isaac's nightmare shows the floor's Treasure Room item and boss. Grants half a soul heart when entering a new floor.

When Isaac uses a card, pill, or rune, he also uses a copy of every card/pill/rune he used after picking up Echo Chamber.

If Isaac has an empty heart container, another one is added at the start of each floor.

Increases luck by 2.0. Provides immunity to burn, confusion, fear, and poison.

Lowers the tear delay in Isaac's left eye, causing his eyes to fire at different rates.

Isaac's tears are now controlled mid-flight with tear controls. Also increases damage and range, but decreases shot speed.

Causes Isaac to occasionally extra fire tears in random directions while shooting.

Converts good pills into bad pills and identifies all pills. Bad pills now have secondary positive effects. Grants one Black Heart.

Spawns a shooting familiar that has a chance to petrify enemies, and Freezes monsters upon killing them.

Gives Isaac a miniature Baby Plum familiar that propels itself diagonally around the room, firing tears behind itself as it travels.

Gives Isaac 5 bombs and causes his bombs to spawn ghosts that deal contact damage to enemies and explode after 10 seconds.

Causes Isaac to spawn micro-Isaacs when he takes damage, which chase and shoot at nearby enemies.

Before being picked up, item pedestals cycle between 5 random items.

Shows the contents of Chests, Sacks, and Fire Places before they're opened.

Grants 3 broken hearts and +0.25 damage for every broken heart Isaac has. Every otherwise fatal hit will add 2 more until Isaac has nothing but broken hearts.

Double-tapping a fire button causes Isaac to sneeze blood, dealing damage to enemies in front of him.

Enemies have a chance to spawn ghosts on death, which chase and deal contact damage to enemies and explode after a short time.

After taking damage from an enemy, launches a half or full red heart from Isaac that despawns after 1.5 seconds.

Causes Isaac to throw poop, create buffing creep, or drop bombs while fighting enemies.

Adds one red heart container and fully restores health. x1.2 damage multiplier. Isaac will occasionally fire extra tears that orbit around him.

Upon death, Isaac respawns in the current room with half a heart left, a massive size down, and +0.2 speed.

Spawns an Old Chest at the start of each floor.

Releases a ring of tears and increases tears for the current room when Isaac takes damage.

+2 red Heart containers, -0.3 speed. Isaac builds speed while standing still, and releases poison gas clouds when he moves afterwards.

Rocks and props spawn spiders over time while in a room with enemies, and spawn two blue spiders when destroyed.

Gives range, speed, or damage when buying things from a shop. Also spawns three coins and a key on pickup.

Combined with Knife Piece 2, creates a knife familiar that damages enemies and can open the door to the Corpse.

Combined with Knife Piece 1, creates a knife familiar that damages enemies and can open the door to the Corpse.

Adds a chance to shoot a fist tear that has extremely high knockback and confuses enemies.

Spawns a familiar that charges a miniature Maw of the Void attack while Isaac shoots.

Gives Isaac a Dumpy familiar that pushes, confuses, or poisons nearby enemies and flies in a random direction after taking damage.

A familiar that flies forward, consuming pickups in its path. Each one will increase its size and damage and spawn a Blue Fly. Every four pickups, it opens a portal that leads to an unexplored room.

Gives Isaac the chance to fire tears that magnetize enemies they hit, causing them to attract nearby pickups and enemies, as well as tears/shots from all sources.

Gives Isaac a soul familiar that dies in one hit, respawning at the start of the next floor. If it survives an entire floor, it rewards Isaac with hearts or items.

Adds an extra Secret Room and Super Secret Room to each floor. Secret Rooms contain a beam of light that increases tears for the current floor and give soul hearts.

Dash by double-tapping the movement key, becoming invulnerable and damaging enemies. There's a short cooldown before Isaac can dash again.

Adds a trapdoor to every shop that leads to a second shop with a unique stock and marked up prices.

+0.4 speed. Doors stay open after entering a room, even in rooms with enemies.

Isaac gains an aura that deals damage to enemies inside it.

While firing, Isaac charges up a short-ranged Brimstone-like diarrhea beam that shoots behind him.

Gives Isaac the chance to fire spore tears that stick to enemies and blow up after a few seconds, dealing damage and poisoning nearby enemies and releasing more spores.

Gives Isaac +5 bombs and gives his bombs random bomb synergies.

Isaac's mouth fills with tears over time while not firing, up to a cap. Holding the fire button will release all stored tears in rapid succession.

Gives Isaac the chance to fire tears that create rifts where they land, which damage nearby enemies and pull in enemies, pickups, and tears/shots from all sources.

If a room gives a reward when cleared, there will be two different rewards to chose from. Taking one causes the other to disappear.

Prevents creep and floor spikes from damaging Isaac. Also gives Isaac +0.3 speed and 2 soul hearts.

Gives Isaac a tears bonus based on how many consecutive rooms he's cleared without taking damage.

Grants multicolored tears. Each color comes with a different status or tear effect.

Significantly shrinks Isaac, allowing him to squeeze between objects and makes some enemy shots pass over him. Also gives +0.7 tears.

Spawns a fly orbital familiar that chases and deflects enemy shots and converts them into homing tears.

While in a room with enemies, spawns cracks on the ground. Walking over these cracks summons ghosts that launch themselves at enemies and explode.

Killing enemies spawns a stationary shooting familiar where they died for the current room.

Refills all heart containers. Grants an enormous damage boost that wears off over time.

Gives Isaac a soul heart and +1 damage if he goes into a Devil Room but doesn't take anything from it.

Allows Isaac to charge a holy laser by continuously firing for 2.5 seconds, then releasing the fire buttons. Also gives Isaac flight and 2 soul hearts.

Locks Isaac's attributes to their highest values reached.

+5 bombs. If Isaac is currently moving, placing a bomb will instead shoot a fast-moving, explosive rocket in the direction he's facing.

Adds a chance to fire tears that Mark enemies. Marked enemies are attacked by other enemies.

Prevents low-quality items from spawning, greatly increasing the quality of items received from all items pools.

Gives Isaac a halo that summons beams of light on enemies inside it. The halo grows larger the more times Isaac has taken damage this floor.

Spawns a special set of spikes in the Devil Room. Taking damage from the spikes has a chance to grant a reward.

Upon entering a room, a circle of tears orbits Isaac. Enemy tears have a chance to be caught in orbit, turning them friendly.

Adds a Red Heart container, and increases speed, damage, tears, range, shot speed, and luck.

Reveals the location of the Boss room. Upon defeating a boss, activates XIX - The Sun, fully recharges Isaac's active item, and grants bonus damage and luck for the rest of the floor.

Gives Isaac a permanent stat boost whenever he picks up a soul heart.

On death, Isaac's ghost is chained to his dead body and he can continue to fight with 1/2 of a heart, returning to life after 10 seconds. Must be recharged by picking up a soul heart.

Instead of tears, Isaac swings a sword. Charging does a spin attack and fires a projectile, and a projectile is sometimes fired with normal swings if Isaac has no empty red hearts.

+1 damage. Prevents Isaac from firing tears from one eye, like Cain.

Spawns a star familiar that slowly travels towards the Boss Room, giving an aura that increases damage and tears and grants homing.

Spawns Keeper to fight enemies alongside Isaac. If Keeper dies, he spawns blue spiders and Strawman is removed from Isaac's inventory.

Grants one full Red Heart container. Heals 1 additional heart of health.

Replaces tears with rocks that deal variable damage, have increased knockback, and can destroy obstacles.

A familiar burrows in Isaac's head, firing 4 slowing tears. Upon taking damage, there's a chance it will burst out of Isaac's head, spawning blue spiders and chasing enemies for the current room.

Generates a ladder at the start of every floor that leads to a unique Angel Room shop.

Spawns nine orbital flies, which turn into Blue Flies after they block a shot. Each time a room is cleared, spawns another orbital fly.

Gives Isaac a Teratoma orbital that blocks shots, deals contact damage, and splits into smaller versions of itself upon taking damage. The smaller versions break into blue spiders.

Causes all future items to be "glitched", granting them completely random effects.

Isaac periodically turns into a spiked statue, briefly becoming invulnerable and dealing contact damage.

+1.5 range, Increases tear size.

Gives Isaac two familiars that stand by Isaac's side and fire tears that use Isaac's tears, range, shot speed, and tear effects and scale with Isaac's damage.

Isaac shoots ice tears, which slow enemies and freeze monsters they kill. Frozen enemies slide away and explode into ice shards when touched.

Spawns a familiar that becomes a clone of the floor's boss when entering the boss room. Defeating it drops an extra item.

Enemies explode into tears upon death, which inherit the effects of Isaac's tears.

After taking damage, spawns an orbital wisp that lasts for the entire floor, up to a maximum of six. They fire tears but do not block shots.

Adds one red Heart container. Enemies near Isaac become charmed.

Spawns an additional curse room on each floor.

Gives Isaac a nerve ending familiar that burrows out of the ground to grab and deal damage to enemies over time.