communion, the lost item pool, circle, cross, white, yellow, +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. * item room, treasure room, item room pool, round, circle, white, REPENTANCE - Homing tears now target enemies much more reliably, * item room, treasure room, item room pool, grey, gray, bent, x1.5 times Damage Multiplier (Does not stack with the Magic Mushroom multiplier), Cricket's Head used to be known as Max's Head in the original game and was renamed for Rebirth, * crickets head, cricket head, item room, treasure room, item room pool, golden chest pool, gold chest pool, cat, dead, brown, pink, * item room, treasure room, item room pool, broken, mirror, cracked, grey, gray, silver, Gives you a very high tear rate in exchange for a big range down, * item room, treasure room, item room pool, mm sweet lemonade, urine, yellow, tear, drop, x1.5 times Damage Multiplier if you also have Book of Belial (Does not stack with Magic Mushroom or Cricket's Head multipliers), * item room, treasure room, item room pool, crown, thorns, brown, hat, A familiar which follows Isaac and shoots normal tears which do 3.5 damage, REPENTANCE - Brother Bobby now has an increased rate of fire, * item room, treasure room, item room pool, devil pool, devil room pool, devil deal, purple, blue, dead, baby, 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. UNLOCK: Unlock this item by defeating Ultra Greed as Apollyon, 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, * pokemon, phone, black, green, blue, gps, 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, *, knife, dagger, red, heart, silver, knife, 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), 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), Its speed is not affected by the Guardian Angel item, 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, REPENTANCE - Bloodshot Eye now blocks enemy shots, has increased shot speed and rate of fire, and now only shoots when lined up with enemies, 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. Each secret room contains a beam of light, that gives half a soul heart, and a Tears Up for the rest of the floor. Yeah I saw one of those rooms on the map too. the lost item pool, A familiar that follows Isaac and fires black tar tears, which slow enemy movement and projectile speed for a few seconds, Little Gish fires tears at a rate of 1 tear per second, A Guaranteed drop from the Gish boss fight, UNLOCK: Unlock this item by beating the Depths 20 times and killing the Gish boss, * item room, treasure room, item room pool, grey, gray, yellow, eyes, face, 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, UNLOCK: Unlock this item by killing the Steven boss for the first time, * boss room pool, boss room item, item room, treasure room, item room pool, black, baby, white, eyes, UNLOCK: Unlock this item by killing Mom (Mom's Foot or Mom's Heart) using The Bible, * angel room pool, god room pool, angel room item, boss room pool, boss room item, item room, Spawns coins as The Keeper, I can see forever - Opens secret room and super secret room entrances on the current floor, I found pills - Changes the appearance of Isaac's face for the current room (Cosmetic change only), Lemon Party - Spawns a large yellow pool on the floor around you, damaging enemies which walk in it, Paralysis - Prevents you from moving for a short while, Pheromones - Applies the charm effect to all enemies in the room for a short while, Puberty - Causes Isaac to grow hair for the rest of the run. brown, brass, copper, dads key, dad key, * boss room pool, boss room item, item room, treasure room, item room pool, lumpy, red, balls, Using the portable slot takes a coin and has a chance to give a pickup - similar to how the normal slot machines work, REPENTANCE - The delay between uses was removed, allowing you to spam-use it, * normal beggar pool, normal judgement pool, coin beggar pool, coin judgement pool, UNLOCK: Unlock this item by defeating Delirium in The Void floor with Isaac, 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. Tear Appearance Isaac appears demonic with large curved horns and an angry expression. The only way to remove it is via having a second trinket slot (Mom's Purse, Belly Button) or absorbing it (Marbles, Smelter, Gulp! as Bethany, Gives you a random syringe effect every room, The effect can be The Virus, Roid Rage, Speed Ball, Experimental Treatment, Synthoil, Euthanasia or Growth Hormones, Placed bombs explode after 0.66 seconds instead of the usual 1.5 seconds, This was called Exploded Firecracker in Antibirth, Farts produced by Isaac or familiars will be twice as large, Chance for enemies to burn when entering a room, The chance for this effect to activate is effected by your Luck stat, This includes key blocks and golden chests, Pickups left on current floor will appear in the starting room of the next floor, up to a maximum of 4 pickups, Active items will be rerolled upon using them, Using with Book of Virtues will only reroll the item the book is holding, Has no effect with Notched Axe due to how its durability works, UNLOCK: Unlock this trinket by defeating Mother as Eden, Random luck-based tear effects have an extra chance of occurring, The additional chance is effectively +3 Luck Up, Picking up red hearts now has a high chance to spawn 1-4 blue attack spiders, instead of giving you health back, This effect also works while fully healed, giving a guaranteed chance of getting spiders, While missing any red health the chance for spiders is less, Works for characters that don't use red health, which always gives you spiders, Hearts in Shops can be converted into spiders for free, Gives your familiars improved rate of fire while held, In Antibirth this trinket was called Song of the Siren, UNLOCK: Unlock this trinket by bombing the skull left by The Siren boss after her death, While held at the start of each floor, this trinket spawns four wisp familiar orbitals around Isaac, These wisps are the same as the ones created by the Book of Virtues item, UNLOCK: Unlock this trinket by beating the Boss Rush as Bethany, Your active item no longer gains charges, but battery drops become much more common, UNLOCK: Unlock this trinket by blowing up 10 Battery Beggars, Tears that miss enemies will redirect themselves and travel 90 degrees towards enemies, Tears must be roughly 2 tiles or closer to activate this effect, +10 Luck while held, but the trinket is destroyed when damage is taken, Blood donation machines, Curse Rooms and Sacrifice Rooms wont destroy it, Taking a hit and activating Holy Mantle won't destroy it, Can be dropped in order to avoid breaking it, This trinket is automatically given to you after clearing 3 bosses without taking damage, Treasure Rooms are replaced with Red Treasure Rooms, which contain a deal with the devil in place of a regular item pedestal, If an item room has not yet been entered, it can be transformed to either a regular or Red Treasure Room by picking up or dropping this trinket before entering, Does not affect the mirrored treasure room in Downpour II, UNLOCK: Unlock this trinket by defeating Mother as Azazel, Every time you pick up a coin, you have a small chance to gain 1 bar of charge on your active item, The chance for this effect to happen is 1/6th of the value of the coin picked up, Can only activate once per coin collected, In Antibirth this trinket was called Electric Penny, UNLOCK: Unlock this trinket by donating to a battery beggar until he pays out with an item 5 times, While held, your familiars will now orbit around Isaac instead of following behind him, Activates your active item just before damage would be taken, It doesn't activate for free - the charges are used up as normal if this effect activates. One of the sounds lasers can make when Isaac's tear size is large (or when damage is 10.0 or more). After a minute or so of not hurting her she will fly away and spawn Plum Flute, UNLOCK: Unlock this item by allowing Baby Plum to escape instead of killing her, 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, UNLOCK: Unlock this item by defeating Delirium as Bethany, 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. On my previous version of this guide, I made the mistake of assuming nobody would need a version that just had everything, since various wikis already have that. 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, UNLOCK: Unlock this item by completing every post-it note for every character, including the Tainted characters, 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, Item Pool: Item Room, Key Beggar, Crane Game, 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. Characters Curses After taking two hits, the fire will be extinguished, The Book can be held at the same time as another active item. Corpse II drops same as Womb II, UNLOCK: Unlock this item by beating the Dark Room with Lazarus, * red chest pool, red chest item pool, shop room pool, shop item pool, blue box, pandoras box, 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, * item room, treasure room, item room pool, white, lump, grey, gray, blob, 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, * astrology, astronomy, item room, treasure room, item room pool, blue, glow, circle, horns, Gives huge horns which stick out, allowing you to deal 18 contact damage if you hit something with enough speed, Will not deal contact damage unless you are moving fast enough (at least 0.8 speed), REPENTANCE - Aries now prevents receiving contact damage if ramming and killing enemies at full speed, * astrology, astronomy, item room, treasure room, item room pool, black, blue, cyan, glow, After getting hit once, you gain a damage reduction for the rest of the room similar to The Wafer item (-50% damage taken), * astrology, astronomy, item room, treasure room, item room pool, cyan, black, the lost item pool, Based on the Steam Workshop mod (originally called Water Balloon) created by HiHowAreYou, UNLOCK: Unlock this item by picking up the Blood Clot item 10 times, 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. Monsters ?, Satan and The Lamb as Tainted Lost. Chemical Peel is a passive item. 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, UNLOCK: Unlock this item by defeating The Beast as Tainted Azazel, 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, UNLOCK: Unlock this item by defeating The Beast as Tainted Apollyon, 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, UNLOCK: Unlock this item by defeating The Beast as Tainted Forgotten, 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, UNLOCK: Unlock this item by defeating The Beast as Tainted Bethany, 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. Bad Trip becomes Balls of Steel. 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. Trinkets Each tear has a random size multiplier between 0.9x to 1.33x, but there is no effect on damage. This update brings more than just fixes, the patch also performed some tweaks and changes to the game's health and armor values of some items, so if after a couple of matches you feel like the game is different . Krampus Head) can still spawn, Bible drops caused by the Rosary item are not prevented by this trinket, *, stop, red, circle, line, cross, entry, warning, Causes your familiars to stay closer to each other, Poop in the environment will now explode when destroyed, While held you have an increased chance for Black Poops to spawn, which deal damage to all enemies in the room when destroyed, Gives The Poop active item a chance to spawn a Black Poop too. It rerolls enemies and pickups it comes into contact with, then despawns. DQY7 QK7M (The Basement XL: Second boss's Devil Room), PC QFJL Q6SC (One of the chests in Curse Room adjacent to spawn), PC QW44 N10D (Second floor Devil Room; Isaac may proceed normally, but all other characters must not enter the first floor Treasure Room.