Items are one of the most important element of this game; they can give you new abilities, increase your stats, give you familiars, and also change your appearance! There is a huge variety of items in the game especially with the Wrath of the Lamb expansion installed, totaling at 132 items in the vanilla game and 198 with the expansion installed.
Most of these items can be found in Treasure Rooms, but some items have unique locations in which they can spawn such as Secret Rooms, Devil Rooms, Angel Rooms, and Curse Rooms.
Items can also be obtained from the following locations:
Some items can only be obtained through special means, such as A Dollar that is won from the Slot Machine or the IV Bag that is won from the Blood Donation Machine. Such items will have their "drop source" added to their description.
You may notice that the selection of items you get when you first start playing the game is pretty limited. This is because most items must be unlocked first before they can appear in the game. Items that need to be unlocked will have their unlock method listed in the description.
Items fall under two main categories; activated and passive.
Activated items are shown in the top part of the screen and must be used by pressing the spacebar. The white bar to the right of the item shows it's current charge which must be full before the item can be used. These items recharge after a certain number of rooms which varies depending upon the item's strength. The player can only hold one of these items at a time; picking up another such item will drop your current one.
Passive items cannot be used by the player and have no recharge time, but instead add a passive effect or ability that persists for the current run. The player can pick up as many of these items as he wants, and since some of them change Isaac's appearance, can result in some very funky results!
Passive items are further organized into the following categories:
- Tear Modifiers
- Stat Boosting
While activated items are sorted under damaging or defensive.
The items collected by the player (both active and passive) during the current run can be seen by pressing the escape key. Even though the cursor changes when hovering over these items, clicking on them does nothing.
Picking up an item will stop it from being found again during the current run, even if the item is dropped. You can use this to your advantage when finding really bad items by picking them up and dropping them down again.
Finally, there is a "Collection" page that can be accessed from the main menu that shows every item you have collected throughout the game. Items that have never been collected are shown as a box containing a question mark. Hovering over these items will show a bigger version of them as well as their name.
Use the following menu to quickly navigate this page:
These items provide some sort of offensive power for the player.
Spawns 6 Troll Bombs in random locations of the room. This item has the same effect as The Tower Tarot Card and is often dropped by Pride.
Can also be found in the Library.
Creates a cloud of green gas around Isaac that damages enemies in the vicinity. This item works exactly like the Bad Gas Pill. In order to unlock this item you must destroy 50 piles of poop.
Best Friend (WoTL only)
Creates a decoy on the ground that looks a lot like Isaac and will shake for a while before exploding. You can move the decoy around by shooting at it just like a regular bomb. Any orbital items you may have when using this item will temporarily follow the decoy until it explodes, then return to you. This item is very effective against Chub since he is very prone to eating it.
Bob's Rotten Head
Allows you to throw a bomb in any direction you choose that does big damage as well as poison the enemy. This item cannot be used if the player has Technology 2, so keep that in mind. Be careful when throwing this bomb in a closed environment as the blast can hurt you, although it will not poison you.
Besides the regular spawn locations, this item can also be found in Secret Rooms or as a drop from Sloth.
Using this item against Sloth or against Pestilence has very limited use since they are almost immune to its effects, but it is a very effective item when searching for secret rooms or destroying Tinted Rocks since it basically gives you a lot of free bombs.
Blood Rights (WoTL only)
Using this item will damage Isaac for one full heart but will also damage all enemies in the room. It has no recharge time so you can use it as many times as you want, although be warned that it will kill you if you don't have enough health. As an added visual effect using this item will cause a massive amount of blood to spew from the walls of the room.
You must first unlock this item before it can be found in the game by killing Satan with Samson.
The Book of Belial
Turns Isaac int an angry demonic entity that has +3 damage for the duration of the room. Judas starts with this item. The Devil Tarot Card has the same effect as this item.
It is possible to find this item in Secret Rooms, Devil Rooms, and Libraries besides the regular spawn locations. It must be unlocked by beating the full game however.
The Candle (WoTL only)
One of the most effective items in the game, although one of the misunderstood as well. The Candle is one of the few items that recharges itself, meaning that you can use it multiple times per room. When used The Candle will shoot out a blue flame (in any direction you choose) that damages everything it passes through, flying over pits but not over other obstacles such as rocks. The blue flame also destroys any enemy projectiles it touches, making it a very good item against Isaac and ???. The "Dark was the Night" challenge must be completed first before this item is unlocked.
This item is most probably a reference to the blue candle from The Legend of Zelda.
Crack the Sky (WoTL only)
When used this item causes several beams of light to drop down in random locations of the room, damaging enemies that move through them. The beams cannot actually damage Isaac.
Dead Sea Scrolls
This item does not actually have its own effect, instead choosing a random effect from the many activated items found in the game. Since some activated items can hurt you (like Kamikaze!), Dead Sea Scrolls can potentially kill you. Also note that if the effect is taken from an item that has no recharge time (such as Blood Rites), Dead Sea Scrolls will also not have a recharge time. Items that have yet to be unlocked can still be picked when determining what item to mimic.
When used this item creates a red reticle on the ground that can be moved with the arrow keys. After a brief moment a huge missile will hit the target causing large damage to anything it hits, including Isaac. This item is very good for finding Secret Rooms as it effectively gives you infinite bombs.
Doctor's Remote is an obvious reference to Dr. Fetus from Super Meat Boy.
This item is very powerful. On use it will turn Isaac into a Pac-Man style monster that is invincible and can damage enemies by touching them. All enemies will turn blue for the duration of the item and will also run away from you, but every two you manage to kill will heal you for half a heart. As you can probably tell by the cast visual similarities, the actual item is a reference to the Nintendo Gameboy.
Unlocking this item is pretty easy, all you have to do is visit the Arcade ten times.
Guppy's Head (WoTL only)
Up to 4 blue flies will spawn every time this item is used, which will circle Isaac until they find an enemy to explode into. This item counts as one of the three you need to collect in order to become Guppy. Although you can have more than 5 blue flies in a room, they will be reduced to 5 when entering a new room.
It can be found in the Devil Room, Challenge Room, or inside a Red Chest.
Gives Isaac a bunch of explosives strapped to his chest that can be used as a suicide explosion; damaging Isaac for one heart and also any enemies caught in the blast. I never actually found a good use for this item since it requires so much health for such a little effect.
Creates a temporary yellow puddle on the ground that damages all enemies that walk over it (except for flying enemies).
Drops a very large bomb when used that explodes after a short duration. Allows the player to search more easily for the Secret Room since this item gives a lot of free bombs.
My Little Unicorn
When used makes Isaac invincible, gives him a giant horn on his forehead, and allows him to damage enemies by running into them. Enemies will run away from you while this item is active, so make sure you are close before activating it. You cannot shoot while this item is active, but Mom's Knife still works (possibly a bug).
My Little Unicorn is based on My Little Pony.
The Pinking Shears
When used this item cuts Isaac's head from his body, creating two entities. The body will chase after enemies and damage them, while the head is still under player control and can shoot. The player is considered to be flying after using this item, allowing him to move over obstacles. If you manage to recharge this item multiple times per room (by using the Habit) it will create a "body" each time, allowing you to build a small army.
This item is unlocked by dying 100 times.
Spider Butt (WoTL only)
Damages all enemies in the room while also slowing them. Unlocked by finishing the "Spider Boy!" challenge.
Telepathy for Dummies (WoTL only)
Gives you homing tears for one room, just like Spoon Bender does. Can also be found in Libraries.
Picks a random familiar or orbital object from the game and gives it to the player for the current room, even ones you have not yet unlocked. Note that when this item picks the Cube of Meat, the level of the meat boy will be random each time (ie. it is possible to get a level 4 meat boy). This item bears a very strong resemblance to the Monster Manual from Dungeons & Dragons, suggesting that it is a refernece to it.
This item must be unlocked by finishing Sheol with Judas.
Picking up this item gives Isaac a snazzy necklace that can be used to summon Monstro, which will jump on a random enemy dealing heavy damage. This item cannot be used when there are no enemies in the room, although it can hurt you if you run into Monstro after he falls on an enemy. For obvious reasons, this item cannot be used when fighting Monstro.
Monstro's Tooth is unlocked by killing all of the bosses found in the Basement.
Gives a Soul Heart, 2 bonus damage, the ability to crush rocks, and a super cool demon look for the current room. This item is very good for ??? since it gives a steady supply of health. This item is found in the Devil Room and in all places that can spawn Devil Room items which are Curse Rooms, Devil Beggars, and The Fallen.
Must be unlocked first by finishing the game three times.
Damages all enemies in the room as well as destroying all of their projectiles. This item is pretty much a reusable version of the Death Tarot Card, and is unlocked by using said card four times.
Holding this item will allow Isaac to charge in any direction, dealing damage to any monsters along the way. It also increases speed by 2 and makes you flying for as long as you hold it, making it one of the very few activated items that actually give a passive bonus.
This item is sometimes dropped by the Headless Horseman.
The White Pony (WoTL only)
Has the same exact effects as the A Pony item above but causes rays of white light to drop down in the room when charging similar to how the Crack the Sky item works.
Sometimes dropped by Conquest.
When using this item the player is damaged for a full heart in exchange for increased damage for the current room. The player also turns red after using this item, for some reason. This item is most probably a reference to "Emos" cutting them with blades.
Unlocked by beating The Womb using Eve.
Remote Detonator (WoTL only)
This item will allow you detonate your bombs w hen you please, instead of on their own, while also giving you 5 extra bombs. This item has no cooldown but will obviously not work if you don't have any bombs. This is possibly a bug, but when used against Wrath this item will cause his bombs to not explode (you can still explode them using this item).
When used shoots a 10-way circular shot originating from Isaac's current position. It is important to note that any tear modifier currently effecting Isaac will also effect this item, such as homing tears for example. This item is a reference to one of Edmund Mcmillen's four cats, which happens to be a hairless breed.
Shoop Da Whoop!
Shoots a laser from Isaac's mouth when used that pierces all obstacles and enemies in its path. This item is a reference to the popular internet meme of the same name.
This item is most commonly dropped by Envy, although it can spawn in Treasure Rooms.
Items that provide a defensive boost or some sort of utility for the player.
We Need To Go Deeper
Also known as the shovel, this item will create a trap door when used that allows Isaac to skip the current floor. I normally never uses this item as it makes you loose a lot of potential items, but I guess it has its uses. This item can be used to access floors you have not yet unlocked by using it on the previous floor, such as using it in The Womb to access Sheol. Note that this item cannot be used to access The Chest from the Cathedral.
Book of Shadows
Grants Isaac invulnerability to all damage for about 12 seconds. This item is notorious for its exploiting potential as it allows players to get free Devil Room items, free Blood Donation Machine uses, and free Devil Beggar uses while its effect is active. This item is a reference to the Book of Shadows from the Charmed television series.
It can be found in the Library besides the regular spawn locations.
Book Of Revelations
Adds one Soul Heart per use while also greatly increasing the chance of meeting a Harbinger on the current floor. This item is the best thing you can hope for when playing as ??? since it will greatly increase his health. Unlocking this item requires you to kill one of the Harbingers.
This item can also be found in the Library.
When used creates a poop object at your location. This item is mostly useless, but it can be used to farm the poop for potential pickup items as well as using it to block enemy movement. Since The Poop is ???'s starting item, you unlock it by unlocking him (finishing the game 10 times).
When used places a bra on Isaac's head that freezes all enemies in the room for about 5 seconds.
Causes enemies to run away from Isaac for a short duration.
This item has two uses; to get the flying ability for a single room (represented by angel wings) and to instantly kill Mom, Mom's Heart, and It Lives. Be careful when using this item against Satan, Isaac, or ??? as you will instantly die.
This item can also spawn in the Library and Angel Room besides the regular places.
The Book of Sin
When used spawns a either a pickup item (heart, coin, bomb, or key), a pill, or a Tarot Card. To have a chance of finding this item you must unlock it by killing each of the "Seven Deadly Sins" Mini-Bosses.
Can also be found in Libraries and Devil Rooms.
Crystal Ball (WoTL only)
When used this item reveals the rooms and room icons for the current floor while also giving you a Soul Heart or a Tarot Card. This item can only be obtained by winning from the Fortune Telling Machine. When I come across this item I usually use it on the spot then abandon it; I don't feel as if this item is good enough to carry around especially if I already have Treasure Map or The Compass.
For some unknown reason there appears to be Isaac's face in the ball's reflection.
The D20 (WoTL only)
The D20 allows you to re-roll pickup items, Trinkets, Chests, and Tarot Cards. The best use of this item is on already opened chests and Troll Bombs, which will be changed into usable items (most of the time). Items that can normally be re-rolled with the D20 cannot be re-rolled when found in the Shop, so keep that in mind to avoid wasting charges. This item is most probably a reference to the D20 System from Dungeons & Dragons.
Unlocked by finishing the Cathedral with Isaac.
This item (also know as the D6) allows the player to re-roll any activated or passive item in the game. This includes boss drops, Shop items, etc. Note that re-rolled items are still picked from the same pool, meaning that if you re-roll a Treasure Room item you can never get a Secret Room item. For this reason The Dice is useless for situations where only one item can drop (such as the Cube of Meat from The Harbingers).
This item is unlocked by completing The Womb with ???, at which point it also becomes Isaac's starting item.
Dad's Key (WoTL only)
Allows the player to open the current room's doors during a fight. While this can normally be done using bombs, some doors cannot be opened in this way such as Boss Room doors or Challenge Room doors. Dad's Key works on these doors too. Dad's Key does not open special doors however such as Shops and Treasure Rooms, severely hindering its use. I find that this item has very limited use overall and don't normally pick it up. It can also be found in the Secret Room.
Using this item in a Boss Room will also open up the Devil/Angel Room, but only if it was going to spawn normally after killing the boss.
Dad's Key is unlocked by beating The Chest.
Deck of Cards
Simply and effectively gives the player a random Tarot Card. Depending on your luck, this item can be very effective in the long run. Note that the Tarot Card is put directly in your inventory, meaning that any currently held Pill or Tarot Card will be dropped.
Forget Me Now
This white little pill will reset the current level and generate a new one. The best way to use this item is on an XL floor, since you will have gotten two items yet the floor will reset and give you more. After using this item it dissapears from your inventory, meaning that you can never carry a spacebar item into the new floor. This item is most probably a reference to the show Arrested Development where a character calls the rape-drug Roofies by the name of "forget me now" in this episode.
Forget Me Now is unlocked by finishing Sheol with ???.
Guppy's Paw (WoTL only)
On use transforms 1 red heart into 3 Soul Hearts. This item can be used as many times as you want provided you have red hearts left, and will not kill you if you use it on your last heart. Temporary red hearts can also be transformed into Soul Hearts, so take advantage of any Strength Tarot Cards you may come across. Since ??? has no red hearts this item is useless for him.
This item is very useful for when you want to go with the "permanent invincibility" tactic, where all of your hearts need to be Soul Hearts.
Guppy's Paw counts as one of the three "Guppy items" that you need to collect in order to transform into Guppy.
This item can be found in Red Chests, Devil Rooms, and as a drop from bosses.
When used slows down all enemies in the room for a round 7 seconds while also tinting them white.
IV Bag (WoTL only)
A portable version of the Blood Donation Machine that allows you to exchange hearts for coins. Health cost is the as the Blood Donation Machine; half a heart up to The Depths/Necropolis and one full heart from The Womb/Utero. If timed correctly you can get multiple uses of this item (since it has no cooldown) at the cost of just half a heart by taking advantage of post-damage invulnerability. You normally get 1 to 3 random coins per use, but it changes to 2-4 coins when the player has the PhD item.
Important - This item can kill you!
You can get this item by winning it from the Blood Donation Machine.
Mom's Bottle of Pills
Spawns a random pill in the player's inventory. Since the pill goes directly in the inventory, any currently held Tarot Card or pill will be dropped.
Unlocked by using the Blood Donation Machine thirty times.
Notched Pickaxe (WoTL only)
Allows the player to break one rock, poop, or fireplace per use. This item is a reference to the popular game Minecraft.
Portable Slots (WoTL only)
Quite simply a portable version of the Slot Machine.
Prayer Card (WoTL only)
Gives one Eternal Heart per use, effectively netting a lot of free health upgrades. Also found in the Angel Room.
When used teleports the player to a random room. The random room chosen can be a Secret Room or Super Secret Room, but it can also be a Boss Room. Note that teleporting is the only way to access the I AM ERROR room. Can also be used to escape from otherwise un-escapable rooms such as boss fights and mini-boss fights.
Heals the player for one read heart. Since ??? has no read hearts this item is useless for him. Magdalene starts with this item, and as such, must be unlocked by unlocking her (having 7 red heart containers in a single run).
Familiars follow you around, providing either offensive support or some form of utility.
Gives Isaac a cute little bag with a bomb icon that follows him around, dropping a random bomb every 3 completed rooms. Note that since the bomb dropped is random it could potentially be a Troll Bomb, so watch out.
Unlocked by finishing Sheol with Cain.
Sack of Pennies
Similar to the Bomb Bag, but drops a coin instead of a bomb every 2 completed rooms. Even though this item is called Sack of Pennies, the coin is random and can be a Dime or a Nickel.
Unlocked by beating The Womb with Cain.
Bum Friend (WoTL only)
Gives you a portable Beggar that follows you around and collects coins from the ground. It can drop anything the regular Beggar can drop except items. Bum Friend will only collect coins after the fight has finished, so you have a chance to take them yourself if you wish. In cases were the coin was "separated" from you by pits, Bum Friend will still get the coin but will come back to your position before dropping any potential items. Bum Friend is pretty useful in The Womb/Utero and deeper since he will give you a way to utilize coins (remember that Shops are no longer present here!). Finally, when Bum Friend picks up a Dime or a Nickel it will count as multiple coins and will cause him to drop several pickups most of the time.
An important thing to note about this guy is that he will push around your bombs when touching them.
Follows the player around and drops half a heart for every 2 rooms you complete. Very useful if you have a lot of red heart containers, but is useless for ???.
Besides the regular spawn locations, this item will always be dropped after killing C.H.A.D., and is also unlocked by killing him for the first time.
Adds a blue cross as Isaac's follower that gives a Soul Heart after every 4th completed room. Very useful for ???.
Unlocked by beating the The Womb with Magdalene.
Abel (WoTL only)
Gives Isaac a baby-like companion that mirrors his movement and projectiles, similar to how the Dopple enemy works.
Must be unlocked first by beating the Cathedral as Cain.
Gives a follower that shoots when Isaac shoots, dealing minor damage. Can also be found in the Devil Room besides the usual spawn locations.
Similar to Brother Bobby but shoots stronger red tears instead. Can be found in the Devil Room besides the ordinary spawn locations.
One of the more useful familiars since it shoots on its own and at any angle. Will also take advantage of certain shot modifiers the player has such as slowing effects. The downside to this familiar is that it has quite a short attack range. Can be found in the Devil Room apart from the regular spawn locations.
Unlocked by finishing Sheol with Eve.
Ghost Baby (WoTL only)
Shooting familiar that has spectral tears (pass over objects). Takes on certain player shot modifiers such as slowing effects.
Harlequin Baby (WoTL only)
Shoots a two tears in a V pattern when Isaac is shooting. This familiar is based on an actual medical condition called Harlequin-type ichthyosis.
A baby version of Chub that periodically charges forward when the player is shooting damaging all enemies in its path. This familiar can be shot diagonally if the player times it correctly.
Unlocked by killing all of the bosses found in the Caves.
A smaller version of Gish that shoots slowing projectiles while the player is shooting. The slowing effect on this familiar makes him one of the most effective ones in the game.
Dropped and unlocked by killing Gish, but can also be found in the Treasure Room.
A dark familiar that follows Isaac around, shooting homing projectiles when Isaac is shooting.
This familiar is unlocked by killing Steven for the first time, and is also dropped by him. It can be found in Treasure Rooms too.
Rainbow Baby (WoTL only)
A pink familiar that shoots ever-changing projectiles when the player is shooting. Each projectile is different and can be of any of the following familiars:
- V-shot from Harlequin Baby
- Slowing shot from Gish
- Homing tears from Little Steve
- Large or small red tears
- Regular white tears
- Spectral tear from Ghost Baby
Unlocked by beating the Cathedral as ???.
A robotic baby that shoots a laser beam similar to Technology. His beam pierces enemies but doesn't go through obstacles such as rocks.
Must be unlocked first by finishing The Womb as Judas.
Daddy Long Legs (WoTL only)
Creates a shadow that will chase enemies around the room, causing Daddy Long Legs to stomp on them. This item does good damage but has a very hard time hitting fast moving enemies. Note that it cannot hurt Isaac even if he runs into it. This item is also refereed to as The Egg Sack and Daddy's Love.
When fighting Isaac or ???, Daddy Long Legs will only stomp them once then stop (possibly a bug).
This item is unlocked by finishing "The Purist" challenge, at which point it will have a big chance of dropping from Daddy Long Legs and a 100% drop chance from Triachnid.
Guppy's Hairball (WoTL only)
Gives you a hairball that follows you around like regular familiars, but it doesn't actually attack. Instead you have to move Isaac around in circles at which point the hairball will start flailing around you at very high speeds. You can do this to hit enemies with the hairball and damage them. Killing enemies with the hairball will make it larger up to a maximum size, increasing its damage each time. Its size resets at the start of each floor however.
This item is unlocked by transforming into Guppy in any one of your playthrough.
Holy Water (WoTL only)
Gives you a vial of blue liquid that follows you around. When Isaac receives damage the vial will break and create a puddle on the ground which will damage any enemy that moves over it. The puddle lasts about 5 seconds and can only happen once in a given room, but the vial resets on a new room. This item is pretty weak but could have been very useful if the puddle wasn't temporary.
The Peeper (WoTL only)
Takes out of Isaac's eyes and causes it to move around the room in the same way Peep's eyes do. Tears shot from the empty eye socket turn red, possibly doing more damage. Note that the eye will push any bombs it comes across.
Cube of Meat (Levels 3 and 4)
At levels 3 and 4 the Cube of Meat turns into a familiar that will actively chase down enemies in the room. The difference between level 3 and 4 is that Meat Boy is bigger and does more damage. Note that Meat Boy has the annoying tendency to push around any bombs he touches, so keep that in mind when trying to explode something.
Orbital items create some sort of object that circles around Isaac, giving him protection while also damaging any enemies they happen to touch. Since these items block enemy shots, they are very useful for the later fights against Isaac and ???.
Cube of Meat (Levels 1 and 2)
At level 1 this item will give you an orbital cube that will damage any enemies it touches. At level 2 the cube changes into a head that actively shoots when Isaac is shooting while still damaging enemies it touches. You increase the levels of this item by picking up more of it, up to a maximum level of 4. Since levels 3 and 4 turn this item into a familiar, it was placed in the previous section.
The Cube of Meat only drops from The Harbingers, so you must unlock them first before you can hope of seeing it.
The Cube of Meat is a reference to Meat Boy from Super Meat Boy.
Sacrificial Dagger (WoTL only)
Gives Isaac a bloody dagger that circles around him. This item is the highest damaging orbital object in the game.
Unlocked by finishing the Cathedral as Eve.
Gives Isaac a red fly that will circle around him at medium range. This fly will block shots and also damage any enemy it touches, dealing higher damage than the other fly-type orbitals.
Gives Isaac a blue fly that will orbit him at a really long range. This item is a reference to internet meme of the same name.
Creates an angel around Isaac that orbits at a very high speed. This item will also increase the orbit speed of other orbital objects, making it very useful when you already have such items. Can also be found in the Angel Room.
This item is unlocked by beating Sheol with Magdalene.
Halo of Flies
Gives Isaac two flies that circle around him. Unlike most other orbital objects the flies given by this item will not cause impact damage to enemies in the game except to other flies, making them purely a defensive item.
Getting a Pretty Fly (from pills or a Slot Machine), will give you an additional fly up to a maximum of three.
These items alter the way Isaac's tears work.
3 Dollar Bill (WoTL only)
Makes Isaac smile while also giving him random tear effects upon entering a room. The random effect is chosen from the following:
- My Reflection
- Ouija Board
- Inner Eye
- Spoon Bender
- Mom's Contacts
- Tough Love
- Number One
- Range up or Tears up
This item sometimes bugs out and gives the player the effect of Magneto. You can exploit this to get items that are otherwise out of reach by repeatedly going in and out of a room until you get Magneto.
Turns Isaac into a bad ass black demon that can fire blood streams. This new attack must be charged by holding any one of the arrow keys, then fired by releasing said key. You will know when the attack has charged because Isaac's face will start flashing red.
Note that if you charge an attack then enter a new room, it will only hit for half the damage.
Can be found in the Devil Room.
Allows Isaac to charge his shots for increased damage and size. Note that auto fire is disabled after picking up this item; you must continually press the attack key if you want to shoot.
The Common Cold
Makes Isaac sick, turning his tears green. These new tears have a chance to poison enemy with each hit, dealing damage over time. This item is unlocked by picking up to "syringe" items in a single run, such as Growth Hormone.
Can also be found in the Devil Room.
Gives Isaac piercing shots that go through enemies but not through obstacles (such as rocks). This item allows you to damage Knights from the front, making them a lot easier to kill. The downside to this upgrade is that your shots will no longer knockback enemies. Also gives Isaac an Indian feather on his head.
Turns Isaac's tears into a bomb, greatly increasing damage. The bombs shot by this upgrade will slide a fixed distance before exploding, but can be pushed around by running into them. The bombs will also move over pits allowing you to hit hard to reach enemies. The bombs will explode faster the higher your rate of fire is, allowing you to shoot more bombs.
Any item that upgrades your regular bombs will also work on the bombs fired by this item making Mr. Mega, Bobby-Bomb, and Bob's Curse very useful items to have.
Dr. Fetus is unlocked by beating the game five times.
This item is a reference to Dr. Fetus from Super Meat Boy.
Epic Fetus (WoTL only)
Arguably the strongest item in the game, this upgrade will turn your tears into missiles similar to Doctor's Remote. This item must be unlocked by finishing the "The Doctor's Revenge!" challenge.
Found in the Secret Room.
Gives Isaac an extra eye on his forehead allowing him to shoot three tears at once. When picked up this item will lower your rate of fire to the minimum possible, but even so it is a very good item to have.
Ipecac (WoTL only)
Makes Isaac look horribly sick, turning his tears into green exploding balls. These new projectiles are fired in an arc and will deal poison damage to any enemy they hit.
This item is a reference to an old medicine of the same name that was used to induce vomiting.
When shooting gives Isaac a chance to fire 4 tears in a cross pattern instead of the usual 1. The chance for this to happen goes up as you increase your Tears stat.
Must be unlocked first by killing all of the bossed found in The Depths.
One of the best items you can stumble upon since it gives your shots a random chance to freeze enemies. Frozen enemies cannot move or shoot, making them easy targets for the player. Coupled with a fast rate of fire this item will make most bosses a piece of cake, but note that it doesn't actually work on Mom.
In terms of visual effects this item will give Isaac a blood-red contact on his left eye along with bright red tears.
This item is unlocked by picking up Mom's Eye and any other mom item in a single run.
Gives Isaac an extra eye at the back of his head that will randomly shoot tears when the player is shooting. Also increases Isaac's rate of fire.
The best item you can hope for in terms of damage, Mom's Knife will dress Isaac up like his mom while also giving him her knife. Note that you can no longer shoot tears after collecting this item, but the alternative is well worth it. There are two ways you can use this new weapon:
- Melee style by running into enemies dealing massive damage
- Boomerang style by charging up your shot, then releasing causing the knife to be thrown
The distance which the knife travels when thrown depends on your range stat. It can also be thrown diagonally by holding two of the attack buttons at the same time (such as up and left for example). The knife also counts as being piercing and spectral, meaning it will damage all enemies in its path while also moving over obstacles such as rocks.
Certain items boost this upgrade. Worthy of mention are The Common Cold which turns your knife green and gives it occasional poison damage, and Brimstone which greatly increases the knife's damage.
Although I don't think it has any effect on the actual attack, collection Number One will turn the knife yellow.
Unlocked by beating Sheol with Isaac. This item can be found in the Devil Room besides the regular spawn locations.
The Mulligan (WoTL only)
Gives a chance to spawn blue flies with each successful attack which will charge your current target. Works very well when you have a high rate of fire. When this item is picked up Isaac will get a ton of fly bites on his head, causing boils to show up.
Mutant Spider (WoTL only)
An upgraded version Inner Eye that gives Isaac two extra eyes instead of 1. As you can probably guess, this causes your regular shot to be replaced by a quad shot at the cost of a reduced rate of fire. One of my favorite items in the game!
Causes Isaac's shots to get a boomerang effect. I have never actually found a good use for this item and usually don't pick it up, but it is perfectly possible that I am missing something. Unless you want to ruin your current run, don't pick up this item when you have Ipecac or the other way round; trust me!
Also gives Isaac a blue moon symbol on his forehead.
Makes Isaac's tears spectral, allowing them to go through obstacles such as rocks. This item is very useful when you also have a flying upgrade because it pretty much nullifies the room's layout. The only downside to this upgrade is that destructible objects such as poop and fireplaces are damaged at a much slower rate. Isaac's face turns ghostly after picking up this item.
In real life an Ouija Board is a tool used to (supposedly) communicate with spirits.
Can also be found in Devil Rooms apart from the regular spawn locations.
Turns tears orange and allows them to split into two when they hit a target. Note that since your tears need to actually hit something in order to split, certain upgrades will nullify this effect. For example Cupid's Arrow will stop tears from splitting on enemies and Ouija Board will stop tears from splitting on obstacles. Also gives Isaac an orange parasite on his head.
This item must be unlocked by picking up two items that are considered dead in one playthrough, such as Max's Head and Bob's Rotten Head. Can be found in the Devil Room.
Polyphemus (WoTL only)
Gives Isaac one huge eye in the middle of his head. This allows him to shoot a really big tear, boosts damage to max, but lowers rate of fire to minimum. This upgrade also has a special property where if your shot does more damage than an enemy's health, it will continue moving forward with the remaining damage.
When combined with other items, Polyphemus can be made even more powerful. Mutant Spider will allow you to shoot 4 very large tears for example:
While Mom's Eye will give you a 100% chance to fire another projectile from the back of your head when shooting regularly:
Number One will allow you to shoot high damage projectiles with a fast rate of fire, albeit at a reduced range:
This item is a reference to the cyclops from Greek mythology of the same name.
Sacred Heart (WoTL only)
Gives the following effects:
- Tears travel slower
- Tears home in on enemies
- Tears deal more damage
- Tears are bigger
- Rate of Fire is reduced
- Fully heals the player when picked up while also giving him a Soul Heart
This item is pretty good overall but it can be a real pain to hit fast moving enemies with it. Also note that since your shot speed is reduced your range is reduced as well (see the stats page for more information).
Visually, it makes Isaac's eyes and tears glow white.
Can be found in the Angel Room.
Turns Isaac's shots purple and gives them the ability to home in on enemies. A very useful upgrade to have as it will allow you to hit enemies easier. In terms of visual differences, this upgraded causes Isaac's two normal eyes to close and opens a new cavity in his forehead. This cavity contains what appears to be a black eye burning with a red flame, and is where the new shots will come out of.
This item is a reference to the fact that people with psychic abilities are said to be able to bend spoons with their minds.
Gives Isaac's shots a chance to slow down enemies. Slowed enemies also shoot slower, making their projectiles easier to dodge. Visually this item gives Isaac a big lump on his head and turns his tears white.
This item must first be unlocked by beating the Basement floors for the first time. Found in the Secret Room.
Gives Isaac a mechanical left eye that shoots lasers, replacing his regular tears. The laser has infinite range and will pierce enemies but will not go through obstacles such as rocks. Like all piercing upgrades your shots will no longer knockback enemies. The rate at which the laser fires depends upon your Tears stat, so try stacking it up whenever possible.
While a great item on its own, Technology can be made even better by combining it with other upgrades. Here are my top picks:
The Common Cold will turn your laser green and give it a chance to poison enemies:
Ipecac makes the laser thicker and increases the damage, but reduces your Tears stat:
And the grand daddy of all Technology upgrades: Polyphemus. This item will make your laser huge and increase your damage, but like Ipecac also reduces your Tears stat.
Technology 2 (WoTL only)
Similar to regular Technology in that it fires a laser, but varies greatly otherwise. Like Technology this item will give Isaac a mechanical eye, but it is placed over his right eye instead. When this item is collected your Rate of Fire is lowered, but you are still able to fire regular tears from your left eye. Note that since Cain doesn't have a left eye he will only fire the laser.
The laser retains its piercing property and has the added advantage of constantly firing, providing a constant supply of damage as long as you hold the attack button.
This item can also be improved by picking up certain items.
Polyphemus will greatly increase your laser's damage when picked up:
Mom's Contacts will give each laser hit a chance to freeze the target. Since the laser fires so rapidly, you are almost guaranteed to freeze any target in place when you have this upgrade.
Finally, I would like to mention that Technology and Technology 2 will stack with each other, providing two lasers. While rare to come across both items in the same run, the damage they provide is incredible.
Tough Love (WoTL only)
Bruises Isaac's face as if he was beaten up, but also gives him the chance to fire a tooth projectile that deals massive damage. The tooth does your current damage multiplied by 3.2, and the chance for it to fire depends on your luck stat.
The exact percentages for each luck level is shown in the stats page, culminating at a 100% firing chance when Luck is maxed.
This item can greatly increase your damage; it all depends on your luck (both in-game and outside!). Can be found in the Devil Room and the regular spawn places.
A useless (in my opinion) upgrade that simply causes your tears to shake instead of moving in a straight line. Besides making enemies harder to hit, I never quite understood what the use for this item was. To make things worst, it is also impossible to angle shots using momentum after picking up this upgrade.
The only good thing about this item is that it makes your face look funky!