- Isaac gains a green trail of poisonous creep.
|Bob's Rotten Head||Upon use, Isaac holds a poison bomb which can be thrown towards any of the four cardinal points and explodes on impact.||3|
|Bob's Brain||Spawns a familiar that charges forward when shooting tears, explodes upon contact with an enemy and poisons them. Respawns after few seconds.|
|Bob's Curse||Gives 5 bombs and grants all bombs poison effect.|
|Ipecac||Replaces tears with explosive and poisoning projectiles fired in an arc from the mouth.|
- When attacking, the tumor faces shoot tears diagonally outwards, similar to the effect of The Wiz.
- -0.3 damage.
- Slightly decreases tears.
|Brother Bobby||Follows Isaac around shooting normal tears.|
|Harlequin Baby||Spawns a familiar that follows Isaac around and fires two tears at once in a V-pattern.|
|Headless Baby||Familiar that follows Isaac, leaving blood creep on the ground.|
|Little Steven||Spawns a familiar that follows Isaac around and fires homing tears.|
|Mongo Baby||Summons a familiar that copies the tears of Isaac's other familiars.|
|Rotten Baby||A familiar that spawns Blue Flies.|
|Sister Maggy||A Familiar that follows Isaac around shooting blood tears.|
|God's Flesh||Tears now have a random chance to apply a shrinking effect, causing enemies to shrink in size and also run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.|
|Mini Mush||Increases Speed and Shot Height and decreases Isaac's size, but lowers Range.|
|Magic Mushroom||Increases all stats and enlargens Isaac|
|Odd Mushroom (Thin)||Increases Tears and Speed while reducing Damage.|
|Odd Mushroom (Large)||Grants an empty heart container. Increases damage, range and shot height while reducing speed.|
|1up!||45x45px||Gives an extra life. Upon death, you will respawn in the previous room with full health and lose the 1up!.|
|Blue Cap||Grants 1 heart container and increases tears, but decreases shot speed.|
|The Nail||Adds one Soul Heart and allows the breaking of Rocks and damaging enemies by simply walking over them. Increases Damage and decreases Speed. All effects except for the Soul Heart wear off upon leaving the room.||6|
|The Mark||Increases Damage and Speed, plus adds one Soul Heart.|
|The Pact||Increases damage by 0.5, tears by 0.7 and grants two soul hearts upon pickup.|
|Pentagram||Increases Damage and increases chances of the Devil Room appearing.|
|Spirit Of The Night||45x45px||Grants spectral tears and flight.|
|Maw Of The Void||45x45px||+1.0 Damage Up. After continuously firing tears for 3 seconds, a red cross appears on Isaac's head that, upon releasing the fire button, creates a black ring which deals a lot of damage to any enemies inside it. The ring rapidly deals damage equal to Isaac's tear damage to any enemies in contact with it.|
|Abaddon||Increases damage and speed, removes all red heart containers, grants six black hearts, and adds a chance to shoot fear tears.|
|Brimstone||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.|
- Whenever a pile of poop is destroyed, health is replenished by half a heart.
|Flush!||Changes all enemies in the room into poop. Does not work on all enemies (Knights and bosses are immune). Instantly kills Dingle, Dangle, and Brownie.||6|
|The Poop||Spawns a pile of poop where the character is standing and knocks nearby monsters back. May yield pickups like regular poop.||1|
|E Coli||Gives "Turdy Touch" Effect. Enemies that touch Isaac are changed into Poop.|
|The Bible||Upon activation, Isaac gains Flight, allowing him to pass over all obstacles in the current room. Instantly kills Mom, Mom's Heart, and It Lives when activated, but will kill Isaac when activated while fighting Satan.||6|
|Dead Dove||Grants spectral tears and flight.|
|Guardian Angel||Spawns an orbital familiar that blocks enemy projectiles, deals contact damage to enemies and increases the speed of all orbital familiars.|
|Holy Grail||Grants flight and one heart container.|
|Holy Mantle||Automatically negates first taken damage in every room.|
|Mitre||Grants a chance of converting any red hearts pickups into soul hearts instead.|
|Rosary||Adds 3 Soul Hearts and increases the chance for The Bible to appear in any item pool.|
|Sworn Protector||An orbital angel which does 7 contact damage per tick and blocks enemy shots. When it blocks a shot, it has a very small chance to drop an eternal heart.|
|The Halo||Grants one Heart Container, +0.3 Damage, +0.2 Tears, +0.25 Range, +0.3 Speed, and +0.5 Tear Height.|
- +2 damage.
- +0.15 speed.
- Spawns a random pill upon transformation.
|Experimental Treatment||Randomly increases and decreases some of the character's stats. There will always be at least one stat increase and one decrease and the same stats can be increased/decreased multiple times.|
|Growth Hormones||Increases damage by 1 and speed by 0.4.|
|Roid Rage||Increases speed by 0.6, range by 5.25, and tear height by 0.5.|
|Speed Ball||Increases speed by 0.3 and shot speed by 20%.|
|Synthoil||Increases damage by 1, range by 5.25, and tear height by 0.5.|
|The Virus||Inflicts poison to enemies who make contact with Isaac. Speed down.|
- Isaac gains a stationary knife that trails directly behind him. It synergizes like Mom's Knife would.
|Mom's Bottle Of Pills||45x45px||Gives Isaac a random Pill, and will cause him to drop any held Q-slot item (If any). The player will only receive six different pill types in one playthrough.||6|
|Mom's Bra||Upon use, petrifies all enemies in the current room for approximately 4 seconds.||3|
|Mom's Pad||Upon use, inflicts fear to all enemies in the room for 5 seconds.||3|
|Mom's Wig||Adds a chance to spawn Blue Spiders when firing tears. Restores 1 red heart.|
|Mom's Eye||Allows Isaac to fire tears from the back of his head.|
|Mom's Purse||Allows Isaac to hold 1 additional trinket.|
|Mom's Contacts||Adds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.|
|Mom's Knife||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.|
|Mom's Heels||Increases range.|
|Mom's Eyeshadow||Tears have a chance to charm enemies.|
|Mom's Perfume||Adds a chance to shoot fear tears and increases Tears by 0.16.|
|Mom's Key||Spawns 2 keys. Generates additional pickups from chests.|
|Mom's Lipstick||Increases range and shot height.|
|Mom's Underwear||Increases range.|
|Mom's Coin Purse||Spawns 4 random Pills around Isaac.|
|Mom's Pearls||+1.25 Range Up. +0.5 Tear Height. +1 Luck Up.|
- Replaces Bum Friend, Dark Bum, and Key Bum for Super Bum.
He collects any of the other beggars' pickups, and offers twice the rewards.
|Bum Friend||A portable Beggar who follows Isaac, picks up coins for himself, and occasionally drops a Pickup after collecting a coin. Does not spawn Collectibles.|
|Dark Bum||Spawns a familiar that follows Isaac around and collects Red Hearts. For every one-and-a-half red hearts collected, Dark Bum will generate one Soul Heart, one hostile Spider or one friendly Blue Spider.|
|Key Bum||Spawns a portable Key Master that follows Isaac and collects keys, giving random chests in return.|