Pills

Pills are pickups that can provide useful or inhibiting effects. They take up the same slot as cards and runes.

At the start of each run, an effect is randomly assigned to each color of pill. The pill effect for each color will remain constant throughout the run. (However, it is possible for, , , or to reassign some of the effects, such that 2 different colored pills will have the same effect.) Pills will start the game unidentified (unless the player is holding  or ); their effect is shown as "???" when picked up. Upon using a particular pill for the first time, its effect will be revealed and all subsequent pills with the same color will have their effect shown as well. The set of pill effects for any given run is usually known as the pill pool.
 * The pill pool for each run has increased from 9 to 13.

Gold Pills
Repentance introduces Gold Pills (or Golden Pills). Using them will give a random pill effect. Gold pills only have a chance to be "used up" upon using them, which means that you can often use them many times before they finally disappear.


 * Unlocked by:.
 * The possible effects are all effects that aren't in the run's pill pool, which means if you see an effect from a normal pill, you will never see it from a golden pill.
 * Gold Pills have an ID of 5.70.14.
 * A Gold Pill can also be a Horse Pill. Golden Horse Pills use the Horse Pill effect on every use.

Horse Pills
Repentance introduces Horse Pills. These are larger versions of the standard pills with a more powerful effect, but only appear very rarely. Unique sound effects can be heard when they are used, and the narrator's voice lines for horse pills are overly loud and exaggerated compared to those for normal pills.


 * Unlocked by:.
 * All items that work with pills work identically with horse pills.
 * A horse pill with a given effect has the same color as the normal pill does.
 * Horse pills have an ID of the normal ID + 2048 (i.e. 1 << 11). For example, a white-blue pill has an ID of 2, so the horse pill version would have an ID of 5.70.2050.
 * It is also possible to have a golden horse pill. (It has an ID of 5.70.2062.)

Strategy

 * Use of unidentified pills is recommended for outside of combat as Hematemesis, R U a Wizard?, Paralysis, Addicted!, X-Lax, and  I'm Excited!!! can be detrimental mid-fight. However,  I'm Drowsy...,  Something's wrong..., Lemon Party, Bad Gas, and Pheromones are useless outside of combat.
 * Percs! can be used in the sacrifice room to reduce the damage Isaac takes, potentially allowing him to do more sacrifices. However, if Isaac is teleported to the Devil/Angel room, he loses the effect.
 * The invincibility effect from Power Pill and Feels like I'm walking on sunshine! can be utilized to get into curse rooms, play blood donation machines, or use Devil beggars without taking any damage.
 * Percs! can be used to reduce damage from these from chapter 4 onward.
 * Taking only golden pills in a run can allow for infinite golden pill generation by repeatedly activating the Vurp! effect. This process can be made more effective by using the to duplicate golden pills on the ground and recharging the  with the 48 hour energy effect.

Trivia

 * The Vurp! pill is a portmanteau of the words vomit and burp.
 * Power Pills activating the Gamekid effect is a reference to Pac-Man, in which the "Super-Pac" powerup is obtained by eating a Power Pellet.
 * "I Found Pills (and Ate Them)," "R U a Wizard?," and "I can see Forever" are all image macro memes.
 * Despite being called I Can See Forever, the effects only last for the rest of that floor.
 * The Feels like I'm walking on sunshine! pill is a reference to the 80s song Walking on Sunshine.
 * Balls of Steel is a reference to Duke Nukem; it is one of Duke's more famous quotes.
 * Explosive Diarrhea is extremely loud and forceful diarrhea. In the original game, the message that displayed when the pill was activated was "Oh No!". The pill name and effect are likely a reference to Atomic Bomberman where a pickup of the same name would cause the player to drop bombs behind them uncontrollably for a short duration.
 * Shot speed effects were introduced in The Binding of Isaac: Eternal Edition, after the release of Rebirth. They were finally added to Rebirth in the Repentance DLC.
 * Hematemesis is a medical term for vomiting blood.
 * Friends Till the End! was originally in the Wrath of the Lamb but removed in Rebirth, then put back into Afterbirth.
 * Friends Till The End! is the only non-narrated pill.
 * 48 Hour Energy is a reference to the drink 5 Hour Energy.
 * X-Lax is a reference to the anti-constipation medicine Ex-Lax.
 * "One makes you larger" and "One makes you small" are references to Alice in Wonderland, and the specific wording is a reference to the song White Rabbit by Jefferson Airplane.
 * "Percs" is a reference to a street name for the prescription drug Percocet, which is more generically known as Oxycodone. This drug is meant to be used to treat pain, but it is often abused for recreational purposes.
 * The "???" is the only pill that has 3 different narrated voice lines.

Gallery

 * YouTube - Pills in Repentance - What is New? What Has Changed?
 * YouTube - All Horse Pills/Giant Pills (With Sound)
 * YouTube - NEW Horse Pills