- Does not grant penetrative shots, despite the appearance of Isaac's tears.
- Any item that normally colors Isaac's tears red will cause the nails to become bloody.
- Blister: The knockback from Blister is stronger than from 8 Inch Nails, and knockback boosts do not stack.
- Brimstone: The beam gains knockback.
- Dr. Fetus / Epic Fetus / Ipecac: Explosions also gain increased knockback.
- The Ludovico Technique: The controlled tear gains knockback.
- Mom's Knife: The knife gains knockback.
- Piercing tears: Allows tears to knock enemies back again.
- Tech.5 / Tech X / Technology / Technology 2: The lasers gain knockback. Especially powerful with Tech X, as the knockback helps keeps enemies within the ring for longer.
- Trisagion: The blasts gain knockback.
- The item is a reference to the nails used to hang Jesus Christ upon the cross when he was crucified.
- The item's name is a reference to the band, Nine Inch Nails.
- The visual effect on Isaac may also be a reference to a line in Eminem's "My Name Is", in which he says, "Wanna see me stick Nine Inch Nails through each one of my eyelids?". This line is also a reference to the aforementioned band.
PC GAXS L7SJ (Treasure Room adjacent to spawn)
PC EVLC J9ED (First floor treasure room)
|The Binding of Isaac: Rebirth|
|Achievements||Attributes||Bosses||Cards and Runes||Challenges||Chapters|