Binding of Isaac: Rebirth Wiki

Added in Afterbirth †

Adrenaline is a passive item added in The Binding of Isaac: Afterbirth †.


  • Gives Isaac a flat damage up based on how many empty Heart containers he has.
    • Removed in Repentance The damage up given is 0.2 for each empty Red Heart container Isaac has.
      • Added in Repentance The damage up given is ((2 * MissingHearts) ^ 1.6) * 0.1, where MissingHearts is the number of full red hearts of health missing.
    • Damage ups are only applied for every fully empty heart container.
  • This item belongs to the Spun set. Collecting three items from this set will transform Isaac into a buff berserker.


  • This item has no effect on characters that can't have any Red Heart containers, unless Bone Heart Bone Hearts are collected. If a Bone Heart is gone, so does the Adrenaline damage. This means that Adrenaline is only truly useless on The Lost The Lost.
  • This item affects both Keeper Keeper and Tainted Keeper Tainted Keeper; empty Coin Hearts increase damage.
  • As The Forgotten The Forgotten, empty Bone Hearts increase damage, but if the Bone Hearts are broken, the damage buff is taken away.
  • The maximum damage bonus from Adrenaline is 14.05 normally, 16.15 with Bone Hearts, and 30.9 for Magdalene with Birthright.


  • Added in RepentanceBirthright Birthright + Magdalene Magdalene: Allows Magdalene to have 6 more Heart containers.
  • Added in RepentanceBlood Oath Blood Oath: Activates the damage up effect of Adrenaline for the resulting empty heart containers at the start of each floor.
  • Added in RepentanceRock Bottom Rock Bottom: Allows Isaac to keep the damage up after refilling hearts.

In-game Footage[]


  • Before v1.06.0190, Adrenaline was named Adderline.
    • Despite having its name changed, Adrenaline's item sprite is named collectibles_493_adderline in the game files.
  • Adrenaline is a hormone produced by the body in situations of high stress that increases blood circulation, breathing, and other things in preparation for the natural flight or fight reflex.
  • Adrenaline causes characters to have an animation that makes them look like they are breathing rapidly. The more health they're missing, the more exaggerated the animation is.