Binding of Isaac: Rebirth Wiki
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(in Afterbirth † and Repentance)

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

Effects[ | ]

  • Gives Isaac a flat damage up based on how many empty Heart containers he has.
    • (except in Repentance) The damage up given is 0.2 for each empty Red Heart container Isaac has.
      • (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. The amount of damage gained this way is exponential, so each heart lost will provide a bigger bonus than the last.
    • Damage ups are only applied for every fully empty heart container.
  • This item belongs to the SpunSpun set. Collecting three items from this set will transform Isaac into a buff berserker.

Notes[ | ]

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

Synergies[ | ]

  • (in Repentance)Collectible Birthright iconBirthright + Character Magdalene iconMagdalene: Allows Magdalene to have gain more damage than the other characters can because of her 6 additional heart containers.
  • (in Repentance)Collectible Blood Oath iconBlood Oath: Activates the damage up effect of Adrenaline for the resulting empty heart containers at the start of each floor.
  • (in Repentance)Collectible Empty Heart iconEmpty Heart: Activates the damage up effect of Adrenaline if an empty heart container is granted at the beginning of each floor.
  • (in Repentance)Collectible Rock Bottom iconRock Bottom: Allows Isaac to keep the damage up after refilling hearts.

In-game Footage[ | ]

Trivia[ | ]

  • 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.


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