Binding of Isaac: Rebirth Wiki

Added in Afterbirth †

Euthanasia is an unlockable passive item added in The Binding of Isaac: Afterbirth †.


  • Adds a chance to fire needles which deal triple Isaac's tear damage.
    • Needles will instantly kill regular enemies and cause them to burst into 10 more tears in all directions.
    • The chance to fire a needle depends on luck.
      • At base luck (0), it is 3.33%
      • Removed in RepentanceIt is 100% at 15 luck.
      • Added in RepentanceIt maxes out at 25% with 15 luck.
  • This item belongs to the Spun set. Collecting three items from this set will transform Isaac into a buff berserker.


  • The needle tears can kill enemies that are normally invincible, such as Peep's eyes, Death's Heads, and Stoneys.
  • The needle tears can kill Grimaces, allowing Isaac to permanently remove any obstacle in a room.
    • Added in Repentance The needle tears can kill Bomb Grimaces, dropping 10 unlit Throwable Bombs. This can make it detrimental to shoot at them, since they are usually provided as a tool rather than an obstacle.
  • Possible needle tears in a burst from killing an enemy do not retain the instant kill and burst-causing capabilities, but still deal triple damage. This prevents chain reactions of bursts.
  • The tears in the burst are larger than normal but do not have a damage bonus.
  • Unless piercing is obtained, Knights will still block the needles if shot from the front.


  • Removed in RepentanceBrimstone Brimstone / Removed in RepentanceDr. Fetus Dr. Fetus / Mom's Knife Mom's Knife / Technology Technology / Trisagion Trisagion: No appearance change, tear burst, or instant kill, but triple damage still works.
  • Added in RepentanceBrimstone Brimstone / Added in RepentanceDr. Fetus Dr. Fetus: Enemies killed by a needle burst into normal tears.
  • Godhead Godhead: The aura of a needle tear will also do triple damage, but does not cause tear burst or instant kill.
  • Ipecac Ipecac: No tear burst or instant kill, but triple damage still works.
    • Added in RepentanceEnemies killed by a needle burst into ipecac shots.
  • Added in RepentanceJacob's Ladder Jacob's Ladder: The electric arcs released from a needle shot also retain the needle's instant kill and tear burst properties.
  • Little Horn Little Horn: If a tear has both the Euthanasia and Little Horn effects and instantly kills an enemy, it does not cause a tear burst.
  • Tech.5 Tech.5: The tears that Isaac fires work normally, and the laser has a chance to deal triple damage with no other effects.
  • Removed in RepentanceTech X Tech X: Completely overrides Euthanasia. No triple damage, no tear burst, or instant kill.
    • Added in RepentanceLaser Rings will sometimes deal triple damage/instantly kill regular enemies, and enemies killed by needles burst into normal tears.
  • Technology 2 Technology 2: The tears that Isaac fires work normally, but the laser is completely unaffected.
    • Added in Repentance The laser has an extremely high chance of executing normal enemies.

In-game Footage[]


  • Euthanasia is the act of intentionally ending a person or animal's life to end their pain and suffering. It is usually carried out by an injection, hence why this item has the appearance of a needle.
  • Euthanasia is the only syringe item that points upwards; all of the other syringes point downwards.
  • Euthanasia and Experimental Treatment Experimental Treatment are the only 2 syringe items that need to be unlocked.


PC Normal and hard modes only LH27 889W (Treasure Room adjacent to spawn)

PC Added in Repentance WLB2 37ZS (Treasure Room to the east)

PC Added in Repentance ZBCQ CWJR (Curse Room adjacent to spawn)

Switch Greed mode only DSX3 LF12 (First Golden Treasure Room)