Binding of Isaac: Rebirth Wiki

Disambig.png This article is about the item. For the monster, see Leech (Enemy).

Leech is a passive item.


  • Spawns a crawling Leech familiar that follows Isaac. If an enemy comes near, the Leech will attack and chase it, doing 1.5 damage per tick or about 3.2 damage per second. If an enemy is killed by the Leech, Isaac will be healed by a Half Red Heart Half Red Heart.


  • The Leech's healing effect does not affect characters that do not have Heart containers.
  • Enemies that turn into flesh piles and regenerate when killed such as Globin Globins and some dark red champions regenerate quicker than the Leech can kill them. Isaac will gain half a heart each time the enemies collapse, granting an easy way to regenerate all Red Hearts. This can also open up many powerful synergies with any item that provides a benefit or resource when Isaac takes damage.
  • Added in RepentanceLike with Ghost Baby Ghost Baby having a chance to drop from skulls, Leech can rarely drop from the buckets in Downpour Downpour or Dross Dross.


  • Arcade Arcades: The player can let the Leech eat Fly Flies from the Shell Game.png Shell Game and use the resulting health to gamble on the Blood Donation Machine.png Blood Donation Machine.
  • BFFS! BFFS!: Leech grows bigger and does double damage. Still only heals for a Half Red Heart.
  • Flush! Flush!: The leech still can attack the enemies turned into poop and gain health.
  • E. Coli E. Coli: Enemies can be turned into Poop Poop at the cost of a Half Red Heart, then consumed by the leech to regain health. Utilization of temporary immunity when hit can allow multiple enemies to be turned into poop, resulting in a net gain of health. However, when combined with Gnawed Leaf (see below), the player can simply stand still and let Leech do the dirty work.
  • Gnawed Leaf Gnawed Leaf: The player can stand still and allow the Leech to clear a room, granting simple clears and easy health.
  • Added in Repentance Tainted Bethany Tainted Bethany: The leech can grant blood charges by killing enemies.


In-game Footage[]


  • This familiar is notorious for having bad tracking AI.


Bug Bug! Tends to get confused when attacking Maggot like enemies and just moves around in the attacking animation without attacking anything until the Maggot is killed by The Player.
Bug Bug! The Leech will continuously heal the player while it's attacking Mama Gurdy.


PC Removed in Repentance Normal and hard modes only M4X7 V0TK (Treasure Room adjacent to spawn)

PC Removed in Repentance Normal mode only 3SWF QKD4 (Treasure Room to the right of spawn)

PC Added in Afterbirth † / Removed in Repentance Normal and hard modes only RZ0C 67HL (Treasure Room adjacent to spawn)

PC Added in Repentance Normal and hard modes only HJYC Y177 (Treasure Room adjacent to spawn)

PC Added in Repentance Hard mode only XRCS NZCN (Treasure Room adjacent to spawn)

PS4 G4YR 243A (Treasure room adjacent to spawn)

Vita L1Y9 Y1KN (Treasure room adjacent to spawn)

Vita 2KAD 2W2B (Treasure room adjacent to spawn)

3DS YG41 04ZN (Treasure room adjacent to spawn)