Binding of Isaac: Rebirth Wiki
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.


  • 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 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.
  • Like 15►Ghost Baby Ghost Baby can drop from skulls, Leech can rarely drop from the buckets in Downpour Downpour.


  • Arcade rooms: The player can let the Leech eat Flies from the Shell Game and use the resulting health to gamble on the Blood Bank.
  • 15►BFFS! BFFS!: Leech grows bigger and does double damage. Still only heals for a Half Red Heart.
  • 15►E Coli E Coli: Enemies can be turned into 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.
  • 15►Flush! Flush!: The leech still can attack the enemies turned into poop and gain health.
  • 15►Gnawed Leaf Gnawed Leaf: The player can stand still and allow the Leech to clear a room, granting simple clears and easy health.
  • Tainted Bethany Tainted Bethany: Due to the fact that Tainted Bethany’s Added in Repentance15►Lemegeton Lemegeton gains charges with red hearts, leech can charge it up 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.
Bug Bug! With Leech and Extension Cord, when electricity occasionally connects Isaac and the Leech, it will not always fully connect.


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)