Binding of Isaac: Rebirth Wiki
Pica   Run
Character Isaac appearance.png
Full red heartFull red heartFull red heart
Table dividing line 1.png
Challenge Number
Available Rooms
Item Pool Treasure Room.png: yes          Item Pool Shop.png: yes
Boss Isaac portrait.png
Ice Cube Ice Cube
Unlock Method

Pica Run Defeat Mom's Heart 11 times and unlock Marbles Marbles

Added in Repentance

Pica Run is challenge #41. The goal is to defeat Isaac Isaac. This challenge is unlocked by defeating Mom's Heart Mom's Heart 11 times and unlocking Marbles Marbles.


The challenge is played as Isaac Isaac, who starts with Mom's Box Mom's Box, Marbles Marbles, and Mom's Purse Mom's Purse, resulting in 4 random trinkets spawned on the floor in the starting room. All item pedestals, including those from Devil Room Devil Rooms, Shop Shops, the Library Library, are replaced with trinket drops (Devil rooms have a circle of spikes around a trinket, making it cost one heart of damage). It is, however, still possible to see a few item pedestals in this challenge.

Unlike its usual function, Marbles now causes Isaac to swallow his held trinkets every time he takes damage, rather than having a low chance of occurring. This allows building up a large collection of trinkets, quite easily making up for the lack of regular items. However, this has its downsides - some trinkets on their own or in combination with others can have undesirable or even disastrous results, such as wild teleportation or spontaneous explosions. If there is any uncertainty, looking up the trinket before committing to it by having it swallowed is recommended.

If you have a way to heal your red hearts, Devil Beggar.png Devil Beggars and Blood Donation Machine.png Blood Donation Machines can be extremely useful to swallow more trinkets while keeping your soul hearts and Devil room chance. Battery Bum.png Battery Bums are a great way to turn many coins into charges for Mom's Box Mom's Box.

Certain Trinkets are much more valuable than others at the beginning of a run, especially since Mom's Box Mom's Box doubles the effects of most Trinkets. If you are struggling to complete the challenge, it may be useful to restart until your starting trinkets include some of the following:

Items can still be obtained through rerolling key pieces.

There are also a number of trinkets you may wish to avoid picking up at all, including (but not limited to):

  • Torn Card Torn Card - causes you to fire an Ipecac + My Reflection tear every so often, which can easily cause you to damage yourself if not constantly tracked.
  • Apple of Sodom Apple of Sodom - picking up red hearts gives you a 50% chance to spawn a spider instead. You take a fair amount of intentional damage while consuming trinkets, so you'll often want the red hearts.
  • Ouroboros Worm Ouroboros Worm - the spiral pattern is generally more bad for you than it is good, even when you get the homing effect.
  • 'M 'M - rerolls your active item each time it is used. Rerolling Mom's Box means you no longer double your trinket effects and is generally inadvisable.


  • In this challenge, every trinket is unlocked. This allows the player to see new trinkets they still have to unlock.
  • Picking up trinkets spawned in the Boss Rush Boss Rush room will not start the Boss Rush.
  • Items created by Wish Bone Wish Bone and Bag Lunch Bag Lunch are not replaced with trinkets.
  • Modeling Clay Modeling Clay does not display the item it is in the item section. Keep this in mind if you chose to keep it.

Unlockable achievements[]

  • Ice Cube
    Ice Cube - Complete Pica Run (challenge #41).


  • Pica is a psychological disorder where a person experiences a compulsion to eat inedible objects and substances.