At the start of each run, an effect is randomly assigned to each color of pill. The pill effect for each color will remain constant throughout the run. (However, it is possible for PHD, Virgo, False PHD, or Lucky Foot to reassign some of the effects, such that 2 different colored pills will have the same effect.) Pills will start the game unidentified (unless the player is holding PHD or False PHD); their effect is shown as "???" when picked up. Upon using a particular pill for the first time, its effect will be revealed and all subsequent pills with the same color will have their effect shown as well. The set of pill effects for any given run is usually known as the pill pool.
- The pill pool for each run has increased from 9 to 13.
|ID||Pill||Effect||Horse Pill Effect|
|0||Bad Gas||Isaac farts, dealing 5 damage and poisoning enemies around him.||The poison applies to the entire room.|
|1||Bad Trip||Injures Isaac by a full heart. If a Bad Trip pill is used while Isaac only has a single heart left or less, the pill will turn into a Full Health pill instead.
This doesn't count as damage for the purposes of Devil Room/ Angel Room generation odds or score reduction.
|Two hearts of damage. If Isaac would not survive, the pill becomes Full Health.|
|2||Balls of Steel||Grants Isaac two soul hearts.||Grants four soul hearts.|
|3||Bombs Are Key||Swaps the values of Isaac's Bombs and Keys.
The effects of Golden Bombs and Golden Keys are also swapped.
|The number of bombs and keys is increased by 50% while swapping.|
|4||Explosive Diarrhea||Spawns five active bombs behind Isaac over a period of five seconds, at one a second.||Spawns more bombs, boosted with Mr. Mega and Bobby-Bomb.|
|5||Full Health||Refills every empty red heart container.||Fully heals and grants 3 soul hearts.|
|6||Health Down||Removes one red heart container upon use. While Isaac has one or fewer red heart containers, it will act as a Health Up pill instead. ??? can encounter Health Down pills, even though he can't have red heart containers. While playing as The Lost due to using the White Fireplace, the pill turns into a Health Up too, regardless of your red heart containers.||Removes two heart containers. If this is not possible, the pill becomes Health Up.|
|7||Health Up||Adds one empty red heart container upon use.||Adds two empty red heart containers.|
|8||I Found Pills||Changes the appearance of Isaac's face. This pill is cosmetic only, and the effect disappears when you leave the room.||Isaac's face gets a permanent, very exaggerated expression resembling a horse.|
|9||Puberty||Causes Isaac to grow four hairs from the top of his head and zits on his face. This pill is cosmetic only and will stay for the rest of the run.
Consuming three puberty pills will grant the Adult transformation, granting one red heart container and making Isaac's voice slightly deeper (one time effect).
|Isaac gains very fluffy hair covering his entire head and even face.|
|10||Pretty Fly||Grants a fly orbital, up to 3 maximum, that circles the player, blocking projectiles and damaging fly-type enemies on touch.||Spawns a Big Fan instead. There is no upper limit.|
|11||Range Down||-2.00 range.
|12||Range Up||+2.50 range.
|13||Speed Down||-0.12 speed.||-0.24 speed.|
|14||Speed Up||+0.15 speed.||+0.30 speed.|
|15||Tears Down||-0.28 tears.||-0.56 tears.|
|16||Tears Up||+0.35 tears.||+0.70 tears.|
|17||Luck Down||-1 luck.||-2 luck.|
|18||Luck Up||+1 luck.||+2 luck.|
|19||Telepills||Isaac gets teleported to a random room. Has a small chance to teleport Isaac to the I AM ERROR room, and an extremely small chance to teleport him to the Black Market, like Undefined. Unobtainable in Greed Mode.||No difference.|
|20||48 Hour Energy||Drops one to two Lil' Batteries and fully charges the spacebar item. Can be used with the Placebo or D1 to generate infinite batteries.||Spawns 3-4 batteries.|
|21||Hematemesis||Empties all but one red heart container and spawns 1-4 Red Hearts. If Isaac only has half of a heart left, it will heal him to one heart. If used without any red heart containers, no health will be deducted, but red hearts will still spawn. If used in a Black Heart or Eternal Heart-containing Super Secret Room, it will spawn those types of hearts instead.||Spawns 4-7 hearts.|
|22||Paralysis||Prevents Isaac from moving and shooting for 2 seconds.||The effect lasts 4 seconds.|
|23||I can see forever!||Opens all entrances to the Secret Room and Super Secret Room for the current floor.||In addition to the normal effect, fully reveals the map like The Mind.|
|24||Pheromones||Charms all enemies in the room for a short period of time.||The charm is permanent, turning the enemies friendly.|
|25||Amnesia||Replaces the floor map with a ? for the rest of the floor, identical to the effect of Curse of the Lost. If no other curses are active for the floor, the Curse of the Lost will appear under the level name when the map key is held. This effect can be negated by picking up Black Candle, but will not prevent future uses of the Amnesia pill from giving the Curse of the Lost effect. Also the only pill to have its flavor text appear on a piece of paper as curses do.||No difference.|
|26||Lemon Party||Spawns a large yellow pool (similar to Lemon Mishap) around your character. Greatly damages any enemy that steps on it, for 22 damage per tick or 66 damage per second.||The puddle is way bigger.|
|27||R U a Wizard?||Tears are shot diagonally outwards for 30 seconds, making it much harder to aim. This effect will persist between rooms until it wears off.||The effect lasts for 60 seconds.|
|28||Percs!||Gives The Wafer effect while in the room: reduces all damage taken to half a heart.
Unlocked by: Complete PAY TO PLAY (challenge #24).
|29||Addicted!||Makes Isaac take a full heart of damage from all sources for the current room. Also changes his appearance for the room.
Unlocked by: Complete PAY TO PLAY (challenge #24).
|30||Re-Lax||For a short time, Poop spawns wherever Isaac moves, like Explosive Diarrhea but with poop. A higher move speed means you can touch more tiles in the same time. A pun on laxatives.
Unlocked by: Complete Have a Heart (challenge #25).
|The effect lasts much longer, with high speed long enough to cover nearly the entire room.|
|31||???||Gives the Curse of the Maze effect for the remainder of the floor. The effect can stack with other curses. If no other curses are active for the floor, Curse of the Maze will appear under the level name when Tab is held. This effect can be negated by picking up Black Candle, but will not prevent future uses of the ??? pill from giving the Curse of the Maze effect. As the pill's name is "???", the same as what unidentified pills are referred to, it is easy to accidentally use it more than once per run. It is recommended to memorize its color upon first using it.
Unlocked by: Complete Have a Heart (challenge #25).
|32||One makes you larger||Increases Isaac's size and decreases the pitch of his voice. This effect does not increase the size of Isaac's hitbox, but will increase the size of The Forgotten's bone club. These pills contribute to the Stompy transformation.||Size increases by two steps.|
|33||One makes you small||Decreases Isaac's size and increases the pitch of his voice. This effect decreases the size of Isaac's hitbox.||Size decreases by two steps.|
|34||Infested!||Destroys all poop in the room and spawns a single blue spider under Isaac and on each destroyed poop.||Double the number of spiders spawned.|
|35||Infested?||Spawns blue spiders equal to the number of enemies in the room. If there are no enemies in the room, spawns 1-3 Blue Spiders.||Double the number of spiders spawned.|
|36||Power Pill!||Temporarily grants invulnerability, inflicts fear on enemies in the room, lets Isaac deal contact damage, and has a chance to replenish a Half Red Heart every time an enemy is killed, similar to The Gamekid.||In addition to the normal effect, grants Huge Growth for +7 flat damage and +3 range. The Huge Growth bonus persists after the Gamekid wears off.|
|37||Retro Vision||Applies a pixelating filter on the screen 3 times over 30 seconds. The effect continues between floors. Downscales all sprites for 30 seconds once. The effect continues between floors.||Lasts 90 seconds, with no breaks.|
|38||Friends Till The End!||Spawns three blue flies.||Spawns 12 blue flies.|
|39||X-Lax||Creates a pool of slippery brown creep underneath Isaac.||The pool lasts much longer.|
|40||Something's wrong...||Creates a pool of black creep beneath Isaac that slows enemies.||The pool lasts much longer.|
|41||I'm Drowsy...|| Slows all enemies for the duration of the room.
Applies the Stop Watch effect, slowing all enemies, Isaac, and the background music as well as additionally applying the Slowness status effect on every enemy for the duration of the room.
|42||I'm Excited!!!|| Increases the speed of all enemies for the duration of the room.
Increases the speed of all enemies, Isaac, and the background music for the duration of the room.
The effect triggers again three additional times.
|43||Gulp!||Any trinkets that the player is holding are destroyed, and their effects are permanently applied to the player.
Unlocked by: Complete a Victory Lap, defeating The Lamb.
|Also heals one red heart per gulped trinket (you can eat up to 2 at the same time with Mom's Purse). No effect for characters who cannot have red hearts. This counts for two gulp pills toward the Marbles achievement.|
|44||Horf!||Isaac shoots an explosive tear with the Ipecac effect that always deals 200 damage.
Unlocked by: Participate in 31 Daily Challenges (they don't have to be consecutive; it will still count if Isaac dies in the first room).
|Isaac shoots a small cluster of Horf! tears, with varying power above normal Horf!.|
|45||Feels like I'm walking on sunshine!||Temporarily makes Isaac invincible, similar to Unicorn Stump.
Unlocked by: Collect every entry in the Bestiary (bugged v190 - Mobs that don't exist in the bestiary are being counted. This allows Sin Collector to be unlocked without a complete bestiary).
|The effect is upgraded to The Gamekid.|
|46||Vurp!||Throws up the last pill used. Will spawn itself if no other pills were taken beforehand, or if Vurp! was the last pill used.
Unlocked by: Obtain 50 items in a run (duplicate passive items/familiars count towards the total, e.g., multiple Breakfast).
|If the last pill was a normal pill, it becomes a horse pill. No further difference on horse pills themselves.|
|47||Shot Speed Down||-0.15 shot speed.||-0.30 shot speed.|
|48||Shot Speed Up||+0.15 shot speed.||+0.30 shot speed.|
|49||Experimental Pill||Increases one attribute and decreases another randomly, with the same power as normal attribute up/down pills. If taken with PHD, it will not reduce an attribute, while if taken with False PHD, it will not increase one.||The two effects are doubled in power.|
|Normal Pills||Horse Pills|
Repentance introduces Gold Pills (or Golden Pills). Using them will give a random pill effect. Gold pills only have a chance to be "used up" upon using them, which means that you can often use them many times before they finally disappear.
- Unlocked by: Defeat Mega Satan as Tainted Cain.
- The possible effects are all effects that aren't in the run's pill pool, which means if you see an effect from a normal pill, you will never see it from a golden pill.
- Items such as PHD or Lucky Foot which alter pill effects also work on the effects of this pill, allowing many beneficial effects to be stacked with little risk. Effects altered by these items may overlap with the effects in the run's pill pool; for example, a run might have Tears Up in the pill pool and Tears Down outside of the pill pool, which will be turned into Tears Up due to the effects of the item.
- Gold Pills have an ID of 5.70.14.
- A Gold Pill can also be a Horse Pill. Golden Horse Pills use the Horse Pill effect on every use.
- Golden horse pills are most likely the rarest pickup in the game with a 0.06% chance of spawning instead of a normal pill.
Repentance introduces Horse Pills. These are larger versions of the standard pills with a more powerful effect, but only appear very rarely. Unique sound effects can be heard when they are used, and the narrator's voice lines for horse pills are overly loud and exaggerated compared to those for normal pills.
- Unlocked by: Defeat Mega Satan as Tainted Eve.
- All items that work with pills work identically with horse pills.
- A horse pill with a given effect has the same color as the normal pill does.
- Horse pills have an ID of the normal ID + 2048 (i.e. 1 << 11). For example, a white-blue pill has an ID of 2, so the horse pill version would have an ID of 5.70.2050.
- It is also possible to have a golden horse pill. (It has an ID of 5.70.2062.)
- Among the attribute modifying pill effects, only five of the seven visible attributes are covered: health, range, tears, speed, and luck. Both shot speed and damage can't be altered by pills.
- Pill effects have a chance to be narrated upon use, as do cards and runes.
- Currently, the "Retro Vision" pill effect can crash the game on some machines, resulting in restarting the current floor when the game is continued.
- The "Addicted!" pill will have no effect if Isaac has The Wafer.
- Despite this, if one takes both the "Addicted!" pill with "Percs!" in the same room, Isaac will take a full heart of damage from all sources.
- Having Midas' Touch, Meconium, or Hallowed Ground and using a "Re-Lax" pill has a chance to spawn Golden Poop, Black Poop, or White Poop, respectively.
- Using an "Infested!" pill on Red Poop will spawn blue spiders and the red poop will regenerate.
- If a Tiny or Large Champion monster drops a "One Makes You Small"/"Larger" pill and either pill is not in the current pill pool, an existing pill will be overwritten. If the chosen pill was already identified, the new pill will also be.
- "R U A Wizard" does not affect Lilith's Incubus.
- Using a "Gulp!" pill while holding two trinkets (with Belly Button or Mom's Purse) will cause both trinkets to be absorbed.
- Isaac's hitbox can be reduced to 30% of original, which is achieved after 6 One Makes You Small pills. Further pills will only make him visually smaller, with no additional benefit.
- All golden pills in the run have a shared sequence of effects they activate, so reversing the effects of one golden pill through Glowing Hour Glass and consuming another golden pill will activate the same effects.
- If a Vurp! effect is activated by a golden pill, it will spawn the last non-golden pill taken by Isaac, or a golden pill if no non-golden pills have been taken by Isaac in the run.
- Magdalene's starting pill will override one of the pills in the current run's pill set if it doesn't exist in it (Speed Up for Afterbirth+, or Full Health in Repentance). The pill that is converted is dependent on the run's seed.
- If a Marked Skull is destroyed while Isaac is holding Little Baggy, it will spawn a Telepill instead of 0 - The Fool. If Telepills doesn't exist in the current run's pill set, one of the pills in the run's set will be turned into Telepills. The pill that is converted is dependent on the run's seed.
- All other pills with the same color as the Telepill spawned will also be converted into Telepills for the rest of the run, even if they're currently being held by Isaac. This can also override Magdalene's starting Full Health pill.
- There are 24 good effects, 14 neutral (sometimes good/sometimes bad) effects, and 12 negative effects. This means taking mystery pills is usually beneficial. However, you should consider not taking one if an effect like Hematemesis or Tears Down would ruin your run.
- Use of unidentified pills is recommended for outside of combat as Hematemesis, R U a Wizard?, Paralysis, Addicted!, X-Lax, and I'm Excited!!! can be detrimental mid-fight. However, I'm Drowsy..., Something's wrong..., Lemon Party, Bad Gas, and Pheromones are useless outside of combat.
- Percs! can be used in the Sacrifice Room to reduce the damage Isaac takes, potentially allowing him to do more sacrifices. However, if Isaac is teleported to the Devil/Angel room, he loses the effect.
- The invincibility effect from Power Pill and Feels like I'm walking on sunshine! can be utilized to get into Curse Rooms, play Blood Donation Machines and Confessionals, or use Devil Beggars and Hell Games without taking any damage.
- Percs! can be used to reduce damage from these from chapter 4 onward.
- Taking only golden pills in a run can allow for infinite golden pill generation by repeatedly activating the Vurp! effect.
- Endless Nameless can be used to effectively generate infinite golden pills, as the trinket's ability to respawn collectibles applies with every use.
- The Vurp! pill is a portmanteau of the words vomit and burp.
- Power Pills activating the Gamekid effect is a reference to Pac-Man, in which the "Super-Pac" powerup is obtained by eating a Power Pellet.
- "I Found Pills (and Ate Them)," "R U a Wizard?," and "I can see Forever" are all image macro memes.
- Despite being called I Can See Forever, the effects only last for the rest of that floor.
- The Feels like I'm walking on sunshine! pill is a reference to the 80s song Walking on Sunshine.
- Furthermore, creator Edmund McMillen made in 2010 a video with the same name, although it doesn't feature the actual Walking on Sunshine song.
- Balls of Steel is a reference to Duke Nukem; it is one of Duke's more famous quotes.
- Explosive Diarrhea is extremely loud and forceful diarrhea. In the original game, the message that displayed when the pill was activated was "Oh No!". The pill name and effect are likely a reference to Atomic Bomberman where a pickup of the same name would cause the player to drop bombs behind them uncontrollably for a short duration.
- Shot speed effects were introduced in The Binding of Isaac: Eternal Edition, after the release of Rebirth. They were finally added to Rebirth in the Repentance DLC.
- Hematemesis is a medical term for vomiting blood.
- Friends Till the End! was originally in the Wrath of the Lamb but removed in Rebirth, then put back into Afterbirth.
- Friends Till The End! is the only non-narrated pill.
- 48 Hour Energy is a reference to the drink 5 Hour Energy.
- X-Lax is a reference to the anti-constipation medicine Ex-Lax.
- "One makes you larger" and "One makes you small" are references to Alice in Wonderland, and the specific wording is a reference to the song White Rabbit by Jefferson Airplane.
- "Percs" is a reference to a street name for the prescription drug Percocet, which is more generically known as Oxycodone. This drug is meant to be used to treat pain, but it is often abused for recreational purposes.
- The "???" is the only pill that has 3 different narrated voice lines.
- "Horse pills" is a slang term used to refer to large, hard to swallow pills, hence their sprites being larger than those of regular pills.
|Pill||Voiceover (Standard Pills)||Voiceover (Horse Pills)|
|48 Hour Energy|
|Balls of Steel|
|Bombs Are Key|
|Feels like I'm walking on sunshine!|
|Friends Till the End!|
|I Can See Forever|
|I Found Pills|
|One Makes You Larger|
|One Makes You Small|
|R U a Wizard?|
|Shot Speed Down|
|Shot Speed Up|
- YouTube - Pills in Repentance - What is New? What Has Changed?
- YouTube - All Horse Pills/Giant Pills (With Sound)
- YouTube - NEW Horse Pills
|Tainted Cain Unlocks|
|Tainted Eve Unlocks|
|Mega Satan Unlocks|
|The Binding of Isaac: Rebirth|
Collection • Item Pools • Version History • Modding • Music