Binding of Isaac: Rebirth Wiki

Pills are pickups that can provide useful or inhibiting effects. They take up the same slot as cards and runes.

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 PHD, Virgo Virgo, Added in RepentanceFalse PHD False PHD, or Added in RepentanceLucky Foot 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 PHD or Added in RepentanceFalse PHD 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.

  • Added in Afterbirth The pill pool for each run has increased from 9 to 13.

Pill Effects[]

ID Pill Effect Added in Repentance 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.
Added in Repentance This doesn't count as damage for the purposes of Devil Room Devil Room/Angel 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 Bomb Bombs and Key Keys.
Added in RepentanceThe effects of Added in Afterbirth Golden Bomb Golden Bombs and Golden Key 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 Mr. Mega and Bobby-Bomb 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. Added in Repentance While playing as The Lost 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, Removed in Afterbirthand 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.
Added in Afterbirth † Consuming three puberty pills will grant the Adult 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 Big Fan instead. There is no upper limit.
11 Range Down Removed in Repentance-2.00 range.
Added in Repentance-0.60 range.
-1.20 range.
12 Range Up Removed in Repentance+2.50 range.
Added in Repentance+0.75 range.
+1.50 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 I AM ERROR room, and an extremely small chance to teleport him to the Black Market Black Market, like Undefined Undefined. Removed in RepentanceUnobtainable in Greed Mode.

Added in Repentance Has a chance to teleport you to an Ultra Secret Room Ultra Secret Room if used in the mirrored version of Downpour Downpour/Dross Dross II.

No difference.
20 48 Hour Energy Drops one to two Lil' Battery Lil' Batteries and fully charges the spacebar item. Added in Afterbirth / Removed in Repentance Can be used with the Placebo Placebo or Added in Afterbirth †D1 D1 to generate infinite batteries. Spawns 3-4 batteries.
21 Hematemesis Empties all but one red heart container and spawns 1-4 Red Heart 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 aSuper Secret Room Super Secret Room containing a Black Heart Black Heart or Eternal Heart Eternal Heart, 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 Secret Room and Super Secret Room Super Secret Room for the current floor. In addition to the normal effect, fully reveals the map like The Mind 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 Black Candle, but will not prevent future uses of the Amnesia pill from giving the Curse of the Lost effect. Added in Afterbirth 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 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.
Added in Afterbirth Afterbirth
28 Needs to be unlocked Percs! Gives The Wafer The Wafer effect while in the room: reduces all damage taken to half a heart.
Unlocked by: Added in Afterbirth2 new pills Complete PAY TO PLAY (challenge #24).
No difference.
29 Needs to be unlocked 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: Added in Afterbirth2 new pills Complete PAY TO PLAY (challenge #24).
No difference.
30 Needs to be unlocked Re-Lax For a short time, Poop 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: Added in Afterbirth2 new pills Complete Have a Heart (challenge #25).
The effect lasts much longer, with high speed long enough to cover nearly the entire room.
31 Needs to be unlocked ??? 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 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: Added in Afterbirth2 new pills Complete Have a Heart (challenge #25).
No difference.
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 The Forgotten's bone club. Added in Afterbirth † 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 Half Red Heart every time an enemy is killed, similar to The Gamekid The Gamekid. In addition to the normal effect, grants Added in Afterbirth †Huge Growth Huge Growth for +7 flat damage and +3 range. The Huge Growth bonus persists after the Gamekid wears off.
37 Retro Vision Removed in RepentanceApplies a pixelating filter on the screen 3 times over 30 seconds. The effect continues between floors. Added in RepentanceDownscales 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.
Added in Afterbirth † Afterbirth †
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... Removed in Repentance Slows all enemies for the duration of the room.
Added in Repentance Applies the Stop Watch 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.
No difference.
42 I'm Excited!!! Removed in Repentance Increases the speed of all enemies for the duration of the room.
Added in Repentance Increases the speed of all enemies, Isaac, and the background music for the duration of the room.
The effect triggers again three additional times.
No difference.
43 Needs to be unlocked Gulp! Any trinkets that the player is holding are destroyed, and their effects are permanently applied to the player.
Unlocked by: Added in Afterbirth †Once More with Feeling! 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 Mom's Purse). No effect for characters who cannot have red hearts. This counts for two gulp pills toward the Added in Afterbirth †Marbles Marbles achievement.
44 Needs to be unlocked Horf! Isaac shoots an explosive tear with the Ipecac Ipecac effect that always deals 200 damage.
Unlocked by: Added in Afterbirth †Dedication 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 Needs to be unlocked Feels like I'm walking on sunshine! Temporarily makes Isaac invincible, similar to Unicorn Stump Unicorn Stump.
Unlocked by: Added in Afterbirth †Sin collector 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 The Gamekid.
46 Needs to be unlocked 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: Added in Afterbirth †U Broke It! Obtain 50 items in a run (duplicate passive items/familiars count towards the total, e.g., multiple Breakfast Breakfast).
If the last pill was a normal pill, it becomes a horse pill. No further difference on horse pills themselves.
Added in Repentance Repentance
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 PHD, it will not reduce an attribute, while if taken with Added in RepentanceFalse PHD False PHD, it will not increase one. The two effects are doubled in power.

Pill Appearances[]

Normal Pills Added in RepentanceHorse Pills
ID Appearance ID Appearance
5.70.1 BlueBlue.png 5.70.2049 Horse Pill Blue-Blue icon.png
5.70.2 WhiteBlue.png 5.70.2050 Horse Pill White-Blue icon.png
5.70.3 OrangeOrange.png 5.70.2051 Horse Pill Orange-Orange icon.png
5.70.4 Pill WhiteWhite.png 5.70.2052 Horse Pill White-White icon.png
5.70.5 RedSpecled.png 5.70.2053 Horse Pill Dots-Red icon.png
5.70.6 WhiteRed.png 5.70.2054 Horse Pill Pink-Red icon.png
5.70.7 BlueCyan.png 5.70.2055 Horse Pill Blue-Cadetblue icon.png
5.70.8 YellowOrange.png 5.70.2056 Horse Pill Yellow-Orange icon.png
5.70.9 SpottedwhiteWhite.png 5.70.2057 Horse Pill Dots-White icon.png
Added in Afterbirth Afterbirth
5.70.10 Pill White Cyan.png 5.70.2058 Horse Pill White-Azure icon.png
5.70.11 Pill Black Yellow.png 5.70.2059 Horse Pill Black-Yellow icon.png
5.70.12 Pill Black White.png 5.70.2060 Horse Pill White-Black icon.png
5.70.13 Pill White Yellow.png 5.70.2061 Horse Pill White-Yellow icon.png
Added in Repentance Repentance
5.70.14 Golden Pill icon.png 5.70.2062 Golden Horse Pill icon.png

Added in Repentance Gold 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: Added in RepentanceGold Pill Defeat Mega Satan as Tainted Cain 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 PHD or Lucky Foot 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.

Added in Repentance Horse Pills[]

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: Added in RepentanceHorse Pill Defeat Mega Satan as Tainted Eve 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.)


Pills that spawn with a sub-type of 0 (i.e. a random pill) will have the following probabilities:

  • Random normal pill - 97.86%
  • Specific normal pill - 7.53%
  • Gold pill - 0.7%
  • Random horse pill - 1.43%
  • Specific horse pill - 0.11%
  • Horse gold pill - 0.01%


  • 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.
    • Damage can be altered if stats are balanced via Libra Libra.
    • Added in Repentance Shot speed can now be altered with pills. Damage can now also be altered with pills with False PHD False PHD.
  • Added in Afterbirth Pill effects have a chance to be narrated upon use, as do cards and runes.
  • Added in Afterbirth Currently, the "Retro Vision" pill effect can crash the game on some machines, resulting in restarting the current floor when the game is continued.
  • Added in Afterbirth The "Addicted!" pill will have no effect if Isaac has The Wafer 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 Midas' Touch, Added in Afterbirth †Meconium Meconium, or Added in Afterbirth †Hallowed Ground Hallowed Ground and using a "Re-Lax" pill has a chance to spawn Golden Poop Golden Poop, Added in Afterbirth Black Poop Black Poop, or Added in Afterbirth † White Poop White Poop, respectively.
  • Added in Afterbirth Using an "Infested!" pill on Red Poop Red Poop will spawn blue spiders and the red poop will regenerate.
  • Added in Afterbirth 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.
  • Added in Afterbirth "R U A Wizard" does not affect Lilith Lilith's Incubus.
  • Added in Afterbirth † Using a "Gulp!" pill while holding two trinkets (with Added in Afterbirth †Belly Button Belly Button or Mom's Purse 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 Added in AfterbirthGlowing Hour Glass Glowing Hour Glass and consuming another golden pill will activate the same effects.
  • Added in Repentance 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 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.
    • This only applies if the run is started as Magdalene or if Magdalene is chosen as a Co-op partner, not if Isaac turns into Magdalene using Added in Afterbirth †Clicker Clicker.
  • If a Marked Skull is destroyed while Isaac is holding Little Baggy Little Baggy, it will spawn a Telepill instead of 0 - The Fool 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.
  • If a "Health up" pill is used while Isaac has 11 empty red hearts and one non-red heart, The non-red heart will be replaced with an empty container, killing Isaac.


  • Added in Repentance 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, Added in AfterbirthAddicted!, Added in Afterbirth † X-Lax, and Added in Afterbirth † I'm Excited!!! can be detrimental mid-fight. However, Added in Afterbirth † I'm Drowsy..., Added in Afterbirth † Something's wrong..., Lemon Party, Bad Gas, and Pheromones are useless outside of combat.
  • Added in Afterbirth Percs! can be used in the Sacrifice Room 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.
  • Added in Afterbirth The invincibility effect from Power Pill and Added in Afterbirth † Feels like I'm walking on sunshine! can be utilized to get into Curse Room Curse Rooms, play Blood Donation Machine.png Blood Donation Machines and Added in Repentance Confessional.png Confessionals, or use Devil Beggar.png Devil Beggars and Added in Repentance Hell Game.png Hell Games without taking any damage.
    • Added in Afterbirth Percs! can be used to reduce damage from these from chapter 4 onward.
  • Added in Repentance Taking only golden pills in a run can allow for infinite golden pill generation by repeatedly activating the Vurp! effect.
  • Added in AfterbirthEndless Nameless Endless Nameless can be used to effectively generate infinite golden pills, as the trinket's ability to respawn collectibles applies with every use.

Unlockable Achievements[]


  • Added in Afterbirth † The Vurp! pill is a portmanteau of the words vomit and burp.
  • Added in Afterbirth 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.
  • Added in Afterbirth † 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.
  • Added in Afterbirth Friends Till the End! was originally in the Wrath of the Lamb but removed in Rebirth, then put back into Afterbirth.
  • Added in Afterbirth / Removed in Afterbirth † Friends Till The End! is the only non-narrated pill.
  • 48 Hour Energy is a reference to the drink 5 Hour Energy.
  • Added in Afterbirth † X-Lax is a reference to the anti-constipation medicine Ex-Lax.
  • Added in Afterbirth "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.
  • Added in Afterbirth "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.
  • Added in Afterbirth The "???" is the only pill that has 3 different narrated voice lines.
  • Added in Repentance "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
Bad Gas
Bad Trip
Balls of Steel
Bombs Are Key
Experimental Pill
Explosive Diarrhea
Feels like I'm walking on sunshine!
Friends Till the End!
Full Health
Health Down
Health Up
I Can See Forever
I Found Pills
I'm Drowsy...
I'm Excited!!!
Lemon Party
Luck Down
Luck Up
One Makes You Larger
One Makes You Small
Power Pill
Pretty Fly
R U a Wizard?
Range Down
Range Up
Retro Vision
Shot Speed Down
Shot Speed Up
Something's wrong...
Speed Down
Speed Up
Tears Down
Tears Up