Pills

Pills are pickups that can provide useful or inhibiting effects on Isaac.

Pills take up the same slot as cards and runes.
They are randomly chosen at the beginning of a run and assigned a color which remains static with that pill effect for the duration of the run, though some items, such as the PHD or Virgo, may reassign some of the effects. As there are a limited number of pill colors, not every effect will appear in every run. In addition to that, one effect might also appear on two different pills. The set of pills for any given run is usually known as the pill rotation.

Pill Effects

Pill	Effect
48 Hour Energy	Drops one to two battery charges and fully charges the spacebar item. Template:Afterbirth Can be used with the Placebo to generate infinite batteries.
Amnesia	Replaces the floor map with a ? for the rest of the floor. If no other curses is active for the floor, the Curse of the Lost will appear under the level name when TAB is held. This effect cannot be negated by Black Candle. Template:Afterbirth Also the only pill to have its flavour text appear on a piece of paper, like curses do.
Bad Gas	Isaac farts, poisoning enemies around him.
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 give Isaac full health instead.
Balls of Steel	Grants Isaac two soul hearts.
Bombs are Key	Switches number of bombs and keys.
Explosive Diarrhea	Spawns five active bombs behind Isaac over a period of five seconds, at one a second.
Full Health	Restores all red heart health.
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.
Health Up	Adds one empty red heart container upon use.
Hematemesis	Empties all but one red heart container and spawns 1-4 full red heart pickups. 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.
I Can See Forever	Opens all entrances to the Secret Room and Super Secret Room for the current floor.
I Found Pills (and Ate Them)	Changes the appearance of Isaac's face. This pill is cosmetic only, and the effect disappears when you leave the room.
Lemon Party	Spawns a large yellow pool (similar to Lemon Mishap) around your character. Greatly damages any enemy that steps on it.
Luck Down	Decreases Isaac's luck by 1.
Luck Up	Increases Isaac's luck by 1.
Paralysis	Prevents Isaac from moving for a short duration.
Pheromones	Charms all enemies in the room for a short period of time.
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.
Pretty Fly	Spawns a fly orbital.
Range Down	Decreases Isaac's range by 2.
Range Up	Increases Isaac's range by 2.5.
R U a Wizard?	Tears are shot diagonally outwards for about one minute. This effect does not reset upon exiting the room.
Speed Down	Decreases Isaac's movement speed by 0.12.
Speed Up	Increases Isaac's movement speed by 0.15.
Tears Down	Decreases Isaac's tears by 0.28.
Tears Up	Increases Isaac's tears by 0.35.
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.
Template:Afterbirth Afterbirth
Addicted	Makes Isaac take a full heart of damage from all sources for the current room
Infested!	Destroys all poop in the room and spawns a single blue spider under Isaac and on each destroyed poop.
Infested?	Spawns three friendly pulsating blue spiders around you.
One makes you small	Decreases Isaac's size and increases the pitch of his voice. The size decrease also affects Isaac's hitbox, making it easier to dodge enemies and projectiles, but harder to pick up consumables and items.
One makes you larger	Increases Isaac's size and decreases the pitch of his voice. The size increase also affects Isaac's hitbox, making it easier to pick up consumables and items, but harder to dodge enemies and projectiles.
Percs	Gives The Wafer effect while in the room.
Power Pill	Activates an effect similar to The Gamekid.
Re-Lax	Spawns up to 8 piles of poop on the ground in rapid succession (fewer can be spawn by moving around less), like Explosive Diarrhea but with poop. A pun on laxatives.
Retro Vision	Briefly pixelates the screen 3 times over 30 seconds.
???	Gives the Curse of the Maze effect for the remainder of the floor.

Pill Appearances

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Notes

• Among the attribute-incrementing and decrementing 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.
• All pills lying in the current Room can be doubled by using the Rune Jera.
• In Afterbirth, pill effects are now accompanied with a narration of the flavor text, just like with Cards and Runes.

Trivia

• Hematemesis is the vomiting of blood.
• Lemon Party is an internet shock site featuring a group of elderly men performing oral sex.
• I Found Pills (and Ate Them), R U a Wizard? and I can see Forever are all image macro memes.
• Balls of Steel is a reference to Duke Nukem; it is one of Duke's more famous quotes.
• In the original game, Wrath of the Lamb, there was another positive pill effect called "Friends Til The End", which summoned 3 blue attack flies. This effect was improved and given to the Rune Berkano in Rebirth. Note that the "Infested?" and "Infested!" pill effects in Rebirth are similar to the original "Friends Til The End" effect, only with spiders instead of flies.
• 48 Hour Energy is a reference to the drink 5 Hour Energy.
• "One makes you larger" and "One makes you small" is a reference to Alice in Wonderland/

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