Binding of Isaac: Rebirth Wiki
Register
Advertisement

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 the pill. The pill effect for that color will remain constant throughout the run. (However, it is possible for Collectible PHD iconPHD, Collectible Virgo iconVirgo, (in Repentance)Collectible False PHD iconFalse PHD, or (in Repentance)Collectible Lucky Foot iconLucky 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 Collectible PHD iconPHD or (in Repentance)Collectible False PHD iconFalse 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.

  • (except in Rebirth) The pill pool for each run has increased from 9 to 13.

Pill Effects

Ambox important This article is incomplete. Please help to improve it, or discuss the issue on the talk page.

Issues: The remaining horse pill effects require more research.

ID Pill Effect (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.
(in Repentance) This doesn't count as damage for the purposes of Devil/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.
(in Repentance)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 Collectible Mr. Mega iconMr. Mega and Collectible Bobby-Bomb iconBobby-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. 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, (in Rebirth), and the effect disappears when you leave the room. Isaac's face gets a permanent, very exaggerated expression.
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.
(in Afterbirth † and Repentance) 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 Collectible Big Fan iconBig Fan instead. There is no upper limit.
11 Range Down (except in Repentance)-2.00 range.
(in Repentance)-0.60 range.
-1.20 range.
12 Range Up (except in Repentance)+2.50 range.
(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 room, and an extremely small chance to teleport him to the Black Market, like Collectible Undefined iconUndefined. (in Repentance) Now has a chance to invoke the XVIII - The Moon? effect, teleporting the player to the Ultra Secret Room. (except in Repentance)Unobtainable in Greed Mode. Unknown.
20 48 Hour Energy Drops one to two little batteries and fully charges the spacebar item. (except in Rebirth) Can be used with the (except in Rebirth)Collectible Placebo iconPlacebo or (in Afterbirth † and Repentance)Collectible D1 iconD1 to generate infinite batteries. Spawns more 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 more 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 Collectible The Mind iconThe 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 Collectible Black Candle iconBlack Candle, but will not prevent future uses of the Amnesia pill from giving the Curse of the Lost effect. (except in Rebirth) Also the only pill to have its flavor text appear on a piece of paper as curses do. Unknown.
26 Lemon Party Spawns a large yellow pool (similar to Collectible Lemon Mishap iconLemon Mishap) around your character. Greatly damages any enemy that steps on it, for 22 damage per tick or 66 damage per second. The puddle covers nearly the entire room.
27 R U a Wizard? Tears are shot diagonally outwards for about 30 seconds. This effect does not reset upon exiting the room. The effect lasts 60 seconds.
(except in Rebirth) Afterbirth
28 Needs to be unlocked Percs! Gives Collectible The Wafer iconThe Wafer effect while in the room: reduces all damage taken to half a heart.
Unlocked by: (except in Rebirth)2 new pills Complete PAY TO PLAY (challenge #24).
Unknown.
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: (except in Rebirth)2 new pills Complete PAY TO PLAY (challenge #24).
Unknown.
30 Needs to be unlocked 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: (except in Rebirth)2 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 Collectible Black Candle iconBlack 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: (except in Rebirth)2 new pills Complete Have a Heart (challenge #25).
Unknown.
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. (in Afterbirth † and Repentance) 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, and lets Isaac deal contact damage, similar to Collectible The Gamekid iconThe Gamekid. In addition to the normal effect, grants (in Afterbirth † and Repentance)Huge GrowthHuge Growth for +7 flat damage and +3 range. The Huge Growth bonus persists after the Gamekid wears off.
37 Retro Vision (except in Repentance)Applies a pixelating filter on the screen 3 times over 30 seconds. The effect continues between floors.

(in Repentance)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. Double the number of flies spawned.
(in Afterbirth † and Repentance) 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... (except in Repentance) Slows all enemies for the duration of the room.
(in Repentance) Slows all enemies, Isaac, and the background music for the duration of the room.
Unknown.
42 I'm Excited!!! (except in Repentance) Increases the speed of all enemies for the duration of the room.
(in Repentance) Increases the speed of all enemies, Isaac, and the background music for the duration of the room.
The effect triggers again 30 seconds after use and 60 seconds after use.
Unknown.
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: (in Afterbirth † and Repentance)Once More with Feeling! Complete a Victory Lap, defeating The Lamb.
Unknown.
44 Needs to be unlocked Horf! Isaac shoots an explosive tear with the Collectible Ipecac iconIpecac effect that always deals 200 damage.
Unlocked by: (in Afterbirth † and Repentance)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 Collectible Unicorn Stump iconUnicorn Stump.
Unlocked by: (in Afterbirth † and Repentance)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 Collectible The Gamekid iconThe 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: (in Afterbirth † and Repentance)U Broke It! Obtain 50 items in a run (duplicate passive items/familiars count towards the total, e.g., multiple Collectible Breakfast iconBreakfast).
If the last pill was a normal pill, it becomes a horse pill. No further difference on horse pills themselves.
(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, it will not reduce an attribute, while if taken with False PHD, it will not increase one. The two effects are doubled in power.

Pill Appearances

ID Pill
1 BlueBlue
2 WhiteBlue
3 OrangeOrange
4 Pill WhiteWhite
5 RedSpecled
6 WhiteRed
7 BlueCyan
8 YellowOrange
9 SpottedwhiteWhite
(except in Rebirth) Afterbirth
10 Pill White Cyan
11 Pill Black Yellow
12 Pill Black White
13 Pill White Yellow

Gold Pills

(in Repentance) 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: Gold Pill Defeat Mega Satan as Character Tainted Cain iconTainted Cain.
  • The possible effects for gold pills are not drawn from the current pill pool, which means that that you have a chance to get any of the 50 pill effects.
  • Gold Pills have an ID of 5.70.14.
  • A gold pill can also be a Horse pill. Golden Horse pills uses the Horse pill effect every use.

Horse Pills

(in Repentance) 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: Horse Pill Defeat Mega Satan as Character Tainted Eve iconTainted 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.)

Notes

  • 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.
    • (in Repentance) Shot speed can now be altered with pills. Damage can now also be altered with pills with False PHD.
  • (except in Rebirth) Pill effects have a chance to be narrated upon use, as do cards and runes.
  • (except in Rebirth) Currently, the "Retro Vision" pill effect can crash the game on some machines, resulting in restarting the current floor when the game is continued.
  • (except in Rebirth) The "Addicted!" pill will have no effect if Isaac has Collectible The Wafer iconThe 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 Collectible Midas' Touch iconMidas' Touch, (in Afterbirth † and Repentance)MeconiumMeconium, or (in Afterbirth † and Repentance)Collectible Hallowed Ground iconHallowed Ground and using a "Re-Lax" pill has a chance to spawn golden poop, black poop, or white poop, respectively.
  • (except in Rebirth) Using an "Infested!" pill on red poop will spawn blue spiders and the red poop will regenerate.
  • (except in Rebirth) 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.
  • (except in Rebirth) "R U A Wizard" does not affect Lilith's Incubus.
  • (in Afterbirth † and Repentance) Using a "Gulp!" pill while holding two trinkets (with (in Afterbirth † and Repentance)Collectible Belly Button iconBelly Button or Collectible Mom's Purse iconMom'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.
  • (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.
    • Taking only golden pills in a run can allow for infinite golden pill generation by repeatedly activating the vurp effect. This process can be made more effective by using the (in Afterbirth † and Repentance)Collectible D1 iconD1 to duplicate golden pills on the ground and recharging the (in Afterbirth † and Repentance)Collectible D1 iconD1 with the 24 hour energy effect.

Strategy

  • Use of unidentified pills is recommended for outside of combat as Hematemesis, R U a Wizard?, Paralysis, (except in Rebirth)Addicted!, (in Afterbirth † and Repentance) X-Lax, and (in Afterbirth † and Repentance) I'm Excited!!! can be detrimental mid-fight. However, (in Afterbirth † and Repentance) I'm Drowsy..., (in Afterbirth † and Repentance) Something's wrong..., Lemon Party, Bad Gas, and Pheromones are useless outside of combat.
  • (except in Rebirth) 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.
  • (except in Rebirth) The invincibility effect from Power Pill and (in Afterbirth † and Repentance) Feels like I'm walking on sunshine! can be utilized to get into curse rooms, play blood donation machines, or use Devil beggars without taking any damage.
    • (except in Rebirth) Percs! can be used to reduce damage from these from chapter 4 onward.

Unlockable Achievements

Trivia

  • (in Afterbirth † and Repentance) The Vurp! pill is a portmanteau of the words vomit and burp.
  • (except in Rebirth) 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.
  • (in Afterbirth † and Repentance) The Feels like I'm walking on sunshine! pill is a reference to the 80s song Walking on Sunshine.
  • 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.
  • (except in Rebirth) Friends Till the End! was originally in the Wrath of the Lamb but removed in Rebirth, then put back into Afterbirth.
  • (in Afterbirth) Friends Till The End! is the only non-narrated pill.
  • 48 Hour Energy is a reference to the drink 5 Hour Energy.
  • (in Afterbirth † and Repentance) X-Lax is a reference to the anti-constipation medicine Ex-Lax.
  • (except in Rebirth) "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.
  • (except in Rebirth) "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.
  • (except in Rebirth) The "???" is the only pill that has 3 different narrated voice lines.

Voiceovers

Pill Voiceover (Standard Pills) Voiceover (Horse Pills)
???


File:Triple question mark 1.wav
File:Triple question mark 2.wav
File:What in the heck.wav
48 Hour Energy
File:48HourEnergyVoiceover.wav.wav
File:48 hr energy!.wav
Addicted
File:Addicted.wav
Amnesia
File:Amnesia.wav
Bad Gas
File:Bad gas.wav
Bad Trip
File:Bad trip.wav
Balls of Steel
File:Balls of steel.wav
Bombs Are Key
Feels like I'm walking on sunshine!
File:FeelsLikeImWalkingonSunshine.wav
Friends Till the End!
Full Health
Gulp!
Health Down
Health Up
Hematemesis
File:HematemisisVoiceover.wav
Horf!
I Can See Forever

File:ICanSeeForever2Voiceover.wav
I Found Pills
I'm Drowsy...
I'm Excited!!!
File:ImExcitedVoiceover.wav
Infested!
Infested?
Lemon Party
Luck Down
Luck Up
One Makes You Larger
File:OneMakesYouLarger.wav
One Makes You Small
Paralysis
Percs
Pheromones
Power Pill
Pretty Fly
File:Pretty fly.wav
Puberty
R U a Wizard?
Range Down
Range Up
Re-Lax
File:RelaxVoiceover.wav
Retro Vision
Something's wrong...
File:SomethingsWrongVoiceover.wav
Speed Down
Speed Up
Tears Down
Tears Up
Telepills
Vurp!
X-Lax

Gallery


Advertisement