Sack Head is a passive item added in The Binding of Isaac: Afterbirth.
Effects[ | ]
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Coins have a 10% chance to be replaced with Grab Bags. Bombs, Keys, Cards, Runes, and Lil' Batteries have a 20% chance.
- This includes pickups spawned by most sources: room rewards, chests, slot machines, special shopkeepers, Greed Mode waves, etc.
- Coins bombed out of a Donation Machine can become sacks.
- The exception to this are pickups spawned by Isaac himself directly, e.g. with the likes of IV Bag or Fanny Pack, and contents of other sacks.
- Spawns a sack upon pickup.
Coins bombed out of a 
Notes[ | ]
- The item does not replace hearts, pills and chests.
- The item can also replace Troll Bombs and Mega Troll Bombs that are not used as attacks, i.e. generated as room rewards, chest contents and such.
- The pickup replacement is applied retroactively when the item is collected: any appropriate pickup already existing on the current level may be replaced by a sack.
- Sacks on each floor tend to have the same contents, which can be taken advantage of if cards are involved.
- Picking up a Golden Penny may spawn a sack instead of another Golden Penny.
- Cracked Key in the Ascent can be replaced by a sack, thus it is not recommended to take the item if you're going to unlock a tainted character.
Sacks on each floor tend to have the same contents, which can be taken advantage of if cards are involved.
Synergies[ | ]
- Equality!: Sacks may drop new sacks while Equality! is active, potentially resulting in massive amounts of resources from a single sack.
- Head of the Keeper: Coins spawned from hitting enemies have a chance to become sacks.
- Tainted Keeper: The coins dropped from killing enemies have a chance to be sacks instead. The sacks do not flash and disappear.
In-game Footage[ | ]
Trivia[ | ]
- The appearance given by the item is most likely based on one of the trailers for Rebirth,[1] where several naked people are wearing sacks with crying eyes, strikingly similar to Sack Head.
Gallery[ | ]
Afterbirth item and trinket concepts, including Sack Head.
 The Binding of Isaac: Rebirth
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