Binding of Isaac: Rebirth Wiki
Binding of Isaac: Rebirth Wiki

The Lost The Lost has no health, dying by any damage taken. Therefore, he needs to be played with extreme care. Although possible, it is extremely difficult to finish a full playthrough without getting hit at all. Powerful item combinations are often necessary for a successful run.

General Tips[]

  • Before attempting runs with The Lost, unlock any items that may be helpful for The Lost.
    • It is absolutely suggested to unlock The Lost's intrinsic 15►Holy Mantle Holy Mantle greatly lowering the difficulty of his usage. This can be done by donating 879 to the Greed Machine.
  • It is recommended to have advanced knowledge of all types of rooms, champions, and enemies.
  • The Lost's ability to fly can be used to hide safely above obstacles and pits, avoiding enemies and projectile contact.
  • Always play on hard mode, as hard mode is required to unlock 15►Godhead Godhead. If the player manages to get good item combinations, the difficulty will not matter much.
  • Bombs can be used to escape rooms you think you cannot handle.
  • The Lost will absorb soul, black, and Eternal Hearts by picking them up, but will not gain any health from them. It is recommended to avoid picking them up in case the 15►D20 D20, a Dice Room (with 3 pips, 2 if the hearts spawn in the Dice Room), or a Added in AfterbirthDice Shard Dice Shard is found later on.
    • The same applies to useless items (except while holding the 15►D4 D4, that can reroll the passive items). If an option to reroll items is found, they can be changed if not yet picked up.
  • Three orbitals of any kind absorb nearly all projectiles. It is recommended to use Slot Machines as much as possible to obtain Pretty Flies.
  • The Lost does not receive Bad Trip or Health Down pills. This makes pills more useful since they are more likely to have positive effects.
  • Added in Afterbirth With the Missing Poster Missing Poster, a run may be taken to the end with an easier character and finished as The Lost by dying on purpose, granting the unlock for The Lost without doing a full run.
  • Added in Afterbirth Since The Lost does not take damage from the Greed Mode button, you can dramatically limit the number of enemies you have to face at a given time by stepping back onto the button after activating it.

"The Still Statue"[]

This strategy is very safe and easily played. It combines 15►Gnawed Leaf Gnawed Leaf with any automatically damaging familiar. This allows The Lost to enter a room, become invulnerable, and let its familiar clear the room. There are almost no rooms where The Lost gets hit before it enters statue form. This strategy requires a lot of patience.

Although many familiars are not able to clear all types of enemies or rooms, it is still recommended to get any type of familiar the player finds. Some examples are:

  • Added in Afterbirth †15►7 Seals 7 Seals: Extremely powerful, as the harbingers will travel anywhere across a room that spawns locusts and leaving trails of creep. The War and Death harbingers will also chase enemies.
  • 15►Daddy Longlegs Daddy Longlegs: Extremely powerful, because it reaches any enemy and will eventually clear the room against any type of hostiles.
  • 15►Demon Baby Demon Baby and 15►Gemini Gemini: Reliably take out enemies nearby, but will not target foes far away.
  • 15►Leech Leech: Can chase after enemies like Lil Haunt, but due to its poor programming, it often gets stuck, causing you to have to move to kill an enemy. It is also unable to pass over pits.
  • 15►Lil Haunt Lil Haunt: While not as powerful as Daddy Longlegs, it's one of the few familiars that chase enemies (and don't require you to take damage to summon).
  • 15►Midas' Touch Midas' Touch: Still dealing damages when 15►Gnawed Leaf Gnawed Leaf is active, maybe useless against bosses who stay away from The Lost.
  • Orbitals: Provide decent damage against chasing enemies, but are useless against enemies that stay on distance.
  • 15►The Peeper The Peeper: It reaches any spot of a room and will be able to take out most enemies. A lot of time is required, though.
  • 15►Robo-Baby 2.0 Robo-Baby 2.0: Shoots only horizontal and vertical, not reaching enemies that stay diagonally. Robo-Baby 2.0 will still clear most rooms. If Robo-Baby 2.0 is moved, a statue form will be exited.
  • 15►Rotten Baby Rotten Baby and 15►Sissy Longlegs Sissy Longlegs: Blue Flies and Spiders target most enemies inside a room. The flies may not attack foes far away, the spiders are unable to pass over pits.
  • Added in Afterbirth15►Succubus Succubus: Similar to The Peeper, but with a much larger area of effect. Still has trouble with large rooms, however.
  • 15►The Virus The Virus: Similar to Midas' Touch, enemies that touch The Lost when 15►Gnawed Leaf Gnawed Leaf is active will be poisoned, but is useless against foes and bosses who stay away from The Lost.


Although the strategy is quite safe, game-ending issues likely occur. Some example scenarios are:

  • The Lost fights Loki with a Poky inside the room. The boss will always stay at distance, making familiars like 15►Distant Admiration Distant Admiration useless. Poky pushes constantly against The Lost, forcing him not to move.
  • The Lost fights a room full of Mask + Heart, the Hearts being behind a pit. Familiars like Leech are useless, while The Lost is constantly attacked by a Mask.
  • The Lost fights Globins, while his follower is not doing enough damage to finish them off after they fell into goo. One Globin is always alive at a time and attacking The Lost.

It is required to have an emergency option if a room cannot be cleared as intended in such scenarios. Spacebar items, cards and pills can be safely activated, even if The Lost in statue form currently has enemy contact.[citation needed] Another option is to exit the run and reenter it by pressing the continue button. This will place the player at the start of the room but all monsters killed would have to be killed again if the player did not clear the room first.

Boss Rush[]

The method may be perfect for the Boss Rush fight itself, however, the player will probably be progressing too slow, not finishing Mom in time. Therefore this method is not recommended to attain the Boss Rush.


The game is restarted until 15►Gnawed Leaf Gnawed Leaf is found in a treasure room adjacent to spawn. Then, the player has to rely on finding proper familiars later on.

"Getting Carried"[]

This strategy is very general, though leading often to success. The goal is to gain a massive offensive potential, killing enemies before they can hurt The Lost. To survive game-ending mistakes, The Lost also tries to find shielding, invulnerability or reviving items. The strategy bases a lot on item luck because some of the most powerful items in the game need to be found early on.

Key Items[]

  • 15►Brimstone Brimstone: Grants massive power, is piercing and spectral, can be charged in the preceding room and instantly fired.
  • Added in Afterbirth15►Glass Cannon Glass Cannon: Shoots a giant damaging tear with no downside.
  • 15►Mom's Knife Mom's Knife: Offers massive damage, is piercing and spectral.
  • 15►Polyphemus Polyphemus Increases tear damage more than most other items. If combined with other damage increasing items, it makes most enemies in the first chapters one-shot and shortens boss fights significantly.
  • The Guppy transformation increases the Lost's offensive potential significantly, and several of the items required for it are useful to the Lost in their own rights.
  • 15►Dead Cat Dead Cat: Gives The Lost nine lives.
  • 15►Holy Mantle Holy Mantle: Absorbs the first hit in each room, nullifying a game-ending mistake once per room. It also allows the Lost to enter Curse Rooms and open Spiked Chests and Mimic Chests.
    • Care must still be taken when making use of curse rooms, as any damage taken inside of it will nullify the Holy Mantle charge, trapping the Lost inside unless he has some way to generate a shield, teleport out, or extra lives.
    • Added in Afterbirth The Holy Mantle as a starting item can be unlocked by donating 879 coins to the Greed Machine.
  • Added in Afterbirth15►Host Hat Host Hat, 15►Infamy Infamy, and Added in Afterbirth †15►Metal Plate Metal Plate: Have a chance of deflecting projectiles that come into contact with the Lost.
    • Also, Added in Afterbirth15►Host Hat Host Hat will also make the Lost immune to explosions and Removed in Repentancestomp attacks, increasing his survivability further and allowing safer use of items like 15►Ipecac Ipecac and 15►Dr. Fetus Dr. Fetus.
  • 15►Lost Contact Lost Contact Destroys bullets upon contact with tears. It makes "bullet-hell" boss fights like It Lives significantly easier.

The goal is to obtain at least one offensive and one defensive item early in the run, additional ones later on. If they are combined with further helpful items, a run becomes very promising.

Note: 15►Godhead Godhead and 15►Sacred Heart Sacred Heart are also major offensive key items. However, it is assumed the player has not yet unlocked Godhead. Sacred Heart can earliest be found on the third floor with very low chances, is therefore not mentioned.


  • Although you can restart a game until you find a key item in the first treasure room, you are still dependent on item luck later in the run.
  • Many key items are special items, lowering the chances of finding such combinations.
  • Running only with key items may not be enough, therefore additional damage ups or emergency options may be necessary.

Boss Rush[]

This method is well suited for the Boss Rush because The Lost can progress quite fast with his massive damage output. The Boss Rush fight itself shall be done with extreme care because many defensive Items lose most of their value in a long fight:

  • 15►Dead Cat Dead Cat would revive you outside, ruining the attempt.
  • 15►Holy Mantle Holy Mantle will still trigger once in the Boss Rush fight, but that may not be enough for the whole duration of the fight.


The game is restarted until one of the key items is found in a Treasure Room adjacent to spawn. Afterward, the player has to rely on finding additional key items and synergies later on.
Note that 15►Brimstone Brimstone can only be found in Devil Rooms, and 15►Dead Cat Dead Cat only in Curse Rooms, Devil Rooms and Red Chests. The player may decide if they want to check on these opportunities or rather restart instantly.
Some players enter a Curse Room if it is located adjacent to the start. Removed in Afterbirth This will usually be fatal. Rarely, though, a 15►Dead Cat Dead Cat can be found in it. This behavior can make sense, as the run would anyway have gotten restarted without a Treasure Room next to the spawn.

"Remote Control"[]

This method bases around any remotely controlled damage source, such as 15►The Ludovico Technique The Ludovico Technique, 15►???'s Only Friend ???'s Only Friend, or 15►Robo-Baby 2.0 Robo-Baby 2.0. After entering a room, The Lost tries to find a safe hiding spot as soon as possible, like above an obstacle. After being safe, he uses his remote damage source to finish the room. Acquiring both 15►The Ludovico Technique The Ludovico Technique and 15►Lost Contact Lost Contact can help immensely, especially during the fights against Isaac and ???, as the tear can easily block all enemy shots. Acquiring 15►The Ludovico Technique The Ludovico Technique and 15►Strange Attractor Strange Attractor can also be very helpful as enemies can be pulled away from The Lost.


  • Many rooms do not contain any safe spot, quickly making the method counterproductive.
  • Flying enemies can reach any spot in the room. Jumping enemies like Hoppers can also jump over obstacles if they find a landing spot behind.
  • 15►The Ludovico Technique The Ludovico Technique prevents The Lost from firing normal tears, which may be fatal in rooms without hiding places.
  • The player may focus on their controlled tear/familiar, rather than watching The Lost, overlooking a deadly danger.

Boss Rush[]

If the player manages to reach the Boss Rush room, their odds are quite good. The Boss Rush room offers some rocks as hiding spots, and many bosses stay quite calm. This allows for a nice damage output with the remotely controlled familiars. Flying, fast or mobile bosses, like Fistula, may still become problematic, and therefore treated with extreme care. Also, the variety of Brimstone and explosive attacks are very dangerous. There is a bug who will give the player the "Boss rush completed" achievement and will unlock the D100 without actually completing the boss rush. To make this, the player needs some bombs before entering the boss rush. Once the player is inside, he should place bombs in all the skulls he can find, until an enemy spawns from one of them. If the player kills the enemy (Without picking up any of the boss rush items) the game will think the room is "cleared" and give the player the achievement.


The game is restarted until one of the above items is found in a Treasure Room adjacent to spawn.

Emergency Options[]

The Lost should always be prepared for the unexpected by having an emergency option.
Note: 15►9 Volt 9 Volt and 15►The Battery The Battery allow a much more flexible use of spacebar items and are generally recommended.

Shield and Invulnerability[]

Becoming invulnerable is often avoiding deadly situations, therefore having such a card or spacebar item is highly recommended.


Teleportation can be used to avoid run-ending situations by just leaving the room on demand. However, depending on the method used and on the floor the item is used, the player may end up in a random, more dangerous room. Teleporting into a Curse Room can potentially end a run, as under normal conditions they cannot be exited without taking damage. There is also a chance of landing in the I AM ERROR room, which forces the player to leave items and pickups behind and potentially forces the player to skip an unlock.

Hard Removal[]

Hard Removal describes the option to clear a dangerous room instantaneously on demand. Items offering hard removal are:

  • Chaos Card Chaos Card kills any enemy in its path, including bosses (not including Added in Afterbirth †Delirium), in one hit. It is very useful for single-targets but doesn't have the area of effect for massive enemy horde rooms.
  • 15►Flush! Flush! clears a room instantly, but doesn't work against bosses, except Added in AfterbirthBrownie, Added in RepentanceClog, Dingle, and Added in AfterbirthDangle.
  • 15►Head of Krampus Head of Krampus deals massive damage in a cross-pattern, killing all non-boss enemies in its path, and severely damaging bosses.
  • 15►Magic Fingers Magic Fingers can clear a whole room extremely fast if the item is spammed, the damage is high enough and if enough coins are available.
  • 15►The Necronomicon The Necronomicon and XIII - Death XIII - Death kill most non-boss enemies in a room.

Resurrection Items[]

These items do still work with The Lost, although the life number does not appear on the HUD. They give the player another chance if a fatal mistake was made.

  • 15►1up! 1up! offers one life.
  • 15►Dead Cat Dead Cat offers nine lives.
  • 15►Guppy's Collar Guppy's Collar has a 50% chance of reviving The Lost.
    • When combined with Dead Cat, Guppy's Collar takes priority over it, potentially granting more lives.

Angel & Devil Rooms[]

Devil and Angel Rooms appear quite frequently to The Lost because he is not allowed to take damage. Removed in RepentanceThe Lost can take Devil deals for free. However, Angel Rooms offer some of the most helpful items for The Lost.

Added in RepentanceThe Lost can only choose one of the available Devil deals.

It is generally recommended to go for Devil deals, and thus hinder Angel Rooms to appear, though the player is free to pursue Angel Rooms if they find them more attractive. 15►Goat Head Goat Head is a strong item to obtain early as it will ensure that The Lost can visit a Devil or Angel Room on every floor except for Basement/Cellar I and everything past The Womb/Utero II. Removed in Afterbirth15►The Book of Belial The Book of Belial fulfills a similar effect, however, another spacebar item may be preferred.

Devil Room[]

Although the Devil Room may only contain Black Hearts or Red Chests that only contain Soul Hearts, Troll Bombs or enemy spiders, it usually has helpful items, though some such as 15►Dark Bum Dark Bum or 15►Razor Blade Razor Blade can be either useless or dangerous. Some of the most valuable are:

For a full list of Devil Room items see Devil Room item pool.

Angel Room[]

The Angel Room often contains Soul or Eternal Hearts, being useless for the Lost. Many items that can be obtained are of no use, too, such as 15►Prayer Card Prayer Card or 15►Celtic Cross Celtic Cross, and some such as 15►Dead Sea Scrolls Dead Sea Scrolls or 15►Breath of Life Breath of Life can actually be dangerous. However, with luck, one may find a very valuable item, such as:

For all Angel Room items see Angel Room item pool.


Positive Items[]

Aside from the already mentioned items, the following are of great use:

  • Any item increasing damage in some way and/or any other of The Lost's stats.
  • The 15►Stop Watch Stop Watch, unlocked by donating 999 coins to the Donation Machine slows down all enemies in the room, all projectiles, and makes enemies that charge for an attack charge forward very slowly.
    • Added in Afterbirth The Stopwatch was nerfed to only work upon taking damage, although, in a recent update, it now works when the Holy Mantle's shield is depleted.
      • Added in RepentanceAlthough not as powerful as before, Stopwatch still slows everything down to a great degree, allowing more room for error.
  • 12►Lil Brimstone▼3►Lil' Brimstone Lil Brimstone is similarly beneficial like 15►Brimstone Brimstone itself.
  • Items that inflict crowd control status effects such as fear, slow or petrification can be useful. On the other hand, some players dislike these items because they can make enemies move in unpredictable ways.
  • 15►Black Candle Black Candle removes curses.
  • The 15►Red Candle Red Candle's properties make it one of the most useful items for defeating the waves of mobs and bosses in Greed Mode. Filling the room with flames before pushing the button to start a new wave, although very time consuming, virtually guarantees a swift victory with very little risk.
  • 15►D4 D4, 15►The D6 The D6, or Rune of Perthro Rune of Perthro can reroll negative or useless items into something useful, while15►D20 D20 can do the same with pickups. 15►D100 D100 acts like the three combined.
    • The D4 and the 15►D100 D100 can deactivate very important items you obtained earlier.
      • Added in Afterbirth As the Lost starts with the Holy Mantle after giving the Greed Machine 879 coins, the D4 can potentially be deprecated from the start.
      • Added in RepentanceIf Added in AfterbirthLost holds Holy Mantle Lost holds Holy Mantle is unlocked, the starting Holy Mantle won't be rerolled while using D4, D100, or anything with similar effect.
    • After multiple re-rolls, the D4 and D100 can be counterproductive. If the item pools are depleted, they will only give The Lost 15►Breakfast Breakfast.
  • 15►There's Options There's Options and Added in Afterbirth15►More Options More Options increase the chances of the Lost finding useful items.
  • 15►Pyromaniac Pyromaniac grants immunity to explosions, making it especially useful should the player have explosive items such as 15►Ipecac Ipecac or 15►Epic Fetus Epic Fetus.
  • Items revealing the map are very useful to avoid unnecessary rooms.
  • 15►Whore of Babylon Whore of Babylon is always active.
  • Added in Afterbirth15►Crown of Light Crown of Light is essentially a permanent double damage as it cannot be deactivated.
  • Added in Afterbirth15►Glass Cannon Glass Cannon can greatly increase The Lost's damage output without any negative effects.
  • Added in AfterbirthMissing Poster Missing Poster effectively acts as a 1-Up on The Lost.
  • Added in Afterbirth15►Empty Vessel Empty Vessel is always active for The Lost. The Lost will not benefit from the flight given but will benefit from the periodic invincibility it grants.
  • Added in AfterbirthSafety Scissors Safety Scissors neutralizes the threat of Troll Bombs and grants additional bomb pickups.
  • Added in Afterbirth †15►Void Void can convert health ups or otherwise useless items into stat boosts.
  • Added in Repentance15►Eternal D6 Eternal D6 allow player to reroll useless item into better/more usable ones, as losing items such as 15►Breakfast Breakfast isn't as significant.
  • Added in RepentanceApple of Sodom Apple of Sodom converts useless red hearts into blue spiders.
    • Despite red heart-dropping items being useless, they can be used in synergy with this item to farm for blue spiders.
  • Added in RepentancePerfection Perfection is essentially a free +10 Luck, as taking any damage results in death, making the loss of Perfection a non-issue. This can synergize with many Luck-based items:
    • 15►Tough Love Tough Love: At 9+ Luck, all tears are replaced with teeth, essentially giving a 3.2x damage multiplier.
    • Added in Afterbirth †15►Ghost Pepper Ghost Pepper or Added in Repentance15►Bird's Eye Bird's Eye: At 11+ Luck, The Lost is guaranteed to shoot fires, which effectively damage enemies and block enemy projectiles.
  • Added in RepentanceVI - The Lovers? VI - The Lovers? has no downside for The Lost, generating free items with no loss of durability or risk of death.
  • Added in Repentance15►Birthright Birthright allows The Lost The Lost to remove useless item from item pool similar to Tainted Lost Tainted Lost, but still allows the player to find strong defensive items like 15►Dead Cat Dead Cat.
  • Added in Repentance15►Psy Fly Psy Fly helps greatly with protecting The Lost from bullets, making bullet-heavy bosses like Hush and Mother much more bearable.
  • Added in Repentance15►Damocles Damocles ' downside becomes a non-issue since any damage taken by The Lost will kill him anyways, essentially giving double the items at no cost.
  • Added in Repentance15►Paschal Candle Paschal Candle stays at maximum level as taking damage would kill the Lost anyways (unless it has extra lives).

Useless Items[]

The following list includes items and trinkets that only affect health, only grant flight, only grant spectral tears, use damage as a trigger or contain a combination of what's listed with no other positive effect. It's advised to pick them after a floor has been explored in case a 15►D4 D4, 15►D100 D100, or a Dice Room (with 1 or 6 dots) are found later on during the run.

Name ID Icon Quote Description Added in Repentance Quality
Converter 5.100.296
Convert your soul Removed in Repentance Upon use, converts two Soul Hearts into one full Heart Container.

Added in Repentance Upon use, converts one Soul or Black Heart into one full Heart Container.

Prayer Card 5.100.146
Prayer Card
6 rooms
Reusable eternity Gives an Eternal Heart per use. 3
The Jar 5.100.290
The Jar
Save your life When at full health, up to 4 extra Red Hearts can be stored in The Jar. 0
Yum Heart 5.100.45
Yum Heart
4 rooms
Reusable regeneration Restores one Red Heart of Isaac's health. 1
Name ID Icon Quote Description Added in Repentance Quality
A Snack 5.100.346 A Snack HP up Grants one full Red Heart container. Added in Repentance Heals 1 additional heart of health. 1
Black Lotus 5.100.226 Black Lotus HP up x3! Grants one Red Heart, one Soul Heart, and one Black Heart. 2
Bloody Lust 5.100.157 Bloody Lust RAGE! Increases Isaac's damage whenever he takes damage, up to six times. The bonus resets when entering a new floor. 3
Breakfast 5.100.25 Breakfast HP up Grants one full Red Heart container. Added in Repentance Heals 1 additional heart of health. 1
Cancer 5.100.301 Cancer HP up + you feel protected Adds 3 Soul Hearts. Grants {{i{The Wafer}} effect for the current room upon taking damage. 3
Celtic Cross 5.100.162 Celtic Cross Blessing of protection Grants a chance to trigger the 15►Book of Shadows Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 7 seconds. 1
Dead Bird 5.100.117 Dead Bird Protective buddy After Isaac takes damage, spawns a flying familiar that chases enemies for the current room, dealing ~5 damage per second. 0
Dead Dove 5.100.185 Dead Dove Flight + spectral tears Grants spectral tears and flight. 3
Dessert 5.100.24 Dessert HP up Grants one full Red Heart container. Added in Repentance Heals 1 additional heart of health. 1
Dinner 5.100.23 Dinner HP up Grants one full Red Heart container. Added in Repentance Heals 1 additional heart of health. 1
Fanny Pack 5.100.204 Fanny Pack Filled with goodies Has a chance to drop a random pickup when Isaac takes damage. 1
Fate 5.100.179 Fate Flight eternal Grants flight and one Eternal Heart. 3
Gimpy 5.100.225 Gimpy Sweet suffering Gives chance of spawning a Soul Heart when taking damage. Enemies have a chance to drop a Half Red Heart after being killed. 2
Habit 5.100.156 Habit Item martyr When Isaac is hit, his active item gains 1 room's worth of charge. 3
Holy Grail 5.100.184 Holy Grail Flight + HP up Grants flight and one Red Heart container. 3
Little C.H.A.D. 5.100.96 Little C.H.A.D. Gives kisses Spawns a familiar who drops a Half Red Heart every 3 rooms. 2
Lunch 5.100.22 Lunch HP up Grants one full Red Heart container. Added in Repentance Heals 1 additional heart of health. 1
Maggy's Bow 5.100.312 Maggy's Bow HP up + you feel healthy Gives one Red Heart container and doubles the healing provided by Red Hearts. 2
Missing Page 2 5.100.262 Missing Page 2 Evil up. Your enemies will pay! Grants one Black Heart. Upon taking damage that reduces Isaac's health to one heart or less, deals damage to all enemies in the room. Added in Repentance Increases the damage of Black Hearts and 15►The Necronomicon The Necronomicon-like effects by 40. 0
Mitre 5.100.173 Mitre Blessing of purity Grants a chance of converting any Red Heart pickups into Soul Hearts instead. 3
Old Bandage 5.100.219 Old Bandage HP up Grants an empty Red Heart container. Adds a chance of dropping a Red Heart after taking damage. 2
Ouija Board 5.100.115 Ouija Board Spectral tears Grants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them. 2
Placenta 5.100.218 Placenta Regeneration + HP up Grants one full Red Heart container, and a chance to regenerate a Half Red Heart of health every minute of gameplay. 2
Raw Liver 5.100.16 Raw Liver HP up Grants 2 Red Heart containers and completely restores health. 2
Rotten Meat 5.100.26 Rotten Meat HP up Grants one full Red Heart container. Added in Repentance Heals 1 additional heart of health. 1
Scapular 5.100.142 Scapular Pray for a miracle Once per room, when Isaac is reduced to his last half heart, he is granted one Soul Heart. 2
Sharp Plug 5.100.205 Sharp Plug Infinite charge... at a cost Damages Isaac in exchange for fully recharging Isaac's current activated item. 1
Spirit of the Night 5.100.159 Spirit of the Night Scary Grants spectral tears and flight. 3
Super Bandage 5.100.92 Super Bandage +2 hearts Grants one full Red Heart container and 2 Soul Hearts. 2
The Body 5.100.334 The Body I feel all Adds 3 Red Heart containers. 3
The Ladder 5.100.60 The Ladder Building bridges Allows Isaac to walk across gaps one square across by automatically placing a ladder between the two walkable sections. 1
The Relic 5.100.98 The Relic Soul generator Spawns a cross familiar that drops a Soul Heart every 5-6 rooms. 4
The Wafer 5.100.108 The Wafer Damage resistance All sources of damage that would cause more than one-half heart of damage are reduced to one-half heart instead. 4
Transcendence 5.100.20 Transcendence We all float down here... Grants flight. 3
Added in Afterbirth Athame 5.100.408 Athame Call to the void When Isaac takes damage, a black ring briefly appears around him, dealing damage to all nearby enemies. 2
Added in Afterbirth Cambion Conception 5.100.412 Cambion Conception Feed them hate After taking damage a certain amount of times, a permanent demonic familiar spawns. 2
Added in Afterbirth Curse of the Tower 5.100.371 Curse of the Tower Embrace chaos Upon taking damage, spawns six Troll Bombs around the room, similar to the effect of XVI - The Tower XVI - The Tower. 1
Added in Afterbirth Milk! 5.100.436 Milk! Don't cry over it... Spawns a glass familiar that spills on the floor upon taking damage. After the milk spills, Isaac's tear delay is decreased by 2 for the current room. 1
Added in Afterbirth My Shadow 5.100.433 My Shadow Me! And my shaaaadow! Each time Isaac takes damage, inflicts fear on all enemies in the room and spawns a black friendly Charger that will attack enemies. The Charger will be killed if it is damaged too much. 0
Added in Afterbirth PJs 5.100.428 PJs You feel cozy Grants 4 Soul Hearts and fully restores Isaac's health. 2
Added in Repentance It Hurts 5.100.560 It Hurts No it doesn't... Releases a ring of tears and increases tears for the current room when Isaac takes damage. 1
Name ID Icon Quote Description
A Missing Page 5.350.48 A Missing Page It glows with power 5% chance to induce 15►The Necronomicon The Necronomicon's effect upon taking damage. Added in Repentance Adds +40 damage to Black Hearts and The Necromonicon-like effects.
Bloody Penny 5.350.49 Bloody Penny Wealth of health Gives a chance to drop a Half Red Heart when a coin is collected.
Callus 5.350.14 Callus Your feet feel stronger Prevents damage from creep and spikes.
Child's Heart 5.350.34 Child's Heart It calls out to its brothers. Increases the chance of a heart pickup dropping after clearing a room, and the chance of finding a heart when opening a Chest.
Cursed Skull 5.350.43 Cursed Skull Cursed? If Isaac has less than one full Red Heart after taking damage, he will be immediately teleported to the last cleared room he was in.
Fish Head 5.350.29 Fish Head It stinks Spawns a Blue Fly every time Isaac takes damage.
Isaac's Fork 5.350.46 Isaac's Fork Consume thy enemy Isaac has a chance to heal for 1/2 a Red Heart upon clearing a room.
Judas' Tongue 5.350.56 Judas' Tongue Payment Received Items in the Devil Room only cost 1 heart. Soul heart trades still cost 3 soul hearts.
Maggy's Faith 5.350.55 Maggy's Faith Faith's reward Gives an eternal heart at the start of every floor.
Mom's Pearl 5.350.38 Mom's Pearl It emanates purity Grants a secondary 10% chance of any non-specific heart drop turning into a soul heart.
Monkey Paw 5.350.20 Monkey Paw Wish granted If the character has half a heart after taking damage, it drops a black heart. The effect can trigger up to three times, after which the trinket will disappear.
Mysterious Paper 5.350.21 Mysterious Paper ??? Has a chance to replicate the effects of A Missing Page A Missing Page, 15►The Polaroid The Polaroid, 15►The Negative The Negative, or Missing Poster Missing Poster.
Red Patch 5.350.40 Red Patch Your rage grows Grants a chance of increasing damage by 1.8 for the current room upon taking damage.
Swallowed Penny 5.350.1 Swallowed Penny Gulp! Upon taking damage, Isaac drops a coin.
Umbilical Cord 5.350.33 Umbilical Cord Fetal Protection When brought down to only a Half Red Heart, spawns a 15►Little Steven Little Steven familiar for the current room. Added in Repentance Adds a high chance to spawn a 15►Gemini Gemini familiar for the current room after taking damage.
Added in Afterbirth Blind Rage 5.350.81 Blind Rage Blind to damage Increases invincibility time after getting hit.
Added in Afterbirth Cracked Dice 5.350.67 Cracked Dice You feel cursed... kinda. Activates the effect of 15►The D6 The D6, Added in Afterbirth15►D8 D8, Added in Afterbirth15►D12 D12, or 15►D20 D20 whenever Isaac takes damage.
Added in Afterbirth Mom's Locket 5.350.87 Mom's Locket You feel her love Grants half a red heart each time a key is used. Converts half red heart pickups into full red hearts.

Notes on item selection

  • 15►Best Bud Best Bud, 15►Guppy's Paw Guppy's Paw, and 15►Infestation Infestation are not included because while they do not provide any passive benefit, they do count for transformations.
  • Listed items that generate heart pickups of any kind are useless in most scenarios, but can be converted to other types of pickups if The Lost is holding the 15►D20 D20 or 15►D100 D100.
  • 15►Bloody Lust Bloody Lust will increase damage if The Lost has multiple lives.
  • Items that activate a 15►The Necronomicon The Necronomicon-like effect upon getting hit have a very limited use, as they can deal the last bit of damage needed to kill a boss, or clear a room if The Lost has multiple lives.
  • 15►Rosary Rosary is mostly useless, but not completely, as it raises the chance of finding 15►The Bible The Bible.
    • Added in Repentance Rosary now gives a tears up as well, making it more useful.
  • Added in AfterbirthMissing Poster Missing Poster is no longer useless for the Lost.
  • Added in Afterbirth15►Ouija Board Ouija Board, 15►Dead Dove Dead Dove and 15►Spirit of the Night Spirit of the Night are useless in Afterbirth because The Lost now starts with spectral tears. They are still useful items in Rebirth.
  • Added in AfterbirthBlind Rage Blind Rage is only useless if the player has not unlocked 15►Holy Mantle Holy Mantle as The Lost's starting item.
  • Added in AfterbirthItems that increase your chances of finding Soul Hearts or Black Hearts gain some use when combined with Added in Afterbirth15►Immaculate Conception Immaculate Conception.

Negative items[]

  • 15►Ankh Ankh, Broken Ankh Broken Ankh, 15►Judas' Shadow Judas' Shadow and 15►Lazarus' Rags Lazarus' Rags grant extra lives but respawn The Lost as ??? ???, Dark Judas Dark Judas, or Lazarus Risen Lazarus Risen respectively, which will cause the game to treat them as these characters instead of The Lost. It is suggested to avoid these three items altogether if the player is interested in gaining The Lost exclusive achievements and/or completion marks.
  • 15►Dark Bum Dark Bum no longer maintains its main benefit of providing Soul Hearts as Soul Hearts are now useless. While it may spawn a friendly spider, it is also likely to spawn an enemy spider, which can instantly kill The Lost if the player is not careful.
    • Added in Repentance Dark Bum now has a 20% chance to spawn a random pill, card or rune, making it slightly more useful for The Lost.
      • With Added in Afterbirth15►Immaculate Conception Immaculate Conception, Dark Bum will be useful to convert useless Red Hearts to useful Soul Hearts. However, the player must still be careful of Spiders.
  • 15►Isaac's Heart Isaac's Heart, while having many useful synergies as well as the added benefit of immunity to Brimstone lasers, makes dodging more difficult in many scenarios, leading many players to take damage when they otherwise would not have. It is also very difficult to avoid a stray laser from an Eye, as The Lost cannot block this shot and protect Isaac's Heart from it. Also, there is a chance it can spawn atop an Eye in the It Lives fight, leading to a very cheap and unavoidable death.
  • Any explosive items, such as 15►Anarchist Cookbook Anarchist Cookbook, Added in Afterbirth15►Curse of the Tower Curse of the Tower, or 15►Ipecac Ipecac should be used with extreme care.
    • If the player chooses to pick up 15►Ipecac Ipecac, they should not pick up 15►Loki's Horns Loki's Horns or 15►Mom's Eye Mom's Eye, as an unexpected shot against a wall will lead to instant death. 15►Lost Contact Lost Contact is also problematic as it can cause explosions to happen in closer proximity to the player than desired.
  • Items that work by causing self-damage, such as the 15►IV Bag IV Bag, 15►Blood Rights Blood Rights or 15►Razor Blade Razor Blade will end the run if used and must be avoided. 15►Dead Sea Scrolls Dead Sea Scrolls also has the potential to prematurely end a run if a self-damaging item is triggered. Removed in Repentance15►Isaac's Heart Isaac's Heart will allow The Lost to use these items without taking damage.
  • 15►Bucket of Lard Bucket of Lard reduces speed by 0.2 and does not provide any benefit.
  • Added in Repentance15►Glyph of Balance Glyph of Balance will replace all room clear and champion drops with soul hearts, resulting in much less pickups throughout the run.
  • 15►Leo Leo and 15►Thunder Thighs Thunder Thighs are not great as they remove The Lost's ability to use obstacles to his advantage, as they can break these obstacles. Also, stepping on a poisonous mushroom, or carelessly stepping on a Bomb Rock can end a run. The only benefit is the small chance of finding a trapdoor or items like 15►Dry Baby Dry Baby or 15►The Small Rock The Small Rock when breaking said obstacles.
  • 15►Strange Attractor Strange Attractor: Unpredictably pulls enemies towards The Lost, especially floating enemies like Boom Flies. It's advised to avoid this item unless The Lost has 15►The Ludovico Technique The Ludovico Technique, as both items combined may create a powerful synergy.
    • Added in Repentance Strange Attractor now pulls enemies towards where the magnetic tear lands, making it safer to take.
  • 15►Proptosis Proptosis may seem useful because it doubles your damage, but it requires you to get closer to enemies, resulting in you being more likely to get hit.


Note that seeded runs do not count towards achievements or unlocks.

PC 4BGT 79XL (Hard) ("Getting Carried" Strategy: Brimstone in the first Devil Room. After obtaining it, Forget Me Now shall be used to get Holy Mantle in the Treasure Room in Basement I. Infamy is found in Necropolis II. Lost Contact will be in the Secret Room in Utero I, Dead Cat in the Super Secret Room and Goat Head in the Dice Room.)

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