The Lost (Strategy)

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 Holy Mantle greatly lowering the difficulty of his usage. This can be done by donating 879 coins to the Greed Donation 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 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 Hearts, Black Hearts, 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 D20, a Dice Room (with 3 pips, 2 if the hearts spawn in the Dice Room), or a Dice Shard is found later on.
  • The same applies to useless items (except while holding the 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 the pill pool is more likely to have positive effects.
• With the 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.
• 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 Lost must never use a Blood Donation Machine or a Devil Beggar as Holy mantle effect won't protect him in this case, resulting in immediate death. The only exception is possessing some source of shield (e.g. Rune of Algiz).

"The Still Statue"

This strategy is very safe and easily played. It combines 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:

• 7 Seals: Extremely powerful, as the harbingers will travel anywhere across a room while spawning locusts and leaving trails of creep. The War and Death harbingers will also chase enemies.
• Daddy Longlegs: Extremely powerful, because it reaches any enemy and will eventually clear the room against any type of hostiles.
• Demon Baby and Gemini: Reliably take out enemies nearby, but will not target foes far away.
• 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.
• 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).
• Midas' Touch: Still dealing damages when 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.
• 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.
• 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.
• Rotten Baby and 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.
• Succubus: Similar to The Peeper, but with a much larger area of effect. Still has trouble with large rooms, however.
• The Virus: Similar to Midas' Touch, enemies that touch The Lost when Gnawed Leaf is active will be poisoned, but is useless against foes and bosses who stay away from The Lost.

Issues

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 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. 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.

Execution

The game is restarted until 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

Offensive

• Brimstone: Grants massive power, is piercing and spectral, can be charged in the preceding room and instantly fired.
• Glass Cannon: Shoots a giant damaging tear with no downside.
• Mom's Knife: Offers massive damage, is piercing and spectral.
• 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.

Defensive

• Dead Cat: Gives The Lost nine lives.
• 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.
  • The Holy Mantle as a starting item can be unlocked by donating 879 coins to the Greed Donation Machine.
• Host Hat, Infamy, and Metal Plate: Have a chance of blocking or deflecting projectiles that come into contact with the Lost.
  • Also, Host Hat will also make the Lost immune to explosions and stomp attacks, increasing his survivability further and allowing safer use of items like Ipecac and Dr. Fetus.
• 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: Godhead and 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.

Issues

• 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:

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

Execution

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 Brimstone can only be found in Devil Rooms, and 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. This will usually be fatal. Rarely, though, a 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 The Ludovico Technique, ???'s Only Friend, or 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 The Ludovico Technique and Lost Contact can help immensely, especially during the fights against Isaac and ???, as the tear can easily block all enemy shots. Acquiring The Ludovico Technique and Strange Attractor can also be very helpful as enemies can be pulled away from The Lost.

Issues

• 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.
• 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 of beating it 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.

Execution

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: 9 Volt ,The Battery and 4.5 Volt allow a much more flexible use of active items and are generally recommended.

Shield and Invulnerability

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

• Rune of Algiz offers a shield for 30 seconds 20 seconds. Combined with the Blank Card Clear Rune, it forms one of the best defensive item combinations.
• Book of Shadows offers a shield for 10 seconds.
• The Gamekid fears all enemies, deals contact damage and offers invulnerability for five seconds.
• My Little Unicorn and VII - The Chariot grant invulnerability and contact damage for five seconds. Taurus has a similar effect, but is not completely controllable.
• Unicorn Stump grants a 5-second invulnerability, letting The Lost reposition himself safely. It comes with only one charge, thus can be used often.
• Car Battery double-activates 'invulnerable' active items, which means doubling invulnerable durations.
• Mega Mush turns The Lost into an invulnerable killing machine for 30 seconds.
• Echo Chamber copies all 'invulnerable' cards and runes to the last 3 cards, pills and runes used.
• 4.5 Volt makes The Lost able to recharge the active item and uses them multiple times during a hard fight.
• Panic Button will always automatically activate the active item (If it's available to use) when The Lost is about to take damage, which makes good synergies with all 'invulnerable' items (Including Butter Bean and How to Jump).

Teleport

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.

• Any card providing teleportation, optionally combined with Blank Card.
• Broken Remote: If combined with a no-cooldown spacebar item, such as How to Jump, it provides infinite teleportation.
• Telepills
• Teleport!
• Undefined
• Door Stop: Allows you to walk out of any room.
• Mercurius

Hard Removal

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

• Chaos Card kills any enemy in its path, including bosses (not including Delirium and The Beast), in one hit. It is very useful for single-targets but doesn't have the area of effect for massive enemy horde rooms.
• Flush! clears a room instantly, but doesn't work against bosses, except Brownie, Clog, Dingle, and Dangle.
• Head of Krampus deals massive damage in a cross-pattern, killing all non-boss enemies in its path, and severely damaging bosses.
• 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.
• The Necronomicon and XIII - Death kill most non-boss enemies in a room.
• Toxic Shock deals 2x tear damage to all enemies when entering 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.

• 1up! and Inner Child offer one life.
• Dead Cat offers nine lives.
• Guppy's Collar has a 50% chance of reviving The Lost.
• Soul of Lazarus acts like Inner Child if dead while holding it.

Angel & Devil Rooms

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

The 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. 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/Burning Basement I and everything past Womb/Utero/Scarred Womb II. 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 Dark Bum/Bloody Lust or Razor Blade/Blood Rights can be either useless or dangerous. Some of the most valuable are:

• Brimstone
• Mom's Knife
• Goat Head
• Whore of Babylon
• Empty Vessel
• Damocles, because since The Lost will immediately die to any damage, and Damocles will never fall from losing Holy Mantle, you would only get the positive effects. It is only negative if you resurrect because dying by taking a hit activates Damocles.
• All items required for Guppy, especially Dead Cat (Note: Red Chests can also contain Guppy items)
• Many damage ups
• Items granting fear tears

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

Angel Room

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

• Censer
• Circle of Protection
• Crown Of Light
• Guardian Angel
• Holy Mantle (if the player has not yet donated 879 coins to the Greed Donation Machine)
• Immaculate Conception (gives The Lost a use for soul and black hearts)
• The Mind (if the player has already defeated Satan as The Lost)
• Sacred Heart
• The Soul (if the player has already defeated The Lamb as The Lost)
• Sworn Protector (if the player has already defeated Hush as The Lost)
• Trinity Shield
• Sacred Orb
• Revelation
• Star of Bethlehem

For all Angel Room items see Angel Room item pool.

Items

Positive Items

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

• The 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.
  • 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.
    • Although not as powerful as before, Stopwatch still slows everything down to a great degree, allowing more room for error.
• Lil Brimstone is similarly beneficial, like Brimstone itself.
  • Lil Brimstone was nerfed and is not as beneficial as before.
• 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.
• Black Candle removes curses.
• The 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.
  • This is no longer effective in Repentance because Red Candle's flames now extinguish after a couple of seconds.
  • After multiple re-rolls, the D4 and D100 can be counterproductive. If the item pools are depleted, they will only give The Lost Breakfast.
• There's Options and More Options increase the chances of the Lost finding useful items.
• Pyromaniac and Host Hat grant immunity to explosions, making them especially useful if the player have explosive items such as Ipecac or Epic Fetus.
• Items revealing the map are very useful to avoid unnecessary rooms.
• Whore of Babylon is always active.
• Crown Of Light is essentially permanent double damage, as it cannot be deactivated.
• Glass Cannon can greatly increase The Lost's damage output without any negative effects.
• Missing Poster effectively acts as a 1-Up on The Lost.
• Empty Vessel is always active for The Lost. The Lost will benefit from the periodic invincibility it grants.
• Safety Scissors neutralizes the threat of Troll Bombs and grants additional bomb pickups.
• Void can convert health ups or otherwise useless items into stat boosts.
• Little Horn can destroy almost all 'invulnerable' enemies, Poky and Stone Grimace before they can hurt The Lost. Ball and Chain are still invulnerable and dangerous.
• Sulfuric Acid and Terra can destroy Spiked Rocks without making explosions.
• Flat File retracts almost all spikes.
• Apple of Sodom converts red hearts into blue spiders.
  • Despite red heart-dropping items normally being useless for The Lost, they can be synergized with this item to farm for blue spiders.
• 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:
  • Tough Love: At 9+ Luck, all tears are replaced with teeth, essentially giving a 3.2x damage multiplier.
  • Ghost Pepper or Bird's Eye: At 11+ Luck, The Lost is guaranteed to shoot fires, which effectively damage enemies and block enemy projectiles.
• VI - The Lovers? has no downside for The Lost, generating free items with no loss of durability or risk of death.
• Birthright allows The Lost to remove useless item from item pool similar to Tainted Lost, but still allows the player to find strong defensive items like Dead Cat.
• Psy Fly helps greatly with protecting The Lost from bullets, making bullet-heavy bosses like Hush and Mother much more bearable.
• Paschal Candle stays at maximum level, as it cannot be deactivated.
• Heartbreak prevents The Lost from fatal damage for 4 times.
• Spirit Shackles, along with a way to generate soul hearts like Book of Revelations can essentially act as an extra life with a room charge and also make soul hearts no longer useless.
• Berserk! and Soul of Samson allow the Lost to survive taking damage.
• Binge Eater makes HP ups useful as each will give one stat up depending on the item and temporary damage up at a cost of a very small speed down.
• Knockout Drops: At 8+ luck, all tears will knock enemies back, which is useful for keeping contact damage enemies away from The Lost.

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 D4, D100, or a Dice Room (with 1 or 6 dots) are found later on during the run.

Name	ID	Icon	Quote	Description	Quality
Blood Rights	5.100.186		Mass enemy damage at a cost	Upon use, takes a full heart of health and deals 40 damage to all enemies in the room. Repeated uses in the same room only take half a heart.	0
Converter	5.100.296		Convert your soul	Converts two Soul Hearts or Black Hearts into one filled Red Heart Container. Converts one Soul Heart or Black Heart into one filled Red Heart Container.	2
IV Bag	5.100.135		Portable blood bank	Upon use, Isaac loses half a heart of health (or a full heart in Chapter 4 onward) for a random amount of coins, similar to a Blood Donation Machine.	1
Prayer Card	5.100.146		Reusable eternity	Gives an Eternal Heart per use.	3
Razor Blade	5.100.126		Feel my pain	Takes one Heart of health and grants +1.2 damage for the current room. Repeated uses in the same room only take half a heart.	0
The Jar	5.100.290		Save your life	When at full health, up to 4 extra Red Hearts can be stored in The Jar. Activating drops the stored hearts on the ground.	0
Yum Heart	5.100.45		Reusable regeneration	Restores one full Red Heart.	1
Potato Peeler	5.100.487		A pound of flesh	Removes a Heart Container, increases damage and range, and grants a Cube of Meat.	2
Sumptorium	5.100.713		Blood to blood	Removes half a heart and creates a Clot familiar that mimics Isaac's movements and tear effects. As Tainted Eve, passively converts health into Clots while firing. Activating returns all Clots to health.	3
Yuck Heart	5.100.639		Gross!	Gives Isaac a Rotten Heart.	1

Name	ID	Icon	Quote	Description	Quality
<3	5.100.15		HP up	Grants Isaac one Red Heart container and fully restores Isaac's health.	2
A Snack	5.100.346		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.	1
Black Lotus	5.100.226		HP up x3!	Grants one Red Heart Container, one Soul Heart, and one Black Heart.	2
Bloody Lust	5.100.157		RAGE!	Increases Isaac's damage whenever he takes damage, up to six times. The bonus resets when entering a new floor.	2
Breakfast	5.100.25		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.	1
Cancer	5.100.301		HP up + you feel protected	Adds 3 Soul Hearts. Grants The Wafer effect for the current room after taking damage.	3
Celtic Cross	5.100.162		Blessing of protection	Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 7 seconds.	1
Charm of the Vampire	5.100.62		DMG up + kills heal	Heals Isaac for a Half Red Heart for every 13 enemies killed. +0.3 damage.	1
Dead Bird	5.100.117		Protective buddy	After Isaac takes damage, spawns a flying familiar that chases enemies for the current room, dealing ~4 damage per second.	0
Dead Dove	5.100.185		Flight + spectral tears	Grants spectral tears and flight.	3
Dessert	5.100.24		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.	1
Dinner	5.100.23		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.	1
Fanny Pack	5.100.204		Filled with goodies	Has a chance to drop a random pickup when Isaac takes damage.	1
Fate	5.100.179		Flight eternal	Grants flight and one Eternal Heart.	3
Gimpy	5.100.225		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		Item martyr	When Isaac is hit, his active item gains 1 room's worth of charge.	2
Holy Grail	5.100.184		Flight + HP up	Grants flight and one Red Heart container. Heals 1 additional Red Heart.	3
Infestation	5.100.148		Fly revenge	1-3 Blue Flies randomly spawn every time Isaac gets hit. 2-6 Blue Flies	0
Little C.H.A.D.	5.100.96		Gives kisses	Spawns a familiar who drops a Half Red Heart every 3 rooms.	2
Lunch	5.100.22		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.	1
Maggy's Bow	5.100.312		HP up + you feel healthy	Gives one Red Heart Container and doubles the healing provided by Red Hearts. Also heals 1 Red Heart when obtained.	2
Missing Page 2	5.100.262		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. Increases the damage of Black Hearts and The Necronomicon-like effects by 40.	0
Mitre	5.100.173		Blessing of purity	Grants a chance of converting any Red Heart pickups into Soul Hearts instead.	3
Old Bandage	5.100.219		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		Spectral tears + tears up	Grants spectral tears that travel through obstacles (but not enemies). +0.5 tears.	2
Placenta	5.100.218		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		HP up	Grants 2 Red Heart containers and completely restores health.	2
Rotten Meat	5.100.26		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.	1
Scapular	5.100.142		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		Infinite charge... at a cost	Damages Isaac in exchange for fully recharging Isaac's current activated item.	2
Spirit of the Night	5.100.159		Scary	Grants spectral tears and flight.	3
Super Bandage	5.100.92		+2 hearts	Grants one full Red Heart container and 2 Soul Hearts.	2
The Body	5.100.334		I feel all	Adds 3 Red Heart Containers.	3
The Ladder	5.100.60		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		Soul generator	Spawns a cross familiar that drops a Soul Heart after clearing enough rooms.	3
The Wafer	5.100.108		Damage resistance	Most 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		We all float down here...	Grants flight.	3
Athame	5.100.408		Call to the void	When Isaac takes damage, a damaging black ring briefly appears around him. This ring can cause enemies to drop Black Hearts. After Isaac kills an enemy, adds a luck-based chance to spawn a damaging black ring around them.	3
Betrayal	5.100.391		Turn your enemy	Charms all enemies in the room when Isaac takes damage. Enemies are able to damage each other. If an enemy is damaged by another enemy, they will attack that enemy instead of Isaac.	1
Cambion Conception	5.100.412		Feed them hate	After taking damage a certain amount of times, a permanent demonic familiar spawns.	2
Curse of the Tower	5.100.371		Embrace chaos	Upon taking damage, spawns six Troll Bombs around the room, similar to the effect of XVI - The Tower.	0
Milk!	5.100.436		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. After the milk spills, Isaac's fire rate is increased by 1 for the current room.	1
My Shadow	5.100.433		Me! And my shaaaadow!	Inflicts fear on all enemies in the room upon taking damage and spawns black friendly Chargers that attack enemies. Spawns a shadow familiar that closely follows behind Isaac. It spawns a black friendly Charger whenever an enemy touches it.	2
PJs	5.100.428		You feel cozy	Grants 4 Soul Hearts and fully restores Isaac's health.	2
Dark Prince's Crown	5.100.442		Loss is power	When at exactly one Red Heart, increases tears, range, tear falling speed, and shot speed. When at exactly one Red Heart, increases fire rate, range, and shot speed.	1
Greed's Gullet	5.100.501		Money = health!	Grants a Red Heart container for every 25 Coins Isaac has.	1
Hallowed Ground	5.100.543		Portable sanctuary	Spawns a white poop familiar, which turns into a White Poop when Isaac is hurt. White poop has an aura that increases tear fire rate and can block enemy shots. The aura also increases damage by 20% and gives homing.	1
Leprosy	5.100.525		You're tearing me apart!	Upon taking damage, grants a body part as an orbital, which blocks enemy shots and deals 7 damage per tick to enemies it comes in contact with. The orbitals will be destroyed if they take enough damage from enemies or enemy shots.	1
Marrow	5.100.541		HP up?	Grants one Bone Heart and spawns three Red Hearts.	1
Midnight Snack	5.100.456		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.	1
Mystery Egg	5.100.539		Sacrificial insemination	Spawns an egg familiar, which hatches a random friendly monster when Isaac is hurt once per room. The power of the monster improves for each consecutive room cleared without taking damage.	1
Shard of Glass	5.100.448		Blood and guts!	Upon taking damage, Isaac has a chance to drop a full red heart, gain 5 range, and leave a trail of damaging red creep for the current room. Taking damage causes Isaac to bleed, spraying a volley of blood in the direction he fires. Bleeding will eventually damage him, but it can be stopped by picking up a Red Heart.	1
Varicose Veins	5.100.452		I'm leaking...	Taking damage releases a ring of 10 high damage tears.	1
Astral Projection	5.100.677		The true out-of-body experience!	Causes Isaac to turn into a ghost if he gets hit while in an uncleared room, giving him flight and spectral tears and blocking the next hit he takes.	2
Bird Cage	5.100.610		Fat buddy	The first time Isaac takes damage in a room, a familiar leaps on an enemy, dealing damage and releasing a rock wave. For the rest of the room, it chases enemies similar to Dead Bird.	1
Blood Oath	5.100.569		Bleed me dry	Stabs Isaac at the beginning of each floor, draining his Red Hearts. Increases damage and speed for the floor based on the amount drained.	1
Bloody Gust	5.100.695		May your rage bring haste	The first 6 times Isaac takes damage on a given floor, he gains Speed and Fire Rate for the rest of the floor, up to a maximum of +1.02 and +3.00, respectively.	2
Candy Heart	5.100.671		Power of love	Gives Isaac a permanent stat boost whenever he heals with Red Heart pickups.	1
Cracked Orb	5.100.675		Shards of knowledge	Unlocks doors and reveals a random room on the map when Isaac takes damage.	1
Empty Heart	5.100.676		It multiplies	If Isaac has one red heart or fewer at the beginning of a floor, he gains an empty red heart container.	1
Giant Cell	5.100.658		Micro friends	Causes Isaac to spawn micro-Isaacs when he takes damage, which chase and shoot at nearby enemies.	1
Hypercoagulation	5.100.724		Thick blooded	After Isaac takes damage from an enemy or donates health, launches Red Hearts from Isaac that despawn after 1.5 seconds.	2
It Hurts	5.100.560		No it doesn't...	Releases a ring of tears and increases fire rate for the current room when Isaac takes damage.	1
Orphan Socks	5.100.571		Speed up + your feet feel stronger	Prevents creep and floor spikes from damaging Isaac. Also gives Isaac +0.3 speed and 2 Soul Hearts.	2
Sanguine Bond	5.100.692		He awaits your offering	Spawns a special set of spikes in the Devil Room. Taking damage from the spikes has a chance to grant a reward.	1
Supper	5.100.707		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.	1
Vengeful Spirit	5.100.702		Hot blooded	After taking damage, spawns an orbital wisp that lasts for the entire floor, up to a maximum of six. They fire tears but do not block shots.	1

Name	ID	Icon	Quote	Description
A Missing Page	5.350.48		It glows with power	5% chance to induce The Necronomicon's effect upon taking damage. Adds +40 damage to Black Hearts and The Necromonicon-like effects.
Bloody Penny	5.350.49		Wealth of health	Gives a chance to drop a Half Red Heart when a coin is collected.
Callus	5.350.14		Your feet feel stronger	Prevents damage from creep and spikes.
Child's Heart	5.350.34		It calls out to its brothers	Increases the chance of a Heart dropping after clearing a room, and the chance of finding a heart when opening a Chest.
Cursed Skull	5.350.43		Cursed?	If Isaac has less than one full Red Heart after taking damage, he will be immediately teleported to a random room.
Fish Head	5.350.29		It stinks	Spawns a Blue Fly every time Isaac takes damage.
Isaac's Fork	5.350.46		Consume thy enemy	Isaac has a chance to heal for a Half Red Heart upon clearing a room.
Judas' Tongue	5.350.56		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		Faith's reward	Gives an Eternal Heart at the start of every floor.
Mom's Pearl	5.350.38		It emanates purity	Grants a secondary 10% chance of any non-specific heart drop turning into a Soul Heart.
Monkey Paw	5.350.20		Wish granted	If Isaac has half a heart after taking damage, drops a Black Heart. The effect can trigger up to three times, after which the trinket will disappear.
Mysterious Paper	5.350.21		???	Has a chance to replicate the effects of [[{{{page}}}|A Missing Page]], The Polaroid, The Negative, or [[{{{page}}}|Missing Poster]].
Red Patch	5.350.40		Your rage grows	Grants a chance to gain +1.8 damage for the current room upon taking damage.
Swallowed Penny	5.350.1		Gulp!	Upon taking damage, Isaac drops a coin.
Umbilical Cord	5.350.33		Fetal Protection	When brought down to only a Half Red Heart, spawns a Little Steven familiar for the current room. Adds a high chance to spawn a Gemini familiar for the current room after taking damage.
Blind Rage	5.350.81		Blind to damage	Increases invincibility time after getting hit.
Cracked Dice	5.350.67		You feel cursed... kinda.	Activates the effect of The D6, D8, D10, D12, or D20 (chosen randomly) whenever Isaac takes damage.
Mom's Locket	5.350.87		You feel her love	Grants a Half Red Heart each time a Key is used. Converts Half Red Heart pickups into Red Hearts.
Bag Lunch	5.350.105		I wonder what it is	Taking damage has a small chance to destroy the trinket and spawn Lunch.
Crow Heart	5.350.107		Drain me	Red Heart damage will be taken before Soul Heart, Black Heart, and Rotten Heart damage.
Finger Bone	5.350.128		It looks brittle	Grants a chance to gain a Bone Heart upon taking damage.
Walnut	5.350.108		That's a hard nut to crack!	Being hit by explosions will eventually destroy the trinket and spawn various pickups.
Wish Bone	5.350.104		Make a wish	Taking damage has a small chance to destroy the trinket and spawn a random item.
Hollow Heart	5.350.168		A brittle blessing	Grants an empty Bone Heart upon entering a new floor.
Mother's Kiss	5.350.156		HP up	Grants one heart container.
Swallowed M80	5.350.178		Bang!	Isaac explodes upon taking damage.
Torn Pocket	5.350.158		A hole in your pocket	Upon taking damage, Isaac drops 2 random Pickups from among those he's currently holding.

Notes on item selection

• Best Bud, Guppy's Paw, Infestation and Adrenaline 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 D20 or D100.
• Bloody Lust will increase damage if The Lost has multiple lives.
• Items that activate a 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.
• Rosary is mostly useless, but not completely, as it raises the chance of finding The Bible.
  • Rosary now gives a tears up as well, making it more useful.
• Missing Poster is no longer useless for the Lost. So is Mysterious Paper as it has a small chance to trigger its effect.
• Ouija Board, Dead Dove and Spirit of the Night are useless in Afterbirth because The Lost now starts with spectral tears. They are still useful items in Rebirth.
  • Ouija Board now gives a tears up as well, making it actually useful.
• Blind Rage is only useless if the player has not unlocked Holy Mantle as The Lost's starting item.
• Items that increase your chances of finding Soul Hearts or Black Hearts gain some use when combined with Immaculate Conception.
• Charm of the Vampire is no longer useless as it now gives a small damage up.
• Athame, My Shadow and Betrayal are no longer useless since they don't require getting hit to activate anymore.

Negative items

• The D4 and the D100 will reroll the Holy Mantle The Lost starts with after giving the Greed Machine 879 coins.
  • If Lost holds Holy Mantle is unlocked, the starting Holy Mantle cannot be rerolled anymore.
• Ankh, Broken Ankh, Judas' Shadow and Lazarus' Rags grant extra lives but respawn The Lost as ???, Dark Judas, or 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.
• Dark Bum no longer maintains its main benefit of providing Soul Hearts as they 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.
  • Dark Bum now has a 20% chance to spawn a random pill, card or rune, making it slightly more useful for The Lost.
  • With 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.
• 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 Anarchist Cookbook, Curse of the Tower, or Ipecac should be used with extreme care.
  • If the player chooses to pick up Ipecac, they should not pick up Loki's Horns or Mom's Eye, as an unexpected shot against a wall will lead to instant death. 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 IV Bag, Blood Rights or Razor Blade will end the run if used and must be avoided. Dead Sea Scrolls also has the potential to prematurely end a run if Kamikaze! is triggered and the player doesn't have its Holy Mantle active. Isaac's Heart will allow The Lost to use these items without taking damage.
• Bucket of Lard reduces speed by 0.2 and does not provide any benefit.
• Glyph of Balance will replace all room clear and champion drops with soul hearts, resulting in much less pickups throughout the run.
• Leo and 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 Dry Baby or The Small Rock when breaking said obstacles.
• 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 The Ludovico Technique, as both items combined may create a powerful synergy.
  • Strange Attractor now pulls enemies towards where the magnetic tear lands, making it safer to take.
• 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.
  • Lost Contact / Orbitals nullify this a bit, but you still have to get close to enemies.
• Ocular Rift, as it can uncontrollably pull enemies around, especially with items like Loki's Horns or Mom's Eye, though it can also be very useful in avoiding damage when played right.

The Binding of Isaac: Rebirth
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