- Upon taking damage, Isaac drops 2 random Pickups from his inventory (except Hearts, Pills, or Cards).
- All pickups are subjected to standard pickup spawn rules, which means that trinket's effect won't necessarily result in a net neutral.
- Coins dropped have a chance of being replaced with Golden Pennies, Lucky Pennies, Nickels, Sticky Nickels or Dimes.
- Bombs dropped have a chance of being replaced with double Bombs, Golden Bombs, Troll Bombs or Megatroll Bombs.
- When a dropped bomb is replaced with a Troll/Megatroll bomb, the game will still subtract that bomb from the total bomb count.
- Giga bombs, however, can't be dropped if Isaac has them, but their count will still be retained unless the bomb count reaches 0.
- Keys dropped have a chance of being replaced with Golden Keys or Charged Keys.
- Bogo Bombs: Dropped bombs will be their doubled variants.
- Humbling Bundle: All dropped pickups have a chance to be replaced with doubled variants.
- Scapular: Can be used to infinitely generate pickups when down to half a Heart by re-entering a room to regenerate a Soul Heart.
- Mom's Box: No effect.
- Nuh Uh!: Coins and Keys will be replaced with other pickups starting from Chapter 4.
- Tainted ???: Does not drop poop nuggets after taking damage.
|Tainted Lazarus Unlocks|
|Isaac (Boss) Unlocks|
|The Lamb Unlocks|
|??? (Boss) Unlocks|
|The Binding of Isaac: Rebirth|
|Achievements||Attributes||Bosses||Cards and Runes||Challenges||Chapters|