Effect: If used without holding any "Act" passive item (see below), rerolls item pedestals in the room to a random Act. This does not work in the Shop or Devil room.

While held, has a chance to replace any item pedestal with a random Act of the Apostles, which each give additional benefits to this item:

• Act I - One use, increases one of Isaac's six major stats until entering a new room

• Act II - On use, prevents contact damage from non-boss enemies until entering a new room

• Act III - Upon dying, revives Isaac with full health and removes this item

• Act IV - On use, heals Isaac two red hearts

• Act V  - On use, will revive Isaac with one Soul Heart if he dies in the current room

• Act VI - Passively increases chance to receive an Angel or Devil room at the end of the floor

• Act VII - On use, grants Strange Attractor tears until entering a new room

• Act VIII - On use, decreases Size until entering a new room

• Act IX - On use, increases Speed until entering a new floor

• Act X - Reduces the prices of pick-ups, and sets maximum item price outside of the Shop to 20 Coins

• Act XI - On use, resets Isaac's chance to receive a Health Upgrade at the end of the floor

• Act XII - On use, increases chance to receive an Angel or Devil deal to 100 percent; this is reverted upon entering a new room

• Act XIII - On use, grants Flight until entering a new floor

• Act XIV - On use, kills all non-boss enemies in the room, but deals one full heart of damage to Isaac

• Act XV - On use, activates a random 'holy' book

Effect: Causes Isaac to fire tears that have increased knockback and fall suddenly at the end of their range

Effect: At the start of each floor, randomly increases one of Isaac's six major stats based on the number of rooms available on the floor

Effect:  In addition to the effects of both Alpha and Omega, grants Flight and a small bonus to stat increases gained from the aforementioned items

Effect: Provides various mapping effects based on Isaac's filled red health:

• At three hearts or less, reveals secret rooms

• At four hearts or more, reveals secret and special rooms

• At six hearts or more, reveals the entire map and prevents Curse of the Lost

Effect: Massively increases Damage; this bonus is reduced for each collectible Isaac has

Effect: Grants the Stompy effect

Effect: All standard coins that spawn are replaced with their double variant

Effect: All standard keys that spawn are replaced with their double variant

Effect: Increases Fire Rate until Isaac enters a new room

Effect: Spawns a trapdoor, similar to using We Need to Go Deeper

• While held, gives Isaac the Compass effect, revealing Special rooms on the map 

Effect: Teleports Isaac to the Treasure Room, similar to using a Stars card

• While held, increases the chance of receiving a Planetarium on the next floor

Effect: Increases Fire Rate, grants Flight, and decreases Damage until entering a new room

• While held, increases the chance of receiving an Angel or Devil room at the end of the floor

Effect: On pick-up, randomly gives one of the five other collectibles related to Enoch:

• Book of Dreams

• Book of Luminaries

• Book of the Watchers

• Epistle of Enoch

• Similitudes of Enoch

Using any of these active items removes it from Isaac, then gives another at random.

Effect: Teleports Isaac to the beginning of a random stage

• This consists of all legitimate floors in the base game, and may push Isaac forward if used early

Effect: Spawns a random, charmed enemy as a familiar; provides health regen to all charmed allies

• Removes all available red hearts, but cannot kill Isaac

Effect: Replaces all of Isaac's Soul Hearts with Black Hearts, then temporarily increases Damage based on the number of Black Hearts held; this bonus lasts until entering a new room

Effect: Replaces all of Isaac's Black Hearts with Soul Hearts, gives one Key, and replaces all chests in the room with Eternal Chests

Effect: While firing (or charging), has a luck-based chance to increase Damage, but decrease Fire Rate and Shot Speed

Effect: When used, removes all projectiles on screen and inflicts Fear on enemies for a short time

Effect: When used, removes a Heart and adds a Broken Heart. For each use, increases Damage and Luck, but decreases Speed.

• Item cannot be used if Isaac has less than two hearts available.

Effect: Replaces all Brown chests with Haunted Chests

Effect: Guarantees an Angel Room will spawn at the end of the floor after Isaac kills at least fifteen enemies

• Taking damage resets kill count and incurs a penalty to deal chance

Effect: Teleports Isaac to the Angel or Devil room, similar to using a Joker card

• While held, if Isaac is reduced to one heart (or less), gives a Soul Heart, but switches to another Book of Enoch

Effect: Has a small chance to negate self-inflicted damage; additionally, has a luck-based chance to spawn a random heart at the beginning of a new floor

Effect: If Isaac has at least one full Soul Heart, has a small chance to negate incoming damage from any source

• Additionally, prevents Curse of the Blind, Curse of the Lost, and Curse of the Unknown from appearing on future floors 

Effect: Has a small, luck-based chance to fire a small explosive tear

Effect: Randomly increases one of Isaac's six major stats; this boost is reduced as the item gains charge

• May instead grant flight or decrease Isaac's size, which lasts until the item is fully charged

Effect: Activates one of the following effects at random -

• "Rock" - uses the D12 or a Hagalaz rune

• "Paper" - uses the Book of Secrets or a Moon card

• "Scissors" - uses Scissors or Pinking Shears

Effect: When used, massively increases Luck; this boost slowly wears off over the course of 30 seconds

Effect: When entering a Boss or Miniboss room at full health, all enemies inside take damage equal to one-quarter of their total health

• This effect does not trigger on Blue Womb, or after Sheol/Cathedral

Effect: Hearts that spawn on the floor have a chance to be automatically consumed, adding them to Isaac's health. If health is full...

• Red Hearts increase Luck

• Soul Hearts increase Fire Rate

• Black Hearts increase Damage

• Eternal, Bone, and Rotten Hearts add Blue Flies

Effect: Increases Move Speed, then grants one of the following effects:

• Randomly increases one of Isaac's six major stats

• Decreases Size

• Grants Piercing and Bouncing tears

This bonus lasts until Isaac has explored four new rooms, at which point he has a 'sugar crash.'

• This decreases Fire Rate, Move Speed, and Shot Speed until Isaac explores an additional two rooms, or uses this item again

Effect: Taking contact damage causes the entity hurting Isaac to become permanently Charmed

Effect: Gives Isaac ten Keys

Effect: Slightly increases all six major stats when Isaac kills a boss or champion enemy

• This effect does not trigger after Blue Womb

Effect: Upon dying, revives Isaac in the current room with 3 Rotten Hearts, and kills all active non-boss enemies (turning them into Blue flies)

• This extra life will only be used after all others, and will not appear in the HUD

• This item is removed after reviving

Effect: Increases Damage and Fire Rate for each Blue Fly or Spider Isaac has

• If Isaac has no Flies or Spiders, instead increases Luck

Effect: Replaces all Golden chests with either Brown or Red chests, and causes all basic Red Spiders to become Blue Spiders

Effect: When Isaac takes damage, inflicts Confusion on all enemies in the room; if this was contact damage, also deals three times tear  damage to the enemy hurting Isaac

Effect: Forces any "Mom" or "Dad" items collected to be dropped, then immediately activates an effect similar to using a Black Rune

• Also prevents any "Mom" or "Dad" trinkets from being picked up

Effect: After killing the floor boss, randomly increases one of Isaac's six major stats based on the number of rooms explored up to that point

• This effect does not trigger on Blue Womb, or after Sheol/Cathedral

Effect: Rerolls currently held trinket(s) and randomly adds one of the following:

• 3 - 6 Coins

• 2 - 5 Bombs

• 1 - 4 Keys

Effect: Upon dying, immediately revives Isaac with full health and three soul hearts; reviving then causes tears to have a chance to set enemies on fire

• This extra life will only be used after all others, and will not appear in the HUD

• This item is removed after reviving

Effect: When entering a special room first time, causes item pedestals to rotate between multiple collectibles; instead has a small chance to cause items to 'glitch' (similar to having TMTrainer)

Effect: Increases Luck after entering a Library for the first time; increases Damage when holding an 'evil' book, and increases Fire Rate when holding a 'holy' book

• When entering a new floor, if Isaac has an item that provides partial mapping, fully reveals the map

Effect: Upon dying, revives Isaac with full health and restarts the floor; reviving then increases Fire Rate and Range, decreases Damage, and causes tears to orbit around Isaac 

• This extra life will only be used after all others, and will not appear in the HUD

• This item is removed after reviving

Effect: Improves Red Chest payouts, preventing Troll Bombs and enemy spiders.

• 20% chance for an item

• 10% chance for 3-5 blue flies and a rotten heart

• 10% chance for 4 blue spiders

• 10% chance (each) for 2 soul, black, bone hearts

• 10% chance for 3 bombs

• 10% chance for black sack

• 10% chance for 3 pills

Effect: If Isaac's Luck is less than seven, increases it to seven

Effect: Picks up and stores Slot Machines and Beggars, allowing them to be moved to another room.

• When used again, any stored entities are spawned in the same spot they were taken from

• Can only pick up one of each type of slot/beggar

Effect: Deals ten times Isaac's damage to all enemies in the current room

• While held, killing any of the Four Horsemen bosses permanently increases Damage and Fire Rate

Effect: Increases Fire Rate and Shot Speed based on the total number of rooms on the current floor

Effect: While firing (or charging), has a luck-based chance to decrease Damage, but increase Fire Rate and Shot Speed

Effect: When used, removes a Heart and adds a Broken Heart. For each use, increases Fire Rate and Shot Speed, but decreases Speed.

• Item cannot be used if Isaac has less than two hearts available.

Effect: Replaces a random room reward with a Brown Chest

• This only affects core pick-ups and does not include hearts

Effect: After taking damage, grants Isaac freezing tears until he leaves the room; if this was contact damage, causes the entity hurting Isaac to immediately die and shatter into ice shards

Effect: When dealing damage to enemies, has a luck-based chance to double this damage

Effect: When entering a Boss Room for the first time, grants the effects of a reverse Strength card

• This effect does not trigger on Blue Womb, or after Sheol/Cathedral

Effect: When entering a Boss Room for the first time, slightly increases all six of Isaac's major stats based on the number of rooms containing enemies explored on the floor

• This effect does not trigger on Blue Womb, or after Sheol/Cathedral