Spawns a Mysterious Paper, increases tears, and grants a bone heart.
The Ludovico Technique
Instead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.
Spawns a beggar familiar which floats around the room and picks up any nearby coins, leveling up after collecting several coins. At level 2, Bumbo gains a body. At level 3, it begins to fire tears. At level 4, Bumbo chases enemies slowly, dealing contact damage.
Cube of Meat
Orbiting familiar that blocks enemy shots and deals damage to enemies. If collected while already having one, makes the familiar evolve. Only drops from Horsemen. Similar to Ball of Bandages.
Grants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them.
Grants a full heart container, and a chance to regenerate a half-heart of health every minute of gameplay.
Randomly increases and decreases some of the character's stats. There will always be at least one stat increase and one decrease and the same stats can be increased/decreased multiple times.
Chaos causes items to be chosen from random item pools. When picked up, drops between 1-6 random pickups on the floor.
Increases Shot Speed and damage.
Spawns a Mulligan Familiar that will wander the room randomly. Enemies will attack the Mulligan if it's closer.
Connects Isaac's tears with electricity that can damage enemies.
A blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.
Isaac emits a beam from his face. Isaac's tears travel in the path of the beam.
Whore of Babylon
Increases damage and speed whenever Isaac has half a red heart or less (one red heart for Eve), ignoring any soul or black hearts.
A familiar that mirrors the player's movements and shoots in the opposite direction.
Pay to Play
This item turns all doors that require a key into doors which need a coin to enter instead. This affects shops, item rooms, libraries and other key doors.