Tears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.
If the character has half a red heart or no red hearts after taking damage, it triggers the Book Of Shadows effect, creating a shield that nullifies all types of damage for 5 seconds. Also allows entrance into The Chest.
Gives a random chance for projectiles to fire in all 4 cardinal directions.
A purple fly familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.
Tears simultaneously fire out of both eyes diagonally, similar to the effect of the R U A Wizard?pill. Isaac's tears also travel above all obstacles.
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.
+5 bombs. Bombs stick to enemies and spawn 2-4 blue spiders if they kill an enemy.
Spawns a familiar that follows Isaac around and blocks enemy projectiles. Upon blocking a shot, it has a chance of triggering The Necronomicon effect.
Spawns a Hush familiar that bounces around the room and deals contact damage. While firing tears, it stops moving.
Increases Damage and Speed, plus adds one Soul Heart.
Grants charged tears that deal greater damage when fully charged.
Allows Isaac to carry two cards, pills, or any combination of both at the same time. Drops a random card or pill.
Increases tears by 0.4, and spawns 2 Soul Hearts pickups.
Increases Shot Speed and damage.
Increases range and shot speed, while adding 1 Black Heart.
Grants the combined effects of the Blue Map, Treasure Map, and The Compass, revealing the floor layout and all special rooms, including Secret Rooms and Super Secret Rooms.
Fires lasers at any enemy in its line of sight and moves based on the direction Isaac is firing tears.