Item: Sulfuric Acid
Spawns a blue attack fly that orbits a long distance from Isaac.
Increases range and shot height.
Dark Prince's Crown
Increases range, tears, and shot speed when at exactly one red heart.
Tears and Range up. Spawns 3 random types of hearts on the floor when picked up.
Isaac can hold 2 pills at once and all cards are replaced by pills.
Isaac is followed by a small blue cross that will drop a Soul Heart every 4 rooms.
Spear of Destiny
In addition to tears, Isaac now holds a spear in front of him which deals damage equal to 2 times his tear damage, and occasionally inflicts fear. The spear cannot be thrown, but deals damage while it is in contact with an enemy.
All sources of damage that would cause more than one half heart of damage are reduced to one half heart instead.
A glass of milk follows Isaac and spills on the floor upon taking damage. After the milk spills, Isaac's tear delay is decreased by 2 for the rest of the room.
Randomly while firing tears, Isaac will stop firing and turn red, where he will charge and release a lot of 'tears' in one go. In the burst of tears is a kidney stone which deals a lot of damage.
Isaac himself is now immune to all damage, and a heart familiar appears and follows Isaac. If the heart is hurt, Isaac is hurt.
Adds a chance to shoot fear tears and decreases tear delay by 1.
Inflicts poison to enemies who make contact with Isaac. Speed down.
Gives Isaac 99 coins. Can be found multiple times in a single playthrough.
Charm of the Vampire
Heals the character for half of a red heart for every 13 monsters killed.
A familiar that damages enemies by chasing them as well as inducing the fear effect.
A familiar that mirrors the player's movements and shoots in the opposite direction.