Item: The Compass
Doubles damage, halves tears stat, and greatly reduces shot speed.
A blue fly familiar follows Isaac's movements on a 3 second delay. Papa Fly will fire tears at nearby enemies.
Grants 2 Heart Containers and completely restores health.
Spawns a flying familiar that bounces around the room with a black aura, dealing rapid damage to any enemies inside it. While standing in the aura, Isaac gains a 1.5x tear damage multiplier.
Gives one extra pickup (1+1 Free version) of Red Hearts, pennies, bombs, and keys. Does not work with blue, black, and half red hearts, nickels, and dimes.
Isaac's head is removed from his body and floats around him. Increases Damage by 1 and grants -1 Tear Delay.
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.
Creates a ring of light around Isaac that petrifies enemies in contact.
Spawns a familiar that follows Isaac around and collects red hearts. For every one-and-a-half red hearts collected, Dark Bum will generate one soul heart, one hostile Spider or one friendly blue spider.
Enemies, enemy shots, tears, and pickups will briefly freeze in place at random intervals.
While firing tears, Isaac has a chance to fire an eye across the screen with a very slow shot speed, which will fire tears of its own in the same direction as Isaac. The eye will be destroyed if it comes into contact with an enemy or obstacle.
Spawns a finger familiar that points at enemies, dealing constant 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.
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.
Activated Items can be "overcharged" to allow for an additional use.
Increases damage and increases the chance for a Devil or Angel Room to appear.
Gives Isaac a Gurdy familiar that will charge around the room dealing contact damage to enemies. Lil Gurdy is charged by holding down a fire button and letting go. The longer the button is held, the faster Lil Gurdy will fling itself across the screen. Lil Gurdy can pass over objects and obstacles in the room.
Shard of Glass
Upon taking damage, Isaac has a chance to drop a full red heart, gain 5 range, and leave a trail of damaging red creep for the current room.