Pills take up the same slot as cards and runes.
They are randomly chosen at the beginning of a run and assigned a color which remains static with that pill effect for the duration of the run unless the PHD item is picked up. As there are a limited number of pill colors, not every effect will appear in every run. In addition to that, one effect might also appear on two different pills. The set of pills for any given run is usually known as the pill rotation.
|48 Hour Energy|
Replaces the floor map with a ? for the rest of the floor.
|R U a Wizard?|
Tears are shot diagonally, alternating between left and right for about one minute. This does not reset by exiting the room. NOTE: When playing as Cain, you only shoot from your right eye.
Injures Isaac by half a heart. If a Bad Trip pill is used while Isaac only has a single heart left or less, the pill will give Isaac full health instead.
|Balls of Steel|
Gives Isaac two soul hearts. If used while Isaac has half of a black heart, it will fill that black heart and give one and a half soul hearts.
|Bombs are Key|
Switches number of bombs and keys.
Spawns five active bombs behind Isaac.
Restores all red heart health.
|I Can See Forever|
|I Found Pills (and Ate Them)|
Changes the appearance of Isaac's face. This pill is cosmetic only. and disappears after you leave the room.
Spawns a large yellow pool around your character. Greatly damages any enemy that steps on it.
Empties all but one red heart container and spawns 1-4 full red heart pickups. If Isaac only has half of a heart left, it will heal him to one heart. When ??? uses the pill, no health will be deducted, but red hearts will still spawn. If used in a Black Heart or Eternal Heart-containing Super Secret Room, it will spawn those types of hearts instead.
Prevents Isaac from moving for a short duration.
Charms all enemies in the room for a short period of time.
Causes Isaac to grow four hairs from the top of his head and zits on his face. This pill is cosmetic only, and will stay for the rest of the run.
Spawns a fly orbital.
Decreases the distance that Isaac's tears travel.
Increases the distance that Isaac's tears travel.
Decreases Isaac's movement speed.
Increases Isaac's movement speed.
Decreases fire rate.
Increases fire rate.
Removes one red heart container upon use. If a Health Down pill is used while Isaac only has one container heart left, the pill will give Isaac a container heart instead.
Adds one empty red heart container upon use.
Decreases Isaac's luck stat.
Increases Isaac's luck stat.
Isaac farts, poisoning enemies around him.
Isaac gets teleported to a random room. Has a chance to teleport Isaac to the I AM ERROR room.
- Among the attribute-incrementing and decrementing pill effects, only five of the seven visible attributes are covered: Health, Range, Tears, Speed, and Luck. Both Shot Speed and Damage can't be altered by pills.
- Hematemesis is the vomiting of blood.
- Lemon Party is an internet shock site featuring a group of elderly men performing oral sex.
- R U a Wizard? and I can see Forever are both image macro memes.
- Balls of Steel is a reference to Duke Nukem; it is one of Duke's more famous quotes.