The Binding of Isaac: Rebirth All Items Guide

The Binding of Isaac: Rebirth contains over 719 passive and active items across Rebirth, Afterbirth, Afterbirth+, Repentance, and Repentance+. Every run revolves around collecting items from treasure rooms, devil deals, angel rooms, shops, and boss drops. Understanding how items work is the foundation of every successful Isaac run, whether you are chasing Dead God or learning your first boss patterns.

How Items Work in Isaac Rebirth

Items in Isaac are permanent run modifiers. Passive items alter your tears, damage, speed, health, or grant special abilities. Active items occupy your spacebar slot and require charging through room clears or pickups. Once picked up, an item cannot be dropped unless you have specific reroll tools like D4 or Tainted Isaac's ability. Items stack synergistically — Brimstone combined with Polyphemus creates a massive piercing beam, while Ipecac plus My Reflection can create dangerous self-damage loops.

Each item belongs to one or more item pools that determine where it can appear. Treasure room items are the most common pickups, while devil and angel room items require accepting or rejecting deals. Boss pool items drop after defeating floor bosses. Shop items cost coins. Secret room and ultra secret room pools contain some of the most powerful items in the game. After you unlock new items through secrets and completion marks, those items enter the global pool and can appear in future runs — a concept called pool dilution that affects long-term unlock strategy.

Item Categories and DLC Tags

• Passive items — Always active effects like Sacred Heart (+2 soul hearts, x2.3 damage multiplier) or Technology (piercing laser tears).
• Active items — Press spacebar to use. Examples include Blank Card (copies cards), D6 (rerolls items), and R Key (restarts the current floor).
• Familiar items — Orbitals and followers like Brother Bobby, Harlequin Baby, or Incubus that attack independently.
• Trinkets — Small passive modifiers held separately. See our trinkets and cards guide for full coverage.
• Repentance items — Over 200 new items including Spirit Sword, Psy Fly, and Larynx. Many received balance changes in Repentance+.

Item Quality System (Hidden)

Repentance introduced a hidden quality rating from 0 to 4 for every item. Quality 4 items like Sacred Heart, Crown of Light, and R Key are extremely powerful and prioritized by Sacred Orb rerolls and Tainted Lost's fixed reroll rules. Quality 0 items like The Poop or Butter Bean are weak and often avoided. The item quality tier list breaks down every quality tier and explains how quality interacts with NO!, Sacred Orb, and Tainted Lost.

Most Important Items for New Players

Finding Items Efficiently

Learn to identify secret room locations by checking adjacent walls for hollow sounds or using the X-ray vision effect from certain pills. Bomb every tinted rock for possible crawl spaces leading to item rooms or black markets. On alt path floors, tinted rocks may contain golden chests with high-quality items. Devil and angel deals are binary choices — taking a devil deal prevents angel rooms on that floor unless you have Goat Head or Duality. For a deep dive into where items spawn, read our item pools guide.

Synergies transform average items into run-winning combinations. A basic damage up becomes devastating when paired with Proptosis, Cricket's Head, and Magic Mushroom. Conversely, some combinations are harmful — Ipecac with Dr. Fetus causes self-damage explosions. Use our synergy lookup tool to check interactions between two items, or browse the synergies guide for the most impactful combos in Repentance+.