Famine will begin his fight with a very fast charge to the left or right that will make him go through the walls and come back from the other side, stopping at his original location. After that, he will stay in practically the same spot and spawn a Pooter or a Fat Fly, capable of having a maximum of two at any given time.
For as long as these flies are on-screen, he will not move around much and will not charge until Isaac gets in his line of sight. These charges will destroy any flies in the way, so it can be an effective strategy to force him to charge as much as possible.
When he only has a third of his health left, his body and horse will be destroyed leaving only the head, and he will start saying "hey" as pestilence does in his first phase. He won't be able to move around much or spawn any more flies, but it will fire fast-moving triple shots (one in the center and two in a split pattern to the sides) directly at Isaac's location.
Blue Famine's first phase attacks in a six-way pattern (no bullets in vertical directions). He also charges faster, at a much higher rate than normal. While charging, he moves slightly (diagonally if needed) towards Isaac, and makes a complete charge around the room rather than just stopping short as per his non-champion form. When he loses his body and horse, he'll attack by vomiting bullets similar to Scolex or Monstro.
This variant was added in V1.4.
Phase one's charge attack does not go through the walls, instead stopping at the end of the room. During its charge it shoots a ring of projectiles. His attack shoots a volley of projectiles in random directions, and spawns four Pooters and/or Fat Flies around him. Phase two's attack shoots an additional 2 projectiles in a split pattern after the initial 3 projectiles.
The charge deals a full heart of damage, instead of the usual half-heart damage found in the Basement/Cellar.
Famine is pale brown, but he is described as black in the Bible.
Some also refer to him as "Faminic," as this was his name in scripture.
On rare occasions, Famine may use his charge attack and push Isaac into the wall behind the rocks. If the player has no bombs, they may be permanently trapped and the playthrough will need to be restarted.
On later floors, Famine's health is not sufficient to qualify as a boss. Therefore, if encountered with another boss, hurting him will not change the displayed health meter. If encountered alone (like in the Cathedral), there will be no health bar.
When battling Famine (In Phase 2) with the item Mom's Contacts, there's a chance for him to vanish, trapping the player, unless they have Teleport!, a Tarot Card that teleports you, or a Telepill.
On rare occasions, Famine may use his charge attack and push Isaac in the Devil Room (even in the Basement/Cellar 1). If Isaac walks out the room, Famine will have to be fought again, with restored health.