The Binding of Isaac Wiki

A bottle of medicated syrup, with a label that reads "IPECAC" with a red warning label below.


Isaac appears sick.

Allows Isaac to fire projectiles from his mouth, causing explosive/poison damage. IPECAC shots are fired in an arc, making enemies difficult to hit without a proper Range stat.

Each IPECAC shot does normal tear damage + 50 (+40 since Rebirth) to any enemies in the explosion radius. Its poison deals 7 damage per tick.

However, IPECAC shots can hit like normal tears before exploding, which only deals normal tear damage.


  • This item is excellent for finding the Secret Room or the Super Secret Room, due to its infinite explosive potential.
  • Firing directly in front of an obstacle or an enemy is not recommended, as the shots will instantly explode at point-blank and deal damage to Isaac.
  • Items that increase your range stat are not recommended with IPECAC, as they can make it harder to aim your shots.
  • If your movement speed gets too high, the trajectory becomes difficult to control and can even cause shots to hit you while moving backward and firing forwards at the same time.


  • Dr. Fetus - Gives Bombs a green color, with a greatly decreased fire rate. The damage of the bombs is NOT increased, and no poison effect will apply.
  • My Reflection: Causes the shots to come back toward Isaac. This interaction is not advisable, as the shots fired will almost always come back at Isaac and deal explosive damage to him. Use on Rebirth as Challenge #7 Suicide King. It turns into a good synergy with Pyromaniac, allowing for healing shots that boomerang back and health.
  • Brimstone - Overrides IPECAC, but the damage of the beam is tripled, with an increased charge time.
  • Ouija Board, Dead Dove, Spirit Of The Night - Spectral IPECAC doesn't explode against rocks or other obstacles except at the end of the trajectory, allowing the character to hide behind them and launch shots without damage; the same issue with spectral tears and fire still applies (fire must be at the end of the trajectory to be extinguished).
  • Mom's Knife - Overrides IPECAC.
  • The Inner Eye, Mutant Spider - Completely nullified by IPECAC, regardless of order picked up.
  • Polyphemus - Slightly increases damage with no drawbacks.
  • Mutant Spider - No effect.
  • Epic Fetus - Overrides IPECAC.


  • Spoon Bender, Sacred Heart, Telepathy for Dummies - Causes IPECAC shots to home in on enemies, making them easier to hit. However, this can be troublesome with monsters that chase Isaac, such as Globins.
  • Cat-O-Nine-Tails - Projectiles fly faster and farther.
  • Charm Of The Vampire - Being able to force doors open to leave the room makes monsters respawn, allowing for more kills for healing.
  • Chocolate Milk - Stacks. Charging animation will not appear, but shots still deal increased damage.
  • Cupid's Arrow- IPECAC shots do not explode upon contact with enemies, making it safe to shoot enemies at point-blank. The projectile will deal much less damage than the explosion, as it depends on Isaac's current tear damage. As such, it can be boosted with damage upgrades like the explosion itself.
  • A Lump Of Coal - Gains a moderate damage boost due to the long arc travel time.
  • Technology - Overrides IPECAC, with tripled damage and decreased fire rate.
  • Technology 2 - Stacks with IPECAC
  • Tough Love - Stacks. IPECAC shots can be large, green tooth shots that deal increased damage.
  • The Wafer - Due to the increased potential of accidentally hitting yourself with IPECAC shots, The Wafer is useful, as it decreases the damage of IPECAC shots to a half-heart.
  • Pyromaniac - Explosions from IPECAC heal Isaac with limitless healing capabilities.
  • Cricket's Body - Upon exploding, the IPECAC shot will fragment into four more smaller tears, causing a total of five explosions. This causes a tremendous amount of damage very quickly, but if the first tear is fired while running forward, the four split tears will travel very far from the impact point and endanger the player.


  • IPECAC is a drug formerly used medically to induce vomiting (an emetic). This explains the appearance of the item (making Isaac appear sick) and its effects — causing Isaac to spit his projectiles.
  • The name of IPECAC is a short for Portuguese ipecacuanha, which roughly means small vomit leaves.
  • IPECAC is considered as a special item in the original Binding of Isaac, but no longer in Rebirth.


  • Using the Remote Detonator after launching an IPECAC projectile will trigger a second explosion in the same spot where the last projectile landed. Although the explosion is visible, no sound is emitted.
    • The resulting explosion from the Remote Detonator will cause damage to enemies, but less than the actual IPECAC projectile. This bug can be exploited to potentially double your fire rate if you use the Remote Detonator whilst the last shot is arching through the air.
    • This is hard to perform whilst moving, so it is recommended against slow moving/stationary enemies or bosses.
  • If IPECAC hits the player, the one tick poison effect takes place on Isaac. If you put down Best Friend during that time, you will take seven red hearts of damage (potentially killing you even through i-frames if you have red heart containers).