Pills are random items that are dropped by enemies, found in chests, or spawned in rooms. Pills are consumed by pressing 'Q'. They come in many colors and the effects change every time you play. Note, the pills do not work like Tarot cards which effects can be learned before use, the color of a pill does not foretell its effect in any way. However, if a pill is used and another pill is picked up of identical colors in that playthrough, it will have the same effect as before and its name will be shown, replacing "???". The same goes for additional duplicates that are found. Note, however, that if a pill has been used with a certain effect, the same effect may recur with a different pill as well (some examples below).
Pill effects can vary from one-off effects to permanent changes. Both the PHD and Lucky Foot items will almost always replace all negative stat pill effects with their positive counterparts (neutral effects such as Telepills and Bad Gas are not affected), however, it is still possible to be affected by negative stat pills (such as health down or bad trip). This could be a bug. Only one pill can be held at a time, and picking up another pill will drop whatever is held in the "Q" slot.
Negative pill effects, except for Health Down, have an 80% effect of their positive counterparts (e.g. Speed Up increases speed by 30% while Speed Down decreases speed by 24%).
Pills are on the Collection Grid (8,5) and are unlocked by finding any random pill.
If the PhD has been obtained, unknown pill types have a chance to be revealed (1/150 chance every frame). Also, if Telepills has not been identified as a pill yet, PhD will guarantee that it will not be in the pill "rotation".
In Wrath of the Lamb DLC, three new pills and four new effects are added. These appear along with the previous pills/effects and are mixed in with the randomly assigned types and effects.
|Bad Trip||Causes Isaac to suffer 1 heart of damage, including soul hearts. Turns into a Full Health pill when health is down to 1 red heart (Warning: Bad Trip will only turn into Full Health when total health is down to one heart. In other words, Soul Hearts count). When playing as ???, Bad Trip will convert to a Full Health pill if he is at half a soul heart, rather than a full Soul Heart. Therefore, using it at a full Soul Heart will kill him. This can also happen with negative health (due to Devil Room deals) and 1 Soul Heart as any character.|
|Balls of Steel||Gives the player 2 Soul Hearts. The Soul Hearts are directly added to Isaac's health rather than spawning on the floor.|
|Bombs Are Key||Swaps the amount of bombs and keys in the player's inventory.|
|Explosive Diarrhea! (Oh No!)||Causes Isaac to leave a short trail of lit Bombs, which do not deplete his current bomb count.|
|Full Health||Fully restores all heart containers. When playing as ??? and at less than 3 soul hearts, will restore health up to 3 soul hearts. (Playing as another character with no heart containers will not restore soul hearts, rendering the pill useless).|
|Health Down||Decreases Heart Containers by 1. Changes to Health Up when at 1 heart container, regardless of current Soul Heart count.|
|Health Up||Adds an empty Heart Container, and tints Isaac red.
|I Found Pills (And ate Them!)||
Isaac will make a "Durr..." sound and his appearance will change. (In Wrath of The Lamb, this pill is given one of two random effects: The original as shown below and "Puberty").
|Pretty Fly||Adds an Orbital black fly, which blocks enemy shots and damages other Flies.|
|Range Down||Decreases Range by 3.1.|
|Range Up||Increases Range by 3.875. Tints Isaac blue.|
|Speed Down||Decreases Speed by 0.24.|
|Speed Up||Increases Speed by 0.3. Tints Isaac yellow.|
|Tears Down||Decreases Tears by 0.28.|
|Tears Up||Increases Tears by 0.35. Tints Isaac purple.|
|Luck Up||Increases Luck. Tints Isaac green.|
|Luck Down||Decreases Luck.
(Bug causes more chests spawned at the end of rooms.(not confirmed))
|Friends Till The End!||Gives three Attack Flies, similar to the one spawned by The Mulligan.|
Triggers no effects other than causing some hair to appear on Isaac's head.
Holding this item eliminates the possibility of finding Stat Down Pills (does not apply to Rebirth) when consuming an unidentified pill. Unidentified stat downs will count as stat up pills, allowing two different pills to have the same effect if generated as such.
Cain starts the game with this item.
When used, this item gives you a free pill. Recharges after clearing 6 rooms.
Carrying the PHD will automatically identify unknown pills after a short delay and will also reverse stat down effects, making every stat down pill a stat up.
This Trinket, while held, slightly increases the odds of finding pills in chests (67%) and when completing a room (10%).
Spawns 4 random pills.
- Bad Trip pills convert to full health pills when at 1 heart, unless you're playing as ???. If playing as ???, Bad Trip pills will convert when at one-half of a heart. Health Down pills convert into Health Up pills if you have one heart container.
- Consuming the Bad Trip pill with ??? at one Soul Heart will kill him, unlike other characters. The icon on Isaac's Last Will will be a drop of blood, similar to the one seen by dying from a Blood Donation Machine.
- Pills in the Shop cost 5 coins, 3 when on sale.
- If you are in the Sacrifice room with Telepills and another item you want to keep, you can avoid using the door and still keep the second item by running into it and teleporting away. When you use the pills after running, you'll slide a bit. Use that slide to pick up the item.
- Due to a seemingly rare bug the game can lag/stop when a pill named '240' has been identified with the PHD. The pill itself has no effect on the character or its appearance.
- In Hard Mode (Eternal Edition), Full Health Pill will only heal 5 Red Hearts and the pill is identified as "Full Health?" The same healing effect also applies to XIX The Sun.
- The quote shown when picking up a pill ('Pills Here!') is a reference to the character Louis from Left 4 Dead, who is highly known for the catchphrase said when picking up pain pills.
- The sound effect that plays when a good pill effect occurs is the same sound effect that plays when a pill is obtained in Spewer, another of Edmund McMillen's games.
- According to source code, Telepills is intended to have another 1/15 chance to teleport to Devil room/Angel room, but this doesn't work due to a bug.
- The "Balls of Steel" effect refers to the phrase that describes "having balls" as "having the confidence" for doing something, which reflects the concept behind soul hearts being faith.
- The "Friends Till the End!" pill is a reference to Edmund McMillen's comic, "The Lonely Hermit", in which a hermit befriends five maggots that live in his insides before leaving his dead body as flies.
- The "Lemon Party" pill is a reference to a shock site displaying an image of three elderly men in a bed kissing and performing oral sex. It is commonly used as a bait-and-switch link by trolls in discussion forums and imageboard communities.