| Raw Liver |  | Increases available Heart Containers by 2 and completely restores health. | 
		
			| The Relic |  | Isaac is followed by a small blue cross that will drop a Soul Heart every 5 rooms. | 
		
			| Robo-Baby |  | Follows Isaac around, shooting enemies with an eye laser similar to Technology. | 
		
			| Robo-Baby 2.0 |  | Fires lasers at any enemy in its line of sight and moves based onthe direction Isaac is firing tears | 
		
			| Roid Rage |  | Increases speed and range. | 
		
			| Rosary |  | Adds 3 Soul Hearts and increases the chance for The Bible to appear in the Shop. | 
		
			| Rotten Baby |  | A familiar that spawns Blue Flies. | 
		
			| Rotten Meat |  | Adds one heart container. | 
		
			| Rubber Cement |  | Tears bounce off walls and obstacles (including enemies). | 
		
			| Sack Of Pennies |  | Isaac is followed by a small bag that drops a coin every 2 rooms. Usually a penny, sometimes a nickel. | 
		
			| Sacred Heart |  | Increases damage and range while reducing shot speed and grants homing tears. Replenishes all Red Hearts and gives one Soul Heart upon pickup. | 
		
			| Sacrificial Dagger |  | Dagger orbits Isaac, dealing very high damage. | 
		
			| Sad Bombs |  | +5 Bombs. Upon exploding, bombs shoot 8 tears off in every direction, similar to Tammy's Head. The tears are affected by any tear modifiers Isaac has on his own tears. | 
		
			| The Sad Onion |  | Increases Tears by 0.7. | 
		
			| Safety Pin |  | Increases range and shot speed, while adding 1 Black Heart. | 
		
			| Sagittarius |  | Increases speed by +0.2 and grants piercing tears. | 
		
			| Samson's Chains |  | Pull a chain and ball behind you that will damage enemies on contact and is able to break stones. | 
		
			| Scapular |  | Once per room, when Isaac is reduced to his last half red Heart, the aura around his head temporarily vanishes and he is granted one Soul Heart. | 
		
			| Scorpio |  | Grants poison tears, which deal damage over time when inflicted. | 
		
			| Screw |  | Tears and shot speed up. | 
		
			| Sharp Plug |  | Using an activated item while it's not charged will charge it and Sharp Plug does 2 full heart damage to Isaac | 
		
			| Sissy Longlegs |  | Wanders about the room, occasionally spawning blue Spiders. | 
		
			| Sister Maggy |  | A Familiar that follows Isaac around shooting blood tears. | 
		
			| Skatole |  | All types of fly except Boom Fly and Red Boom Fly become passive and slowly move towards Isaac. Does not prevent contact damage. | 
		
			| Skeleton Key |  | Sets your key count to the maximum of 99. | 
		
			| The Small Rock |  | Increases damage by 1. | 
		
			| Smart Fly |  | After Isaac takes damage, this fly will deal continuous touch damage to whatever enemy caused the damage until it is dead. The fly will then systematically attack 1 enemy at a time until the room is cleared. | 
		
			| SMB Super Fan! |  | Increases all stats. | 
		
			| A Snack |  | Adds 1 Heart Container. | 
		
			| Soy Milk |  | Tears shrink and do much less damage, but fire in very rapid succession. | 
		
			| The Soul |  | Grants two Soul Hearts. Isaac now repels enemy projectiles. | 
		
			| Speed Ball |  | Speed and Shot Speed increase. | 
		
			| Spelunker Hat |  | Reveals type of adjacent rooms, including location for secret rooms and super secret rooms. | 
		
			| Spider Bite |  | Adds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them. | 
		
			| Spider Baby |  | When hit, spawn up to 2 Blue Spider. | 
		
			| Spirit Of The Night |  | Grants spectral tears and flight. | 
		
			| Spoon Bender |  | Grants Isaac homing tears. | 
		
			| Squeezy |  | Increases tears by 0.4, and spawns 2 Soul Hearts pickups. | 
		
			| Starter Deck |  | Isaac can hold 2 cards at once and all pills are replaced by cards. | 
		
			| Steam Sale |  | Reduces all Shop prices by 50%, rounded down when an item, rounded up when a pickup. | 
		
			| Stem Cells |  | Adds one filled Heart Container and increases Shot Speed. | 
		
			| Steven |  | Increases Damage by 1. | 
		
			| Stigmata |  | Increases damages, and adds 1 heart container. | 
		
			| Stop Watch |  | Automatically inflicts slow to all enemies in every room. | 
		
			| Strange Attractor |  | Pick Ups, Chests and Monsters are magnetically attracted to your tears. | 
		
			| Super Bandage |  | Grants one Heart Container and gives 2 Soul Hearts. | 
		
			| Synthoil |  | Increases damage and range. | 
		
			| Taurus |  | Speed down, gains speed while in a room with enemies until gaining My Little Unicorn effect for a few seconds. | 
		
			| Tech.5 |  | Grants a unlimited range piercing laser with random rate of fire that does not replace tears. The laser might occasionally fire with the effect of a random item or trinket, such as Hook Worm, Spoon Bender or Tiny Planet. | 
		
			| Technology |  | Replaces tears with a piercing laser with unlimited range. | 
		
			| Technology 2 |  | Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously. | 
		
			| Tiny Planet |  | Range up and makes shot tears revolve around Isaac until they drop. | 
		
			| The Negative |  | If the character has half a red heart or no red hearts after taking damage, it triggers The Necronomicon effect, damaging all enemies in the room. Also allows entrance into the Dark Room. | 
		
			| The Polaroid |  | If the character has half a red heart or no red hearts after taking damage, it triggers the Book Of Shadows effect, creating a shield that nullifies all types of damage for 7 seconds. Also allows entrance into The Chest. | 
		
			| There's Options |  | There will be 2 items available to chose from after defeating a boss. Choosing 1 item causes the other to disappear. Shop item. | 
		
			| Thunder Thighs |  | Destroys rocks upon contact with Isaac. Adds one heart, and Lowers Speed. | 
		
			| Toothpicks |  | Increases tears and shot speed. | 
		
			| Torn Photo |  | Tears + Shot speed up. | 
		
			| Tough Love |  | Adds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears. | 
		
			| Transcendence |  | Grants flight. | 
		
			| Treasure Map |  | Reveals all rooms for every floor. However, it does not reveal icons or secret rooms. | 
		
			| Trinity Shield |  | Isaac gains a shield that will protect him from enemy shots. | 
		
			| The Wafer |  | All sources of damage that would cause one heart loss are reduced to half heart instead. | 
		
			| Whore Of Babylon |  | Increases damage and speed whenever the character health is half red heart or less (one red heart for Eve). | 
		
			| Wire Coat Hanger |  | Increases Tears by 0.7. | 
		
			| Wooden Spoon |  | Increases speed by 0.3. | 
		
			| Virgo |  | Grants a chance to trigger the Book Of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 7 seconds. Also converts "bad pills" into "good pills". | 
		
			| The Virus |  | Inflicts poison to enemies who make contact with Isaac. | 
		
			| X-Ray Vision |  | Reveals and opens all Secret Room and Super Secret Room entrances. |