|“||And when he had opened the third seal, I heard the third beast say, Come and see. And I beheld, and lo a black horse, and he that sat on him had a pair of balances in hand.||”|
He appears as an eyeless, grinning humanoid riding upon a hobby horse, both of which are severely emaciated.
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 and only the head will be left. 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.
- The charge deals a full heart of damage, instead of the usual half-heart damage found in the Basement/Cellar.
Phase one 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 vomitting bullets similar to Scolex or Monstro.
- 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.
|Basement||Larry Jr. • Monstro • The Duke of Flies • Gemini • Steven • Famine|
|Cellar||Widow • Pin • The Duke of Flies • Famine • Gurdy Jr. • The Blighted Ovum|
|The Caves||Fistula • Peep • Gurdy • Chub • C.H.A.D. • Pestilence|
|Catacombs||The Husk • The Hollow • The Blighted Ovum • The Carrion Queen • Peep • Pestilence • The Wretched • Gurdy Jr.|
|The Depths||Loki • Monstro II • Gish • War • Mom|
|Necropolis||Mask of Infamy • Daddy Long Legs • The Carrion Queen • The Bloat • Loki • War • The Wretched • Mom|
|The Womb||Scolex • Blastocyst • The Bloat • Death • Conquest • Daddy Long Legs • Triachnid • Teratoma • Mom's Heart • It Lives|
|Utero||Teratoma • The Bloat • Death • Conquest • Daddy Long Legs • Triachnid • Lokii • Mom's Heart • It Lives|
|Sheol||The Fallen • Satan|
|First to fifth and seventh level||The Fallen • Headless Horseman|