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 you can learn the effects of before use, the color of a pill does NOT foretell its effect in any way. However, if you use a pill and pick up a 2nd pill 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 you find. Note, however, that if you've used a pill 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 replace all negative stat pill effects with their positive counterparts (neutral effects such as Telepills and Bad Gas are not affected; bad trip will change to full health). You may only have one card or pill at a time, and picking up another card or pill will cause you to drop the other one.

Negative pill effects have an 80% effect of their positive counterparts (e.g. Speed Up increases speed by 30% while Speed Down decreases speed by 24%).

"Pills Here!" is item (8,5) on the collection grid and is unlocked by finding any pill.

If the PhD has been obtained, unknown pill types will be revealed after a few seconds.

Pills in the shop cost 5 coins, 3 when on sale.

Contents 1 Pill Variations 2 Pill Effects 3 Wrath of the Lamb 4 Items associated with Pills 5 Notes 6 Trivia

Pill VariationsEdit

Pill EffectsEdit

Pill Name	Effect
Bad Gas	Poisons any enemies near the player. Identical to the item The Bean when activated and the passive effect of The Black Bean.
Bad Trip	Causes player to suffer 1 normal 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 your total health is down to one heart. In other words, Soul Hearts count.). When playing as ??? , Bad Trip will not convert into a full health pill if he is at one heart, and will kill ??? if he has 1 soul heart. Similarly, players who have performed a deal with the devil that has given them negative heart containers (as in giving one heart and all your Soul Hearts for a two-heart item) can also be killed by Bad Trip if they have only one 1 Soul Heart remaining.
Balls of Steel	Gives the player 2 soul hearts. The soul hearts are directly added to the player's health instead of being spawned as drops.
Bombs Are Key	Swaps the amount of bombs and the amount of keys in the player's inventory.
Explosive Diarrhea! (Oh No!)	Causes the player to drop lit bombs while walking for a short period of time (does not use player's bombs). (No Longer obtainable in the online version (1.48) anymore due to a permanent bug. However, avalible in The Most Unholy Edition (1.5))
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.
Health Down	Decreases HP capacity by 1. Changes to Health Up when at max HP of 1
Health Up	Increases HP capacity by 1. Does not increase current HP; only gives an empty heart container. Tints the player red. This pill counts as damage for the purpose of the No Damage Achievements.
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 a fly flying around the player's head which blocks projectiles, similar to Halo Of Flies.
Range Down	Decreases range.
Range Up	Increases range. Tints the player blue.
Speed Down	Decreases speed by 24% base speed.
Speed Up	Increases speed by 30% base speed. Tints the player yellow.
Tears Down	Decreases tear firing rate. (Increases charge time)
Tears Up	Increases tear firing rate. (Decreases charge time) Tints the player purple.
Telepills	Single-use version of the Teleport! item. May teleport to the I AM ERROR room in 1/15 chance. The I AM ERROR room on floors past the Womb does not have an exit, due to an oversight. For this reason, it is not advisable to use this pill on floors past the Womb.

Wrath of the LambEdit

Three new pills and four new effects are added in the Wrath of the Lamb expansion. These appear along with the previous pills/effects and are mixed in with the randomly assigned types and effects.

Pill Name	Effect
Luck Up	Increases the player's Luck. Tints the player green.
Luck Down	Decreases the player's Luck.
Friends Till The End!	Gives you three homing flies.
Puberty	Pubic Hair on Isaac's body.

Items associated with PillsEdit

Lucky Foot

Holding this item eliminates the possibility of finding Stat Down Pills 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.

Mom's Bottle Of Pills

When used, this item gives you a free pill. Recharges after clearing 6 rooms.

PHD

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.

The Safety Cap

This Trinket, while held, slightly increases the odds of finding pills in chests and when completing a room.

Mom's Coin Purse

Spawns 4 random pills.

NotesEdit

• When consuming an unidentified pill at 1 red heart, if the consumed pill would normally be a Health Down pill or Bad Trip pill, the resulting effect will be the opposite of the intended effect. The pill will be labeled as its positive counterpart.

TriviaEdit

• 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 catchy phrase 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 code doesn't work due to a bug.
• The "Balls of Steel" effect is likely a reference to one of Duke Nukem's catchphrases.
  • It refers to the phrase that describes "having balls" as "having the confidence" for doing something, which reflects the concept behind soul hearts - faith.

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