Item Guides
The best and most powerful items in The Binding of Isaac: Rebirth, grouped by type.
Passive Items
Brimstone
Quality: **** (4/4)
Replaces tears with a powerful blood laser beam that charges and fires across the entire room. One of the strongest damage items in the game.
Ipecac
Quality: **** (4/4)
Tears become explosive, arcing shots that deal massive damage on impact. Adds 40 flat damage but can hurt the player with self-splash.
Tech X
Quality: **** (4/4)
Tears are replaced with chargeable laser rings that travel across the room. Damage scales with charge time and synergizes with most tear effects.
Sacred Heart
Quality: **** (4/4)
Grants homing tears, a huge damage multiplier, increased health, and slower shot speed. One of the rarest and most powerful items.
Mom's Knife
Quality: **** (4/4)
Replaces tears with a throwable knife that deals massive damage based on charge. Short range but extremely high DPS at close range.
Polyphemus
Quality: **** (4/4)
Massively increases damage at the cost of fire rate. Tears that kill an enemy continue traveling with leftover damage. Giant tear effect.
Crown of Light
Quality: *** (3/4)
Doubles damage while the player has no empty red heart containers. Deactivates upon taking damage but reactivates after clearing a room.
Dead Cat
Quality: *** (3/4)
Grants 9 extra lives but sets health to one red heart container. Part of the Guppy transformation which grants flight and spawns attack flies.
Guppy's Paw
Quality: *** (3/4)
Converts one red heart container into three soul hearts on use. Part of the Guppy transformation. Excellent for trading health for survivability.
Spirit Sword
Quality: **** (4/4)
Replaces tears with a melee sword that deals high damage and can fire projectile slashes at full health. Spin attacks deal extra damage.
Active Items
Mega Blast
Quality: **** (4/4)
Fires an enormous Brimstone laser for the entire room duration and persists across rooms. The rarest and most powerful active item in the game.
Book of Revelations
Quality: *** (3/4)
Grants one soul heart on use and guarantees a Horseman boss on the current floor, dropping a cube of meat or ball of bandages.
The Bible
Quality: *** (3/4)
Grants flight for the current room. Instantly kills Mom and Mom's Heart bosses but also instantly kills the player against Satan.
Box of Friends
Quality: *** (3/4)
Doubles all familiars for the current room. Essential for Lilith and extremely powerful with multiple familiar items.
Crooked Penny
Quality: *** (3/4)
Has a 50% chance to double all pickups and items in the room, or a 50% chance to destroy them all. High risk, high reward.
D6
Quality: **** (4/4)
Rerolls item pedestals into different items. Isaac's signature item and one of the most consistently useful active items in the game.
Void
Quality: *** (3/4)
Absorbs passive items to gain stat boosts and absorbs active items to trigger their effects on each Void use. Apollyon's starting item.
Death Certificate
Quality: **** (4/4)
Teleports the player to a special floor containing every item in the game. Choose any single item for free. Single use only.