Item Icon Item Name Effect

O The Fool Teleports the player to the starting room of the current level, even if you use the card in the starting room. TIP: This card has little use, but it can teleport you out of inescapable rooms like the Challenge Room and the Mom boss fight, and the damage-upon-entry Curse Room. It can also teleport you out of problematic rooms in a pinch.

I The Magician Player's shots curve towards enemies and may turn purple until you leave the current room. TIP: This effect is the same as Spoon Bender and Telepathy For Dummies; this card is useless in the case of the former and best used when the latter lacks charge.

II The High Priestess Summons Mom's foot stomp on a random enemy (targets the player if fighting Mom or if there are no enemies present), dealing massive damage — enough to kill most bosses and wiping half of Mom's own health if used on her. Acts as an explosion — will destroy rocks and can open secret rooms.

TIP: As mentioned, this card will target Isaac if no enemies are present in the current room; make sure that's something you want to do before you use this.

III The Empress Turns the player into a demon, increasing damage by 2 and speed by 1 until you leave the current room.

TIP: This effect is the same as Whore Of Babylon; as such, this card is useless if you already have this item and it is active.This card is best saved for a room you're going to stay in for awhile, such as a Challenge Room or the Boss Room.

IV The Emperor Teleports the player to the Boss Room. If used while fighting the boss, the fight will restart and the boss will be back at full health. (Will be the same boss, but could possibly change to a different colored version) TIP: Try to save this card for the final floor of your run; also keep in mind that you can use the inertia from running to take another card or pill into the boss room with you, if you're fast enough. When used after defeating mom, you'll unlock another item in the basement.

V The Hierophant Spawns 2 soul hearts. TIP: It spawns these rather than adding them to your life, as Balls of Steel does; use this to your advantage, if you can.

VI The Lovers Spawns 2 full hearts. TIP: It spawns these rather than adding them to your life; use this to your advantage, if you can.

VII The Chariot Grants you temporary invincibility, and causes you to damage enemies with touch. However, you cannot attack unless you're holding Mom's Knife.

TIP: This is the same effect as My Little Unicorn, so this is best used when said item lacks charge.

VIII Justice Spawns 1 random type of Bomb drop, Key drop, Coin drop, and Heart drop. TIP: This can spawn anything dropped by clearing a room, like Troll Bombs, 1+1 Free, Soul Hearts, and nickels; with Wrath of the Lamb, you can also get Super Troll Bombs, Eternal Hearts, Golden Keys and dimes from using this card. Also, as with The Lovers and The Hierophant, it spawns these rather than adding them to your life and inventory; use this to your advantage, if you can. This card will spawn a specific kind of heart if a room forces it (full red heart in the womb-themed top secret room, eternal heart in the cathedral-themed top secret room).

IX The Hermit Teleports the player to the Shop. If there is no Shop (or you are already in one), this will act as a random teleport. TIP: This card can teleport you into a locked Shop, and you will open it without consuming a key if it does.

XI Strength Makes the player bigger, increasing maximum health and damage until the player leaves the current room (same effect as Odd Mushroom (Large)). ??? receives a permanent spirit heart rather than a temporary maximum health increase, however this may be a bug. TIP: This card is best saved for a room you're going to stay in for awhile, such as a challenge room or the boss room; it can also be used as a last-ditch healing effort.

XII The Hanged Man Removes the player's body allowing flight over obstacles, spikes and pits until you leave the current room. If you have Brimstone, instead of removing the players body it will give them wings (All the same as single-use Transcendence). TIP: This card is useless if you have any item that already allows flight, such as Transcendence (as Item), Lord Of The Pit, Fate, or the Holy Grail.

XIII Death Damages all enemies in the room significantly. TIP: This does the same thing as the The Necronomicon, and they can be devastating to enemies in the room if you use them in quick succession. This technique is best saved for Bosses, though; especially those that like to spawn lesser enemies.

XIV Temperance Spawns a Blood Donation Machine.

TIP: If you can, find a room with another Slot Machine, Fortune Telling Machine, or Blood Donation Machine to maximize gambling efficiency.

XV The Devil Increases your damage by 2 until you leave the room.TIP: This has the exact same effect as The Book Of Belial bar the guaranteed devil with the devil chance on boss rooms. Using both in the same room will not cause the damage to stack.

XVI The Tower Spawns six troll bombs around the room. TIP: This does the same thing as the Anarchist Cookbook, and they can be devastating to both yourself and enemies in the room if you use them in quick succession.

XVII The Stars Teleports the player to the Treasure Room. If there is no Treasure Room, this will act as a random teleport. Randomly chooses a Treasure Room in XL floors. TIP: This card can teleport you into a locked Treasure Room, and you will open it without consuming a key if it does.

XVIII The Moon Teleports the player to the Secret Room. This card will open one random wall once inside the Secret Room, so you can leave even if you don't have any bombs available. TIP: This card can teleport you out of inescapable rooms like the Challenge Room and Mom's room. It can also get you out of problematic rooms in a pinch.

XIX The Sun Completely heals player, damages all enemies, reveals the entire map and location of special rooms for the current level and removes the effect of Curse of the Darkness. (Same effect as XXI The World and a Full Health pill combined, though unlike a Full Health Pill, it will not heal ???.) TIP: Try to use this card in an uncleared room or on the Boss, if you need to use it at all.

XX Judgement Spawns a beggar. In Wrath of the Lamb, this may also spawn a Devil Beggar. TIP: Try to wait until you get into a Devil Room or an Angel Room to use this card; if you do and give the Beggar enough money, he will leave behind an item specific to that room instead of a more random item. If you cannot get either before leaving this card behind, use it in the Curse Room or the Secret Room.