Items are an integral part of gameplay in The Binding of Isaac series. They modify a character's stats, grant or modify abilities, and many other things.

Items in general are classified into a number of distinct types and groups. Some items are passive, which add an effect permanently to Isaac, while others only activate when used.

Items dropped in the Binding of Isaac NEVER disappear over time; a coin dropped will remain where it was dropped until you pick it up or leave the floor. A dropped item can be left in its place to be collected at a later time.

Types

Among these types are:

Activated Items

Activated Items fill your spacebar slot. Only one can be carried at a time. An activated item can be used by pressing space, and unlike a pill or card, activated items recharge over time and can be reused when ready. Each item has a unique effect. Most activated items can only appear once per game with few exceptions, so leaving behind an activated item is typically a permanent choice.

Passives

These Items, when picked up, add a permanent effect to Isaac. These cannot be removed and are individually counted on the collection screen. Collectible items can be obtained in a variety of ways and most are unique in that, once appearing in game, they will never appear again during that session.

These go into your Q slot and are one-time-use items. There are a number of different pill styles and effects. At the start of the game, each type is randomly assigned an effect, which remains bound to that pill style for the remainder of that game. Pills start unidentified and are identified once used, unless the player has the PHD item, which identifies pills after a short delay. Picking up a pill or card while you already have one causes the old one to be dropped.

Tarot Cards are also Q slot items, and are also one-time use. Tarot Cards are unidentified when dropped and immediately identified when picked up. Each card has a unique and pre-determined effect. Picking up a pill or card while already carrying one causes the old one to be dropped.

Trinkets fill their own slot and are passive items that affect Isaac in unique ways. Only one can be carried at a time (Unless the player has Mom's Purse, which allows Isaac to hold two Trinkets at once); taking another will replace the current trinket and drop the old one.

These are common items dropped in game and, when taken automatically confer their effect. This category includes items such as coins, hearts, keys and bombs and disappear once picked up.

Collectibles

There are 198 different collectible items in the game. Below is a list of all of the collectibles, separated into categories. Certain collectibles change the appearance of your character when they are acquired. Collectibles you've found can be seen in the Collection page.

Activated Collectibles

These items are stored in the Spacebar slot and are used up once the button is pressed. The items then recharge in one of two ways. Normally, they charge a number of bars after every room you clear—some items charge one bar at a time, others charge faster. Note that only rooms where the doors close until they are cleared count—Bosses, arenas, enemy rooms, etc. The Collectible Item "Battery" can give bars of charge during combat, on top of the normal recharge. Another Collectible Item, the "9 Volt", will automatically recharge 2 bars when an item is used; this effectively reduces the number of rooms required to charge an item if the item requires 3 or more rooms to charge. In the Wrath of the Lamb DLC, there is another item, the Habit, which will recharge bars when taking damage. To see a clearer version of the in-game arrangement, go to the Collection page.

Note: Any two of the same activated item on the same floor will share charge state, i.e. Finding another of the same activated item when one is not fully charged will not give the player another fully charged version of the item. This can be observed in the Library, which can spawn 2 of the same book.

The following activated items can only be acquired in the Wrath of the Lamb DLC.

Rebirth Activated Collectibles

The following activated items were added in The Binding of Isaac: Rebirth.

Passive Collectibles

These items generally give you some kind of a boost to your stats, or add a special passive ability. They take effect immediately once picked up, and continue for the rest of the game (except for several items that do not provide any lasting effect).

Edmund McMillen split them up in his blog into the subcategories "weapon items" (Such as Number One), "stat padding items" (Such as Growth Hormones), "passive items" (Such as Mitre), and Familiars (Such as Little Gish).

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The following collectible items can only be acquired if you have the Wrath of the Lamb DLC.

Rebirth Passive Collectibles