The Binding of Isaac: Repentance - Top 20 Best Items To Pick

TMTRAINER makes all future items “glitched”, causing 2-3 items to combine into one another; gives Isaac random effects. Take it at your own risk.

• Only found in Secret Rooms.
• Can break your run.

Terra lets you open doors and entrances to all special rooms in the game. It also lets you break rocks to fill holes. No more wasting bombs!

• Only found in Planetarium Rooms (1%-15% chance per floor).

With Astral Projection you can reach inaccessible pickups as a ghost, such as stranded hearts, coins, chests, etc.

• Potential lifesaver.
• Found in Treasure Rooms and Secret Rooms.

The sword isn't just strong - it also collects pickups you can’t reach otherwise with your character, and lets you open Mimic chests without taking damage.

• Only found in Angel Rooms.

Because the star finds the shortest way to the Boss Room, it also moves through walls and can uncover Secret Rooms.

• Homing tears + stats up
• Only found in Angel Rooms.

Salvation is the most powerful item if you were also lucky to get the Gnawed Leaf.

Sit back and patiently watch as your enemies get smoked by holy beams while you're invincible. Watch them burn.

• Only found in Angel Rooms.

Revelation is similar to Brimstone, except it doesn’t replace your tears and has a few more advantages. Some players prefer it simply because it's free.

• Only found in Angel Rooms.

Psy Fly is one of the most reliable defense buddies in the DLC.

If you have Box of Friends, you can double the Psy Fly and ensure a pretty solid wall against shooting enemies. 

• Found in Treasure Rooms.

This item has some of the most powerful synergies in the entire game.

For example, if you obtain C Section and Spirit Sword, each of your tears will be holding a sword they swing, dealing extra damage. 

• Found in Treasure Rooms.

Isaac becomes gigantic, indestructible and stompy for 30 seconds. 

• Found in Treasure Rooms and Secret Rooms under mushrooms.

Allows for more and better item choices. Timing is crucial.

• Found in Secret Rooms

By fully charging Flip before entering item rooms you can get two items instead of just one. This is especially useful in Angel/Devil Rooms.

• Tainted Lazarus's starting item
• Found in Curse Rooms and Secret Rooms

In many instances, the underground market will have better items for sale than the Shop, as they are usually from Secret Room, Angel Room, Devil Room, or Boss Room pools. Prepare more coins. 

• Obtained from the Shop for 15 coins. 

Never exit the first room without going up the stairs. Angel Room shops can sell significantly better items than the Shop.

• Only found in Angel Rooms.

Boosts the special attack of each character individually. Also removes characters' weaknesses. The best item to lead you to victory.

• Obtained from the Shop for 15 coins.

Allows Isaac to open doors to Red Rooms that have a chance to be special. One of the best synergies of Red Key is with The Book of Virtues.

• Found in Secret Rooms, Curse Rooms, Red Chest and Mom's Chest.
• Better rooms = better items.

To best utilize Rock Bottom, try and gain as much of a single stat as you can in a single room, like for example using the Strength card and the Devil card together.

• Only found in Secret Rooms.
• No more stat downs!

Using the R Key helps you defeat more than one final boss, and restarting the game with a powerful build makes for a breezy rerun.

• Only found in Secret Rooms.

Genesis is especially useful if you want to re-roll your character build entirely and works best the more items and copies of the same items you’ve previously picked up. 

• Only found in Angel Rooms.

It shows you nearly every item in the game. But remember - you can only pick one, and it's always a tough choice. 

• Only found in Secret Rooms.