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* Special Items are underlined *Activatables are in Italics

Binding of Isaac: Rebirth - Item Tier List OUTDATED - Base Game Only - AFTERBIRTH EDITION COMING SOON

As voted by r/BindingOfIsaac

S Rank A Rank B Rank C Rank D Rank E Rank

Voted Best - The Stopwatch S+ Book of Belial A+ Black Lotus B+ <3 C+ Anemic D+ Abel E+
Voted 2nd - Brimstone* S+ Cricket's Head A+ Cat-O-Nine-Tails B+ BBF C+ Blood Rights D+ Cain's Other Eye E+
Voted 3rd - Mom's Knife S+ Goat Head A+ Champion's Belt B+ Blood Bag C+ Boomerang D+ Holy Water E+
Voted 4th - Epic Fetus S+ Magic Mushroom A+ Cube of Meat B+ Bob's Curse C+ Bum Friend D+ The Bean E+
Voted 5th - Godhead S+ Proptosis A+ Dead Cat B+ Box of Spiders C+ Dead Bird D+ The Poop E+
Voted 6th - Sacred Heart S+ The Wafer A+ Guppy's Tail B+ Celtic Cross C+ Ghost Baby D+ Breath of Life E
Voted 7th - Holy Mantle S Abaddon A Jesus Juice B+ Libra C+ Lemon Mishap D+ D10 E
Voted 8th - 20/20 S Black Candle A Lump of Coal B+ Little Steven C+ Magic 8 Ball D+ Dead Sea Scrolls E
Voted 9th - Ipecac S Blank Card A Odd Mushroom (Thick) B+ Magic Scab C+ Missing No. D+ Kamikaze E
Voted 10th - The D6 S Blue Candle A Pyro B+ Match Book C+ Missing Page 2 D+ The Butter Bean E-
Dark Bum S- Capricorn A Raw Liver B+ Midas Touch C+ Monstros Tooth D+
Polyphemus S- Ceremonial Robes A Sad Onion B+ Mongo Baby C+ Mr Boom D+
Pyromaniac S- Chocolate Milk A Sagittarius B+ Old Bandage C+ Pageant Boy D+
Contract from Below A Small Rock B+ Piggy Bank C+ Portable Slot D+
*Synergy with Tammy's Head voted Cricket's Body A Spoon Bender B+ Rosary C+ Razor Blade D+
best synergy in the game. Dead Dove A Squeezy B+ Samson's Chains C+ Skatole D+
Death's Touch A Steven B+ Sissy Longlegs* C+ Soy Milk D+
Fate A Super Bandage B+ Speed Ball C+ Spider Butt D+
Growth Hormones A The Compass B+ Stem Cells C+ The Hourglass D+
Holy Grail A The Habit B+ Technology 2 C+ The Scissors D+
Humbleing Bundle A Tooth Picks B+ A Snack C Tiny Planet D+
Infestation 2 A Torn Photo B+ Anti Gravity C Anarchist's Cookbook D
Judas' Shadow A Whore of Babylon B+ Aquarius C Best Bud D
Lil' Brimstone A Wire Coat Hanger B+ Aries C Best Friend D
Ludovico Technique A ???'s Only Friend B Bobby - Bomb C Black Bean D
Mitre A 1up B Bogo Bombs C Bob's Brain D
Mom's Contacts A 3 Dollar Bill B Bomb Bag C Brother Bobby D
Money = Power A 9 Volt B Book of Secrets C Isaac's Heart D
Monstro's Lung A A Dollar B Book of Sin C Isaac's Tears D
Mutant Spider A Ball of Bandages B Boom! C Mom's Pad D
Pentagram A Ball of Tar B Bottle of Pills C Monster Manual D
Red Candle A BFFS! B Breakfast C Notched Axe D
Sacrificial Dagger A Big Fan B Butt Bombs C Robo Baby 2.0 D
Satanic Bible A Blood Clot B Caffeine Pill C Shoop Da Woop D
Skeleton Key A Blue Cap B Deck of Cards C Sister Maggy D
SMB Super Fan A Blue Map B Dessert C Strange Attractor D
Spirit of the Night A Book Of Shadows B Dinner C Telepathy for Dummies D
Tech.5 A Chemical Peel B Doctor's Remote C Teleport D
The Halo A Cupid's Arrow B Guillotine C The Jar D
The Mark A D100 B Guppy's Hairball C We Need to go Deeper D
The Mind A D20 B Harlequin Baby C Crack the Sky D-
The Pact A D4 B Headless Baby C Cursed Eye D-
The Polaroid A Dead Onion B Hot Bombs C Experimental Treatment D-
The Relic A Demon Baby B Infestation C
The Soul A Dry Baby B IV Bag C
There's Options A Fire Mind B Lazarus' Rags C
Trinity Shield A Forget Me Now B Leech C
Undefined A Gemini B Little C.H.A.D C
Blood of the Martyr A- Gimpy B Lunch C
Bloody Lust A- Gnawed Leaf B Magic Fingers C
Book of Revelations A- Guardian Angel B Mom's Coin Purse C
Cancer A- Guppy's Head B My Little Unicorn C
Crystal Ball A- Halo of Flies B Mysterious Liquid C
Dark Matter A- Infamy B Mystery Sack C
Daddy Longlegs A- Iron Bar B Rainbow Baby C
Guppy's Paw A- Juicy Sack B Remote Detonator C
Head of Krampus A- Latch Key B Robo-Baby C
Hive Mind A- Leo B Rotten Meat C
Inner Eye A- Lil' Haunt B Sack of Pennies C
Lord of the Pit A- Little Gish B The Ankh C
Lost Contact A- Maggy's Bow B The Belt C
Mom's Key A- Meat B The Bible C
Mom's Wig A- Mini Mush B The Gamekid C
Mulligan A- Mom's Purse B The Ladder C
PHD A- Number One B The Necronomicon C
Pinking Shears A- Odd Mushroom (Thin) B The Peeper C
Rotten Baby A- Ouija Board B Wooden Spoon C
Rubber Cement A- Pandora's Box B Yum Heart C
Sad Bombs A- Pisces B Bob's Rotten Head C-
Synthoil A- Prayer Card B Charm of the Vampire C-
Tammy's Head* A- Punching Bag B Converter C-
The Body A- Scapular B Dr Fetus C-
The Nail A- Scorpio B E. Coli C-
Transcendence A- Screw B Flush! C-
Virgo A- Sharp Plug B How to Jump C-
X-Ray Vision A- Smart Fly B Little Baggy C-
Spider Bite B Loki's Horns C-
*Synergy with Brimstone voted best Steam Sale B Magneto C-
synergy in the game Stigmata B Mom's Bra C-
Taurus B Mom's Eye C-
Technology B Mom's Heels C-
The Battery B Mom's Lipstick C-
The Common Cold B Mom's Underwear C-
The Parasite B My Reflection C-
Thunder Thighs B Spiderbaby C-
Tough Love B The Virus C-
Treasure Map B
Unicorn Stump B
*Voted The Cutest Familiar (by far)
A Pony B-
Box B-
Broken Stopwatch B-
Bucket of Lard B-
Dad's Key B-
Distant Admiration B-
Eve's Mascara B-
Fanny Pack B-
Forever Alone B-
Guppy's Collar B-
Little Chubby B-
Lucky Foot B-
Mom's Eyeshadow B-
Mom's Perfume B-
Mr Mega B-
Roid Rage B-
Placenta B-
Safety Pin B-
Spelunker's Hat B-
Starter Deck B-
The Negative B-
The Quarter B-
White Pony B-
Character Ranking

Character Azazel Isaac + D6 Judas Samson Cain Eve Isaac Magdalene Lazarus ??? The Lost
Rank 1 2 3 4 5 6 7 8 9 10 11
Starting Items Brimstone D6 Book of Belial Bloody Lust Lucky Foot Dead Bird Yum Heart Lazarus' Rags The Poop Flight
Flight Whore of Babylon

HP 3 Black Hearts 3 Red Hearts 1 Red Heart 3 Red Hearts 2 Red Hearts 2 Red Hearts 3 Red Hearts 4 Red Hearts 3 Red Hearts 3 Blue Hearts No Health

Damage *1.5 *1 *1.35 *1 *1.2 *0.75 *1 *1 *1 *1.05 *1

Tears +0.5, *1/3 default default -0.05 default default default default default default default
Speed 1.25 1 1 1.1 1.3 1.23 1 0.85 1 1.1 1
Range 17.75 23.75 23.75 18.75 17.75 23.75 23.75 23.75 17.75 23.75 23.75
Shot Speed 1 1 1 1.31 1 1 1 1 1 1 1
Luck 0 0 0 0 0 0 0 0 -1 0 0
Starting Pickups 0 - The Fool 1 Bomb 3 Coins None 1 Key None 1 Bomb None 1 Pill None 1 Coins
 Trinket Ranking
Click on a trinket name for a link to the wiki page

Great Good Ok Bad Terrible

1st Cancer Ace of Spades ???'s Soul Broken Ankh Butt Penny
2nd Curved Horn Burnt Penny Bible Tract Broken Remote Cursed Skull
3rd AAA Battery Callus Black Lipstick Cain's Eye Missing Poster
4th Paper Clip Daemon's Tail Bloody Penny Hook Worm Mom's Toenail
5th Store Credit Flat Penny Broken Magnet Isaac's Fork Mysterious Candy
6th Mom's Pearl Judas' Tongue Cartridge Missing Page Ring Worm
The Left Hand Child's Heart Mysterious Paper Umbilical Cord
Liberty Cap Counterfeit Penny Purple Heart
Lucky Rock Eve's Bird Foot Wiggle Worm
Petrified Poop FIsh Head
Pinky Eye Goat Hoof
Whip Worm Flat Worm
Isaac's Head
Lucky Toe
Maggy's Faith
Match Stick
Monkey's Paw
Pulse Worm
Push Pin
Red Patch
Rosary Bead
Rusted Key
Safety Cap
Samson's Lock
Swallowed Penny
Tick
Challenge Info
Challenge No. Challenge Name Difficulty Rank Fun Rank Unlocked By: Goal Reward Starting Items Extra Info
1 Pitch Black 15 6 Unlocked by default Mom Hagalaz Rune None Treasure rooms available, no shops, cannot see health, rooms are darker.
2 High Brow 10 5 Unlocked by default Mom Jera Rune Number One, E Coli, Butt Bombs, Flush, Petrified Poop None
3 Head Trauma 3 10 Unlocked by default Mom Ehwaz Rune Tiny Planet, Soy Milk, Small Rock, Iron Bar None
4 Darkness Falls 13 4 Unlocking It Lives Satan Dagaz Rune Pentagram, Dead Bird, Whore of Babylon, Razor Blade, Sacrificial Dagger, Dark Matter Play as Eve
5 The Tank 14 15 Unlocking Magdalene Mom Ansuz Rune Lard, Infamy, Yum Heart, Thunder Thighs Play as Maggy
6 Solar System 1 14 Unlocking Transcendence Mom's Heart Perthro Rune Transcendence, Distant Admiration, Forever Alone, Halo of Flies Cannot use tears. Start as Lord of the Flies
7 Suicide King 6 11 Unlocking It Lives Isaac Suicide King Ipecac, Mr Mega, My Reflection Play as Lazarus.
8 Cat Got Your Tongue 4 17 Transforming into Guppy Mom Algiz Rune Guppy's Head, Guppy's Tail, Guppy's Hair Ball Cannot use tears. Start as Guppy.
9 Demo Man 11 8 Unlocking Dr. Fetus Mom's Heart Chaos Card Dr Fetus, Remote Detonator, Match Stick None
10 Cursed! 9 9 Unlocking Magdalene Mom Credit Card Yum Heart, Raw Liver, The Compass, Treasure Map, Blue Map, Child's Heart Treasure rooms available, normal rooms have cursed (spiked) doors. Play as Maggy.
11 Glass Cannon 18 2 Unlocking Loki's Horns + Epic Fetus Satan Rules Card Epic Fetus, Loki's Horns Play as Judas
12 When Life Give You Lemons 12 12 Unlocked by default Mom Card Against Humanity Lemon mishap, 9 Volt, Habit Start with 1 Lemon Party Pill
13 Beans! 2 20 Unlocked by default Mom Burnt Penny Pyro, The Bean, The Black Bean, 9 Volt, Butt Bombs Cannot use tears.
14 It's in the Cards 17 7 Unlocked by default Mom SMB Super Fan Deck of Cards, Starter Deck, Battery, 9 Volt Start with 2 random cards
15 Slow Roll 19 3 Unlocked by default Mom Swallowed Penny Polyphemus, My Reflection, Cupid's Arrow None
16 Computer Savvy 20 1 Unlocked by default Mom Robo-Baby 2.0 Technology, Technology 2, Spoon Bender None
17 Waka Waka 8 13 Unlocked by default Mom Death's Touch Strange Attractor, Anti - Gravity None
18 The Host 16 16 Unlocked by default Mom Tech.5 Spider-Baby, The Mulligan, The Tick None
19 The Family Man 5 19 Unlocking Dad's Key + It Lives Isaac Epic Fetus Brother Bobby, Sister Maggy, Dad's Key, BFFS!, Rotten Baby Cannot use tears.
20 Purist 7 18 First Mom Kill Mom's Heart Berkano Rune None No shops.
Rune Rankings
Position Name Effect
1st Jera Duplicates all pickups and chests
2nd Perthro One time use D6 effect
3rd Algiz Grants a 30 second long shield
4th Ansuz Reveals entire map, including secret rooms
5th Dagaz Removes curse, adds a soul heart
6th Hagalaz Destroys all rocks/skulls/pots in the room
7th Berkano Spawns 3 friendly flies and 3 friendly spiders
8th Ehwaz Creates a trapdoor