Pills in The Binding of Isaac: Rebirth are single-use consumables that can give Isaac helpful or harmful effects.
They share the same consumable slot as cards and runes, so learning how to use, drop, and identify them is important during every run.
The Binding of Isaac: Rebirth
Release Date: November 04, 2014
Genres: Shooter, Puzzle, Role-playing (RPG), Adventure, Indie, Arcade
To use a pill, pick it up and press the consumable button. On keyboard, that button is Q. On an Xbox-style controller, it is usually RB. On a PlayStation-style controller, it is usually R1.
TL;DR – Key Info
- Use pill on keyboard: press Q.
- Use pill on controller: press RB / R1.
- Drop a pill: hold Left Ctrl on keyboard or hold RT / R2 on controller.
- Pills are unidentified at first and show as ???.
- Once used, that pill color keeps the same effect for the rest of the run.
- Pills can be good or bad, so avoid testing unknown pills during dangerous fights.
How to use pills in The Binding of Isaac
Isaac can hold one consumable at a time unless you have an item that gives you extra consumable slots. When you pick up a pill, it appears in your consumable slot. Press the use consumable button to take it immediately.
| Action | Keyboard | Controller |
|---|---|---|
| Use pill | Q | RB / R1 |
| Drop pill | Hold Left Ctrl | Hold RT / R2 |
| Swap consumable | Left Ctrl | RT / R2 |
Worth Knowing: The swap button only matters when Isaac can hold more than one consumable. Otherwise, holding it lets you drop your current pill, card, rune, or trinket.
How pills work
Pills are random at the start of each run. A pill usually appears as ??? until you use that color for the first time. After that, every pill with the same color will show the revealed effect for the rest of the run.
That means one blue-white pill might be Speed Up in one run, but a completely different effect in another run. Pill colors are not permanently tied to the same effects across all runs.
Good pill effects
Some pills can increase stats, heal Isaac, give useful temporary effects, or help in specific rooms.
Bad pill effects
Some pills can reduce stats, damage your run, or make combat harder, especially if used at the wrong moment.
When should you use unknown pills?
The safest time to test an unknown pill is after clearing a room, away from enemies, spikes, and hazards. Avoid using unidentified pills during boss fights or dangerous rooms, because a bad effect can make the fight much harder.
If you are low on health, carrying a strong card, or close to finishing a floor, it may be better to leave the pill on the ground instead of gambling on an unknown effect.
Items like PHD, False PHD, and Lucky Foot can change how pills behave, making them more predictable or valuable depending on the item.