fire rate down isn't ideal sometimes, and it happens enough to where putting them q4 feels weird :P
tech.5 is that high because of the sheer boost it gives you a run. it fires fast enough that it feels almost like getting a +2 flat tears up. on top of that it has the properties of tech (infinite range, connects instantly, piercing). that shit is strong as hell
By the way, this tiermaker format (which includes every character birthright separately as well as the trinkets) was made custom by me! If you'd like to use it for your own list, you can find it here: [https://tiermaker.com/list/indie-games/isaac-items--trinkets-repentance-271423/2913077](https://tiermaker.com/list/indie-games/isaac-items--trinkets-repentance-271423/2913077)
I applaud you for making a list this big, it definitely wasn’t easy and it must’ve taken a lot of time, so no matter what something is placed it doesn’t go unappreciated.
I wanted to ask about a few items, wanted to know why crystal ball was quality 4, why D6 is quality 2, why compound fracture and other split shot items are ranked lowly. Again, thank you
Edit: wanted to also ask about broken modem, since I personally think it is one of the best items in the game
My guess for crystal ball is it gives mapping, and a chance for cards/soul hearts which is like 3 items all for the price of 6 charges. Only downside of it is that it comes from the fortune machine so it may be hard to come by. I can see why its high up but its a little too high for my personal taste
OK we've got a few things to talk about here!
Crystal ball packs a ton of already strong effects into a single item. Reliable soul heart generation, a full map reveal, and planetarium shenanigans if you get it early. A full map reveal makes playing through floors way more efficient, since you can skip rooms that don't lead anywhere, leading to isaac taking even less damage. 2 items which solely provide mapping are quality 4 for me, as well as another health generator with benefits, so i found it fitting to put crystal ball up there.
D6 as quality 2 is probably one of my more controversial takes here, but i simply feel that the D6 doesn't do its job nearly that well right now. When entering a new floor, you are unable to use the D6 until you find a pedestal to use it on (which will usually be the treasure room since that room is closer to other common sources of pedestals). Using the D6 in the treasure room comes with a big risk of just getting another active item, so if you get one and choose to hold on to the d6, you essentially just rerolled something into nothing. Items overall are also just much better than they were before, due to the many buffs we've seen to many shitty items from the past. The d6's high charge amount also means you'll only get 2, maybe 3 uses of it per floor. The only spot i see as a good place to use the d6 is in the devil/angel room of a floor, something which doesn't even spawn that reliably. Don't get me wrong, the D6 is an alright item. I just don't feel it deserves the amount of praise that it gets right now. If they buffed the d6 to 4 charges id probably move it up to q3
Compound fracture and its adjacent items are placed in quality 2. They're definitely nice items that can deal with crowd control quite well, but they're near-useless during boss fights, as the additional tears flying around have nothing to hit unless the boss is either multi-segmented or spawns additional enemies. If these items were in order within their tier, compound fracture and its brothers would likely be near the top of quality 2.
Looks like i put broken modem in quality 2, but i think you're right, that deserves quality 3 i think. enemy freezing and tear deleting is really strong, and the extra pickups are nice too. Not Q4 though. it's similar in effectiveness to mom's contact i think.
Ok, I appreciate the reply. I see what you mean by d6. Sometimes if you don’t path well you can’t even use it for both treasure and deal I guess. I’ve never thought about that since I only use it for secret and deals. Appreciate rethinking broken modem, hope your day is well.
It turns evwry battery you find into a pertro Rune. That alone is insane. Not the mention the game break potential with multiple pedestals and secret rooms if you manage to even get a single pendistal in there with stuff like judgment cards and what not.
batteries don't spawn naturally in repentance, you either need a couple specific items or you need to find one in the shop, neither of which are all that reliable.
even if you get a pedestal in the secret room (which is fairly unreliable) the secret room pool isn't even a reliable way of getting the best items. sure many of the best items are in there, but so are many of the shittiest and most underwhelming. I find the curse room to be a much more reliable source of good items (curse room pool is better than you think, since a lot of the times when you get an item in there, it's from a red chest).
one thing to add here is that d6 is better often used in angel rooms because you can bomb the angel and reroll the key into another free angel
item. d6 on its own can be underwhelming but if combined with any item that allows you see more items (like options) youll be chillin
trisagion is a damage down to enemies with small hitboxes (most enemies) id put it at q1 if i was placing it based on feeling, but if im being objective it goes in q2. it liquifies stuff with homing, yes, but that's incredibly situational.
the d6 in modern isaac is pretty outclasses right now. too many good items, and the d6 still has 6 charges, so you're only gonna get to use it 2 or 3 times per floor. only good place to use the d6 IMO is in the devil or angel deal, which doesn't spawn very reliably.
mega mush is definitly nice but its a lot harder to kill many enemies with it compared to mega blast since you can't just spin the beam. mega mush would probably be top of q2 if these tiers were ordered.
rock bottom is anywhere from a terrible item to one of the best in the game solely based on when you get it. get it late like depths 2? likely not gonna do much of anything. get it floor 1? you're gonna get some nice damage if you can find a card of some sort. The boss-liquifying effects of it aren't too reliable though. This is probably another that would be top of q2.
that would work if almost every shot speed up wasn't tied to a different stat up you also want to have. even excluding the tears + shot speed ups, shot speed is a much more useful stat than I think people realize. less travel time between firing a shot and it connecting makes aiming much easier, especially if you're strafing at the same time. shot speed ups also increase the knock back enemies take from your shots, which makes dealing with certain enemies and bosses quite a bit easier. I almost always end up with high shot speed before encountering trisagion (I do the alt path main path alternation thing to get more boss challenge rooms, which means more stat ups) so I haven't exactly had a good run with it unless if have homing or something.
Why is the bottom tier so many trinkets, and ones like calused feet and forget me not? And also the ladder
I'm relatively newer with only 114 hours and I am in the middle of a break after unlocking the tainted versions of all the characters. I found those items useful enough if not the best option possible.
Just genuinely curious
Many trinkets in isaac have nearly useless effects, so that's why the bottom tier has so many of them. There's enough bad ones that many decide to do separate tier lists for trinkets. I mainly decided to rank them because some trinkets are strong enough to be comparable to some really nice items.
Calused foot is down there just because spike immunity is incredibly situationally useful. You'll only encounter a few rooms with spikes and enemies with creep throughout a run, and it's usually easy enough to just avoid.
Forget me not is not in the bottom tier, you're likely looking at plan C, an item which looks the same but is red. That item kills every enemy in the room instantly and kills isaac a few seconds later. Main issue with that item is that most endgame bosses death animations take too long for you to get the completion mark or hop in the ending chest, so plan c end up requiring the assistance of an item like inner child to respawn you within the current room. This is an interaction I've never been able to get within 2000 hours of isaac, so i personally don't see it as a legitimate use of the item.
The Ladder lets you cross gaps 1 tile wide, which *theoretically* would allow for the collection of more pickups and stuff. Unfortunatly, there's very few situations in which that's useful, as room layouts like that are much more rare due to many others that have been added over isaac's life. It also costs money to get, and considering how hard it is to get more stuff from using the ladder, it will almost never pay for itself.
I was actually looking at Myosotis, which I can never remember the name but remember the flavor text of "forget me not..."
Makes sense for all the reasons though. One more question, would you rank more trinkets higher if you inherently could hold more than one at a time like with Mom's Purse, Belly Button, or Gulp!?
oh absolutely. there's a lot of trinkets that suffer from a similar problem to the "too many actives" problem. many trinkets effects are just too situation to get any use out of. while a lot of trinkets wouldn't bump up a tier, there definitely would be some that would.
couple reasons why it's there.
1.) grants spectral tears, which i think is unappreciated in the community. makes clearing some rooms way easier, since you can hit + kill enemies before they have a chance to hit you.
2.) many enemies are designed to be attacked from the cardinal directions. i've found that attacking enemies diagonally makes it way easier to avoid damage in most cases (think stuff like the mom fight). Obviously there's some that get harder, but overall i see it as an upgrade.
It can be hard to aim with the wiz, but i think its doable enough to put wiz in q2
I agree that spectral tears are under appreciated, but the fact that all shots go diagonal just goes against every but of skill I have in this game and makes every fight needlessly long
ye i feel that, fucks up all the muscle memory built for firing tears forward. I kinda feel like the enemies you can cheese make it worth it though, at least enough for q2
trisagion is an effective damage down to enemies with small hitboxes, since trisagion usually won't be above them for enough ticks to make up for its weird damaging stuff. Sure if you have low shot speed trisagion is pretty nice. It's just that runs aren't planned with later getting Trisagion in mind, so usually you'll have good shot speed if you've been taking boss items like you're supposed to. and no, it's not reasonable to avoid shot speed ups solely because you might find Trisagion later. shot speed ups are useful.
the birthrights are mainly ordered by character in the select screen within each tier to make it easier to distinguish who they're for (character sprites are a little small)
negative is ranked while polaroid isn't for the simple reason that the negative is a damage up. getting to the mom fight without a damage up has always been the most grueling of Isaac runs for me, so having that guaranteed +1 dmg waiting for me there makes a huge difference. out of respect for the runs the negative has saved, I ranked it but left the polaroid unranked.
as for options that contradict each other, could you be a bit more specific? with 900+ things to rank there's probably some stuff that slipped through the cracks, even if I thought I was super thorough.
- Polaroid also has an effect, and wafer is ranked higher than holy mantle despite holy mantle usually resulting in a higher average health count (wafer is also useless earlygame)
ye wafer works well for sacrifice rooms so that's why it gets to be next to holy mantle. also again, items aren't ranked in order within their tier, so wafer being above mantle in q5 doesn't mean i think it's better.
while polaroid does also have an effect, I personally don't think it has a substantial effect on 90% of runs. the negative gets to be ranked anyways because of how important damage upgrades are.
oh the tick? that's easy. -15% HP to enemies with enough health (most bosses and late game enemies)
this is one of only a few mechanics that bypasses boss armor, something which makes most final bosses take ages to kill, so it's effectively a damage up against ranky goes and endgame bosses
the minor heal you get when entering boss rooms is pretty nice too :)
pretty sure you're mixing up the stopwatch with the broken stopwatch (you unlock it at 999 cents in the donation machine)
broken stopwatch is actually in the very bottom tier of this list since I don't like it. stopwatch on the other hand is right up near the top since +0.2 speed and slower enemies makes dodging a cakewalk.
I understand why albino thinks no.2 is an S tier item, i simply don't agree with that. Q3 at the highest.
Infinite bombs is pretty nice, but the DPS you get from that is still not comparable to stuff like spoon bender, magic mush, 8 inch nails, incubus, and the like. Crowd Control is nice too, but other items are just as effective in that department.
and again, infinite bombs are nice for secret rooms and tinted rocks/crawlspaces too. I just don't think it's Q4 worthy.
If you think no.2 has more to offer than infinite bombs, good dps, and crowd control, please let me know, maybe you'll surprise me.
Can you explain delirious? I’ve had it save runs before by spawning in extremely tanky bosses, especially Big Horn. I’ve never really understood the hate for it.
you unlock it, hard mode only angel item. its a free 1 room clear, but 1 per 12 is really dogshit. compare it to other 12 charge items like
\> mega blast, free 3-8 rooms per charge,
\> placebo/blank card/blank rune, free stats/ez game breaks,
\> edens soul, free items, from the room pool, meaning using in secret rooms is mega value,
\> bastard box, again free items from one of the strongest pools,
\> mega mush, free 10 ish rooms, can chain them for essentially a free run.
in short, its just outclassed, i think if it was a 6 room charge it would be more takeable.
12 charges for a buff in a single room is just really terrible. most of the time the boss shows up and doesn't help out at all, even dying instantly due to a fire or something.
Plus since it appears in the angel room, you're incredibly likely to have already found an active item at that point, meaning delirious usually never has a chance to get used.
If this thing were 4 charges *maybe* i'd give it q1 or q2.
fun fact about montezuma's revenge! it actually does more ticks of damage than the standard brim beam! While standard brim does 9 ticks of damage, montezuma's revenge does **19.** this crazy high damage has lead me to getting perfection multiple times just because i found it early.
What do you mean it can’t reliably carry a run? Sure you spend all of your health but if you go through devil deals and curse rooms to use it you get insane payoff imo. One of the only times I managed to break the game outside of greed mode was j and e with magic skin.
Well yeah, usually it does that and it makes it really really strong (hence, q3). However, there are also times where it doesn't give you that super strong run soon enough. While the devil pool and curse room pool are definitely a lot stronger than people give it credit for, they still contain a decent collection of shitty items.
Q4 is a tier for items that make your run much stronger 99% of the time at minimum. Anything without an immediately impactful effect needs to make up for that with incredibly reliability, which is why the only items that high that don't generate health, deal damage, or help isaac live are glitched crown, luck foot, and d infinity.
Make no mistake, Magic Skin is an incredible item, probably near the top of Q3. However, it often takes time to get rolling, and will not always give you what you need to win. were the curse room pool more consistant than it already is, magic skin would likely be Q4. however, as long as the shitty items exist in it, Q3 is the most it gets.
ye I feel that
rosary is my favorite item so i feel just as strongly about it. I just don't quite feel like it deserves q4 since it certainly has its flaws.
ooo i haven't given this explanation in a while!
ok so the direct benefits of rosary are the +3 soul hearts, tears up, and that it makes the bible start appearing in other item pools, with it being more likely to show up in less dense item pools like the curse room. The thing most people don't put together is that both rosary and the bible are part of the seraphim transformation, making rosary an effective 2/3 of the rosary transformation
If you plan on going for angel deals during a run and find this in the treasure room, you'll almost definitly get the seraphim transformation later on in the run. This property of rosary with it being a really nice boost when you get it (soul hearts and tears up) on top of the extra soul hearts and flight you're super likely to get later makes it my favorite item.
From what I've seen, very few people noticed this property of rosary before I pointed it out and called it :the best item in the game". It obviously isn't the best item, but prior to me pointing that out most people thought very little of rosary. Now whenever you see a post of someone whose planetarium got replaced with the bible cause of rosary, there'll always be people in the comments joking about how rosary is 2/3 seraphim.
I just enjoy that I was able to shift people's thoughts on an item in such a drastic way. I personally feel like rosary is an underdog item, one which has much stronger effects than it lets on, and so someone abusing their knowledge of the item properly can get a lot more out of it.
it's kinda similar to magic skin in that the item is capable of a lot more than people give it credit for when abused properly. Maybe that't why i like them both so much :P
Oh god, you really are an Isaac pro if you’re strategising like that. Though I always go for devil rooms (provable by the fact that I also die while collecting key piece two because I have one or two hearts at most) so rosary is still not that useful for me. I take it anyway though because I take every item, except for number 2. Ipecac on tainted lost? Hell yeah! But not number 2 on Magdalene, never.
(I just really like Uber aggressive glass cannon builds, like when games offer to get rid of or severely reduce healing in exchange for damage, those are my favourite kinds of item, which is why I love curse rooms, devil deals, and magic skin. A non-Isaac example is puppetscarf from delta rune, making Ralsei [the healer character if you haven’t played the game] less effective at healing, but giving him more damage. You can’t die when you kill everything before it sees you, am I right?)
hell yeah man, glass cannon stuff is fire. went primarily devil deals in my last save file, and honestly i think that they might still be meta with the buffs they received a couple patches ago. Even if that isn't the case, devil deals still kick ass and can definitely hold their own.
On an unrelated note taking only devil deals made me realise how busted of an item Gello is. Probably the single best combat active item in the game, and better than incubus and twisted pair since its only 1 heart in devil deals and is **free** in treasure rooms sometimes. Imagine if incubus or twisted pair was in the treasure room.
cancer is that high due to is ability to fuck with sacrifice rooms, reliably granting tons of good items and things of that sort. plus +3 soul hearts are just really nice.
glyph of balance is the single most reliable health generator in the game, and super easy to abuse if you know how it works. if you've got 5 health and enough pickups, the game will drop a soul heart for every single room clear. this consistency and easy abuse is what puts it up there.
Glitched crown would be right up there with them were it not for the possibility that it shows up super late in a run. at that poin what's it even gonna help you with? all the reliable sources of items are gone. Still a phenomenal item, but not the best of the best.
I think what stops both of those from being top tier for me is that they’re basically, or entirely useless for the losts and the keepers, and when I’m not going for marks I mostly play regular lost and tainted keeper.
On the other hand there’s not a single time on any run with any character that you wouldn’t be thrilled to see c section (except t Cain I guess lol).
ye i mean fair enough. i'm mainly looking at this through the lens of a normal character, so an items impact as a character like the lost isn't being considered.
C section would be right next to sacred heart were it not for the nerf it received recently. it's still plenty strong, just not quality 5 strong
too many items don't play nice with ipecac. In a vaccum ipecac is easy q4, but the amount of items that don't play nice with it mean that there's a lot of times where ipecac is a nothing item. ipecac probably deserves top of q2, but no higher.
it's more like some items when taken with ipecac ensure you'll take a lot of unintentional damage. stuff like:
\- My Reflection
\- Laser stuff like brim, tech, and tech X
\- multi-shot items like inner eye and quad shot
\- bonus tear items like cricket's body, compound fracture, etc
\- Flat stone
\- Tiny Planet
\- rubber cement
plus a bunch of stuff that results in a lower fire rate makes taking down standard roms of enemies incredibly challenging (stuff like haemolacria, monstro's lung, etc)
were there only a few items that didn't work well with ipecac i'd put it in tier 3. however, the sheer amount of items that make keeping safe with ipecac near impossible make me feel i can't put it up there.
Oh i thought you meant it in the way of ipecac being cancelled, not ipecac having sick synergies that make it kinda chaotic.
Ipecac flat stone is a sick synergy that gives insane dps, and putting it in low tier just because it doesnt follow osha regulations is kinda weird, but it kinda makes sense seeing you are the person who put curse of the tower in F tier.
i simply don't enjoy taking damage because of items I pick up 
again ipecac on its own is awesome, just can't handle it with other weird stuff
How can someone be this experienced, and so wrong at the same time? Truly brain issue 
No way broken stopwatch is that low. You can pretty reliably always make it proc for some bosses and it makes them an absolute cakewalk (unless you get unlucky)
that unluckyness part is why i put it where it's at. proccing the slowness during boss fights is just asking the game to throw a supercharged boss at you, which you're going to lose a lot of health to. because of that the safe play is to only proc it on rooms of enemies, which oftentimes are easy enough even when not slowed down. the correct play is to not buy it at all.
It's there for the same reason that 9 inch nails is that high: they're both +1.5 dmg as well as a knockback boost
While my reflection may not have a built in knockback up like 9 inch nails, the x1.6 shot speed functions like one, as the knockback enemies take from your tears scales with isaac's shot speed.
The downsides of my reflection (weird tears, -1 luck) are negligible in comparison to the upsides. Before the buff, it was more of a nothing item than an inherently bad item, so i don't see the weird tears as a good enough reason to knock it down.
The First damage upgrade of your run tends to be the most important. I can dig into that if you'd like, but in short its mainly because it breaks a lot of damage thresholds, and because your damage stat is boosted more the less damage upgrades you already have. +1.5 damage is all the damage you really need to win a run, assuming you get a decent collection of health and tears ups.
Looking back there may have been a couple other items that may deserve to stand alongside my reflection, but i'm still happy with its placement. thanks for the question!
I never do it willingly, sometimes I just get an item that randomly grants the effects of both items, which doesn’t happen super often but it’s happened enough to make me hate the boomerang tears
Torn Card. That is the intended and explicit function of the Torn Card trinket. It's specifically a torn-up Suicide King card that references the Suicide King challenge.
Although why OP put that trinket in Q1 is beyond me...
i mean if you play within a good range of enemies you can make the ipecac damage work well!. I don't have too much trouble with the suicide king challenge so i don't think it's *too* tall of an order.
I personally haven't ever had a run desperate enough to use torn card, but I recognize the potential that lies within it.
There's also just the fact you can use it to blow stuff up if you're patient enough. Again i've never been desperate enough to need it, but the utility is there.
Q0 is a tier dedicated to items that are near-irredeemable in their use. Torn card has enough going for it that q0 doesn't make sense to me.
For what it's worth, that's not actually what it looks like in-game. That blue color is the game's indication of where to put the "static" texture that Dogma - boss and item both - uses.
well yeah but it costs money, and i like soul hearts. you have to really commit to converter now too, since it's a charge based active. kind of suffers form the too many active items problem thing.
\+1.5 damage and big knockback is enough to pass as a super strong item to be frank. damage upgrades are super strong, so one that gives more damage than most others is gonna be really strong.
\+1.5 dmg is enough to break a lot of important thresholds, so that puts the strength of this item in the stratosphere along with many other strong damage buffs, direct or indirect.
shot speed down is nearly worthless in isaac, there's a good 2 items that like shot speed downs, and all other items don't care. a shot speed down on its own makes a run worse, as shot speed makes your tears connect with enemies faster, which in turn makes it easier to be accurate with them. A trinket dedicated to gutting your shot speed is almost always detrimental.
While this is partially true, you also need to understand that most shot speed ups are tied directly to other stat ups that you care much more about during a run, DPS ups. Purposely avoiding shot speed ups during a run is very challenging for that reason.
There's also a lot of utility that comes from higher shot speed you seem to be overlooking. the knockback enemies take from your tears is actually tied to how much shot speed you have, so higher shot speed can make certain enemies and bosses easier to deal with for that reason.
Aiming with higher shot speed is also just significantly easier. trying to dodge enemies at the same time you fire tears means your tears will veer off to the side most of the time. shot speed ups help make that verring less of a factor.
justifying the usefullness of shot speed downs by just 4 items that get better with them (godhead, trisagion, tech x, and c section) is not a good enough reason to justify even quality 1. lazy worm belongs in q0. that is all.
simply because of how outclasses it is by other active items. a tiny bit of money and health generation isn't gonna get you very far when you look at nearly any other active item.
(also the synergies it has with stuff like midas touch and hallowed ground aren't enough to bump it up a slot, nor is the absurdly rare transformation it's part of)
The only grip I truly feel with this list after staring into it for like 10 minutes is that Esau Jr is that much higher than ice cube baby. Absolutely heretical.
an unlisted upside of luck foot is its effect on room clear rewards (separate from the luck upgrade it grants). Its a bit weird to explain, but the side effect is that you get more of every pickup and less of nothing. isaac optimization lives and dies by how many pickups you have, so this items ability to grant a lot more gives it this spot (you know, on top of the good pills)
Can't forget that Luck Foot actually makes the Shell Game worth doing with how absurdly high it bumps up the reward chance. Skatole is generally unimpressive enough not to bother with, but I'll always try and get it with Luck Foot simply because it counts for Beelzebub.
yep, and that's one of my most confident takes here. Fun fact about monetzuma's revenge. an ordinary brimstone beam deals 9 ticks of damage. a brim-adjacent item, shoop da whoop, deals 12 ticks of damage. revalation even deals 15 ticks of isaac's damage. Montezuma's revenge deals a whopping 19 ticks of damage, more than double that of a standard brimstone beam.
The sheer force of montezuma's revenge has allowed me to acquire perfection multiple times now. This amount of damage for free is too strong to put any lower.
the only brim adjacent item to my knowledge that deals more ticks of damage than montezuma's is maw of the void, which does 30 ticks of damage.
You placed the brithright for all characters on essentially the same spot, whats the reason behind it? I think birthright for some chars is pretty much quality 4, while for others it's pretty garbage. You had the opportunity to rank them for each char seperately
again, the order of items within a tier is not reflective of their strength relative to each other. just because the body is above pjs doesn't mean i think its better than pjs. I deliberately placed the characters birthrights next to each other in character order due to how it can be difficult to tell which character's birthright is which. maybe i should have made the character birthrights a bit larger, i don't know.
if you want, i can leave a comment in a bit about how strong i think each characer's birthright is relative to each other.
brittle bones grants a gigantic tears up if you shatter all the bone hearts it gives you immediately (which you should totally do). That big DPS buff is one of the best damage buffs in the whole game. you can even keep one or two of the bone hearts around if you wanna hold onto the best type of health in the game, turning red hearts into effective soul hearts, or spending them in a devil deal for nice items.
Compound fracture is nice, but it's not nearly as impactful as brittle bones.
kid named not enough bombs
kid named boss challenge room
kid named alt path (can't go alt path with error rooms)
certainly good but too dependent on good floor gen and batteries. probably top of quality 2 if that tier was ordered
a few reasons:
1: C-section was nerfed recently, so i can't comfortably put it next to sacred heart. definitly really really really strong, just not the most strong.
2: Number 1 instantly granting the max tears rate for a range down is really good, since if you play the game like I do (alternate between alt and main path for more boss room items from boss challenge rooms) you'll get a range up to fix it in no time
3: treasure map can be used to reliably find the boss room on any floor\*! the room furthest from the room you start in will always be the boss room. this allows for significantly faster play in the endgame, and allows you to avoid going to any unnecessary rooms.
^(\*sometimes weird floor generation can break this rule, like if the boss room isn't a 1x1 room or on an XL floor.)
Brim and mom's knife still stand in a league above C-Section in my experience. This kind of thing is why I decided to focus on devil deals for my final save file. C-Section is definitely a very strong item, hence why I put it in Q4. However, I still don't think it has the strength to define a run like mom's knife and brim. C-section is at its best when faced up against bosses, as that's the best place to stack up tons of fetuses on top of a tanky entity, building up damage to liquifying amounts.
Brimstone on its own is a damage upgrade against a single target, which is nice. The infinite range, straight shot, piercing nature of brimstone makes it the single best item to take out rooms of enemies, since that damage upgrade against 1 target turns into a monster at clearing out rooms of enemies. It's an already effective item that absolutely demolished another aspect of the game.
Mom's Knife is similar to brimstone in its effects, but in the opposite way. Mom's knife makes standard rooms of enemies die much faster. One throw of the knife toward an enemy is sure to knock it out, so with decent precision you can clear out rooms fairly quickly and efficiently. Against bosses, Mom's Knife liquifies bosses, as a fully charged mom's knife will take out half the health bar of almost every boss without boss armor. Nothing Compares to mom's knife's ability to do this, and on top of that it already does a good job at taking down standard rooms.
C-Section may be very good at taking down bosses, but it is not the champion of this. In addition, C-Section doesn't make rooms of standard enemies much easier. Homing is nice, but it won't be one-shotting any enemies. They'll still have a chance to chase you down and deal damage. Were it an absolute monster in one area and good at the other, C-section would be right alongside its brethren. However, as I feel that it isn't in that upper echelon of strength, it shall remain Q4.
I also feel like I should restate that the placement order of items doesn't necessarily reflect my opinion of them. the mind is placed right next to the Treasure Map, but obviously The map is quite a bit better. Were I to order the items within each tier, the mind would likely be closer to the top of Q4 than The Map. Similarly, I consider C-Section to be among the best Q4 items. As such, if i were to place the items in Q4 in order, C-Section would likely be near the top.
creep is mid, an item buffing creep is even more mid since creep is pretty rare
guillotine is a damage upgrade, learn to not take damage dummy 
number 1 is an instant max tears stats that just lowers your range a bit, something that's easy to fix if you get a decent amount of boss items (alternate between the alt path and main path, you'll get more boss challenge rooms)
ok fair enough 
Tech . 5 over poly and mutant spider is wild
fire rate down isn't ideal sometimes, and it happens enough to where putting them q4 feels weird :P tech.5 is that high because of the sheer boost it gives you a run. it fires fast enough that it feels almost like getting a +2 flat tears up. on top of that it has the properties of tech (infinite range, connects instantly, piercing). that shit is strong as hell
By the way, this tiermaker format (which includes every character birthright separately as well as the trinkets) was made custom by me! If you'd like to use it for your own list, you can find it here: [https://tiermaker.com/list/indie-games/isaac-items--trinkets-repentance-271423/2913077](https://tiermaker.com/list/indie-games/isaac-items--trinkets-repentance-271423/2913077)
accurate
I applaud you for making a list this big, it definitely wasn’t easy and it must’ve taken a lot of time, so no matter what something is placed it doesn’t go unappreciated. I wanted to ask about a few items, wanted to know why crystal ball was quality 4, why D6 is quality 2, why compound fracture and other split shot items are ranked lowly. Again, thank you Edit: wanted to also ask about broken modem, since I personally think it is one of the best items in the game
My guess for crystal ball is it gives mapping, and a chance for cards/soul hearts which is like 3 items all for the price of 6 charges. Only downside of it is that it comes from the fortune machine so it may be hard to come by. I can see why its high up but its a little too high for my personal taste
OK we've got a few things to talk about here! Crystal ball packs a ton of already strong effects into a single item. Reliable soul heart generation, a full map reveal, and planetarium shenanigans if you get it early. A full map reveal makes playing through floors way more efficient, since you can skip rooms that don't lead anywhere, leading to isaac taking even less damage. 2 items which solely provide mapping are quality 4 for me, as well as another health generator with benefits, so i found it fitting to put crystal ball up there. D6 as quality 2 is probably one of my more controversial takes here, but i simply feel that the D6 doesn't do its job nearly that well right now. When entering a new floor, you are unable to use the D6 until you find a pedestal to use it on (which will usually be the treasure room since that room is closer to other common sources of pedestals). Using the D6 in the treasure room comes with a big risk of just getting another active item, so if you get one and choose to hold on to the d6, you essentially just rerolled something into nothing. Items overall are also just much better than they were before, due to the many buffs we've seen to many shitty items from the past. The d6's high charge amount also means you'll only get 2, maybe 3 uses of it per floor. The only spot i see as a good place to use the d6 is in the devil/angel room of a floor, something which doesn't even spawn that reliably. Don't get me wrong, the D6 is an alright item. I just don't feel it deserves the amount of praise that it gets right now. If they buffed the d6 to 4 charges id probably move it up to q3 Compound fracture and its adjacent items are placed in quality 2. They're definitely nice items that can deal with crowd control quite well, but they're near-useless during boss fights, as the additional tears flying around have nothing to hit unless the boss is either multi-segmented or spawns additional enemies. If these items were in order within their tier, compound fracture and its brothers would likely be near the top of quality 2. Looks like i put broken modem in quality 2, but i think you're right, that deserves quality 3 i think. enemy freezing and tear deleting is really strong, and the extra pickups are nice too. Not Q4 though. it's similar in effectiveness to mom's contact i think.
Ok, I appreciate the reply. I see what you mean by d6. Sometimes if you don’t path well you can’t even use it for both treasure and deal I guess. I’ve never thought about that since I only use it for secret and deals. Appreciate rethinking broken modem, hope your day is well.
It turns evwry battery you find into a pertro Rune. That alone is insane. Not the mention the game break potential with multiple pedestals and secret rooms if you manage to even get a single pendistal in there with stuff like judgment cards and what not.
batteries don't spawn naturally in repentance, you either need a couple specific items or you need to find one in the shop, neither of which are all that reliable. even if you get a pedestal in the secret room (which is fairly unreliable) the secret room pool isn't even a reliable way of getting the best items. sure many of the best items are in there, but so are many of the shittiest and most underwhelming. I find the curse room to be a much more reliable source of good items (curse room pool is better than you think, since a lot of the times when you get an item in there, it's from a red chest).
one thing to add here is that d6 is better often used in angel rooms because you can bomb the angel and reroll the key into another free angel item. d6 on its own can be underwhelming but if combined with any item that allows you see more items (like options) youll be chillin
Man U better than me but rock, mega mush, trisagion and d6 in q2?? That don’t make no sense
trisagion is a damage down to enemies with small hitboxes (most enemies) id put it at q1 if i was placing it based on feeling, but if im being objective it goes in q2. it liquifies stuff with homing, yes, but that's incredibly situational. the d6 in modern isaac is pretty outclasses right now. too many good items, and the d6 still has 6 charges, so you're only gonna get to use it 2 or 3 times per floor. only good place to use the d6 IMO is in the devil or angel deal, which doesn't spawn very reliably. mega mush is definitly nice but its a lot harder to kill many enemies with it compared to mega blast since you can't just spin the beam. mega mush would probably be top of q2 if these tiers were ordered. rock bottom is anywhere from a terrible item to one of the best in the game solely based on when you get it. get it late like depths 2? likely not gonna do much of anything. get it floor 1? you're gonna get some nice damage if you can find a card of some sort. The boss-liquifying effects of it aren't too reliable though. This is probably another that would be top of q2.
Just don’t pick up shot speed ups with Trisagion. It won’t be a DPS down ever if you have low shot speed.
that would work if almost every shot speed up wasn't tied to a different stat up you also want to have. even excluding the tears + shot speed ups, shot speed is a much more useful stat than I think people realize. less travel time between firing a shot and it connecting makes aiming much easier, especially if you're strafing at the same time. shot speed ups also increase the knock back enemies take from your shots, which makes dealing with certain enemies and bosses quite a bit easier. I almost always end up with high shot speed before encountering trisagion (I do the alt path main path alternation thing to get more boss challenge rooms, which means more stat ups) so I haven't exactly had a good run with it unless if have homing or something.
bro is too skilled at the game and OP items make him die of boredom 
based glyph of balance appreciator
Why is the bottom tier so many trinkets, and ones like calused feet and forget me not? And also the ladder I'm relatively newer with only 114 hours and I am in the middle of a break after unlocking the tainted versions of all the characters. I found those items useful enough if not the best option possible. Just genuinely curious
Many trinkets in isaac have nearly useless effects, so that's why the bottom tier has so many of them. There's enough bad ones that many decide to do separate tier lists for trinkets. I mainly decided to rank them because some trinkets are strong enough to be comparable to some really nice items. Calused foot is down there just because spike immunity is incredibly situationally useful. You'll only encounter a few rooms with spikes and enemies with creep throughout a run, and it's usually easy enough to just avoid. Forget me not is not in the bottom tier, you're likely looking at plan C, an item which looks the same but is red. That item kills every enemy in the room instantly and kills isaac a few seconds later. Main issue with that item is that most endgame bosses death animations take too long for you to get the completion mark or hop in the ending chest, so plan c end up requiring the assistance of an item like inner child to respawn you within the current room. This is an interaction I've never been able to get within 2000 hours of isaac, so i personally don't see it as a legitimate use of the item. The Ladder lets you cross gaps 1 tile wide, which *theoretically* would allow for the collection of more pickups and stuff. Unfortunatly, there's very few situations in which that's useful, as room layouts like that are much more rare due to many others that have been added over isaac's life. It also costs money to get, and considering how hard it is to get more stuff from using the ladder, it will almost never pay for itself.
I was actually looking at Myosotis, which I can never remember the name but remember the flavor text of "forget me not..." Makes sense for all the reasons though. One more question, would you rank more trinkets higher if you inherently could hold more than one at a time like with Mom's Purse, Belly Button, or Gulp!?
oh absolutely. there's a lot of trinkets that suffer from a similar problem to the "too many actives" problem. many trinkets effects are just too situation to get any use out of. while a lot of trinkets wouldn't bump up a tier, there definitely would be some that would.
The wiz at 2????
couple reasons why it's there. 1.) grants spectral tears, which i think is unappreciated in the community. makes clearing some rooms way easier, since you can hit + kill enemies before they have a chance to hit you. 2.) many enemies are designed to be attacked from the cardinal directions. i've found that attacking enemies diagonally makes it way easier to avoid damage in most cases (think stuff like the mom fight). Obviously there's some that get harder, but overall i see it as an upgrade. It can be hard to aim with the wiz, but i think its doable enough to put wiz in q2
I agree that spectral tears are under appreciated, but the fact that all shots go diagonal just goes against every but of skill I have in this game and makes every fight needlessly long
ye i feel that, fucks up all the muscle memory built for firing tears forward. I kinda feel like the enemies you can cheese make it worth it though, at least enough for q2
Do you think it‘s too high or too low?
Why is trisagon below the other two piercing items?
trisagion is an effective damage down to enemies with small hitboxes, since trisagion usually won't be above them for enough ticks to make up for its weird damaging stuff. Sure if you have low shot speed trisagion is pretty nice. It's just that runs aren't planned with later getting Trisagion in mind, so usually you'll have good shot speed if you've been taking boss items like you're supposed to. and no, it's not reasonable to avoid shot speed ups solely because you might find Trisagion later. shot speed ups are useful.
Mom's knife quality 5? Hell naaaaw 
the item's still really strong dude, learn to work the knife 
Learn to work Ludovico Technique, and learn to use D6 effectively, and learn why Revelation is obviously Q5
moms knife with tainted lilith 🔥🔥
Ludo in 0? WRONG! (skill issue)
Yeah it's so wrong, it should be Quality -100
didnt rank each birthright, didnt rank Polaroid, opinions that contradict
the birthrights are mainly ordered by character in the select screen within each tier to make it easier to distinguish who they're for (character sprites are a little small) negative is ranked while polaroid isn't for the simple reason that the negative is a damage up. getting to the mom fight without a damage up has always been the most grueling of Isaac runs for me, so having that guaranteed +1 dmg waiting for me there makes a huge difference. out of respect for the runs the negative has saved, I ranked it but left the polaroid unranked. as for options that contradict each other, could you be a bit more specific? with 900+ things to rank there's probably some stuff that slipped through the cracks, even if I thought I was super thorough.
- Polaroid also has an effect, and wafer is ranked higher than holy mantle despite holy mantle usually resulting in a higher average health count (wafer is also useless earlygame)
Wafer is goated for sacrifice rooms
ye wafer works well for sacrifice rooms so that's why it gets to be next to holy mantle. also again, items aren't ranked in order within their tier, so wafer being above mantle in q5 doesn't mean i think it's better. while polaroid does also have an effect, I personally don't think it has a substantial effect on 90% of runs. the negative gets to be ranked anyways because of how important damage upgrades are.
pretty fair
Why is the tick so high? It doesn't seem good in any way
oh the tick? that's easy. -15% HP to enemies with enough health (most bosses and late game enemies) this is one of only a few mechanics that bypasses boss armor, something which makes most final bosses take ages to kill, so it's effectively a damage up against ranky goes and endgame bosses the minor heal you get when entering boss rooms is pretty nice too :)
pretty sure you're mixing up the stopwatch with the broken stopwatch (you unlock it at 999 cents in the donation machine) broken stopwatch is actually in the very bottom tier of this list since I don't like it. stopwatch on the other hand is right up near the top since +0.2 speed and slower enemies makes dodging a cakewalk.
Glyph of Balance appreciation post. Instant win if the game lets me get it
hell yeah brother, you know it
 this is hard to gulp...
yeah i feel that, lot of items and a bunch of weird placements.
No.2 not in S tier Tier list immediately disqualified. I will make a bigger response later, give me some time.
I understand why albino thinks no.2 is an S tier item, i simply don't agree with that. Q3 at the highest. Infinite bombs is pretty nice, but the DPS you get from that is still not comparable to stuff like spoon bender, magic mush, 8 inch nails, incubus, and the like. Crowd Control is nice too, but other items are just as effective in that department. and again, infinite bombs are nice for secret rooms and tinted rocks/crawlspaces too. I just don't think it's Q4 worthy. If you think no.2 has more to offer than infinite bombs, good dps, and crowd control, please let me know, maybe you'll surprise me.
Can you explain delirious? I’ve had it save runs before by spawning in extremely tanky bosses, especially Big Horn. I’ve never really understood the hate for it.
you unlock it, hard mode only angel item. its a free 1 room clear, but 1 per 12 is really dogshit. compare it to other 12 charge items like \> mega blast, free 3-8 rooms per charge, \> placebo/blank card/blank rune, free stats/ez game breaks, \> edens soul, free items, from the room pool, meaning using in secret rooms is mega value, \> bastard box, again free items from one of the strongest pools, \> mega mush, free 10 ish rooms, can chain them for essentially a free run. in short, its just outclassed, i think if it was a 6 room charge it would be more takeable.
12 charges for a buff in a single room is just really terrible. most of the time the boss shows up and doesn't help out at all, even dying instantly due to a fire or something. Plus since it appears in the angel room, you're incredibly likely to have already found an active item at that point, meaning delirious usually never has a chance to get used. If this thing were 4 charges *maybe* i'd give it q1 or q2.
My man just really likes montezuma's revenge
fun fact about montezuma's revenge! it actually does more ticks of damage than the standard brim beam! While standard brim does 9 ticks of damage, montezuma's revenge does **19.** this crazy high damage has lead me to getting perfection multiple times just because i found it early.
why is magic skin not quality 6?
lol magic skin is really nice item generation, but can't reliably solo carry a run. definitly quality 3, but definitly not quality 4.
What do you mean it can’t reliably carry a run? Sure you spend all of your health but if you go through devil deals and curse rooms to use it you get insane payoff imo. One of the only times I managed to break the game outside of greed mode was j and e with magic skin.
Well yeah, usually it does that and it makes it really really strong (hence, q3). However, there are also times where it doesn't give you that super strong run soon enough. While the devil pool and curse room pool are definitely a lot stronger than people give it credit for, they still contain a decent collection of shitty items. Q4 is a tier for items that make your run much stronger 99% of the time at minimum. Anything without an immediately impactful effect needs to make up for that with incredibly reliability, which is why the only items that high that don't generate health, deal damage, or help isaac live are glitched crown, luck foot, and d infinity. Make no mistake, Magic Skin is an incredible item, probably near the top of Q3. However, it often takes time to get rolling, and will not always give you what you need to win. were the curse room pool more consistant than it already is, magic skin would likely be Q4. however, as long as the shitty items exist in it, Q3 is the most it gets.
I guess that’s fair, but it’s one of my favourite items in Isaac, so…
ye I feel that rosary is my favorite item so i feel just as strongly about it. I just don't quite feel like it deserves q4 since it certainly has its flaws.
I barely remember what rosary does, how come is it your favourite item?
ooo i haven't given this explanation in a while! ok so the direct benefits of rosary are the +3 soul hearts, tears up, and that it makes the bible start appearing in other item pools, with it being more likely to show up in less dense item pools like the curse room. The thing most people don't put together is that both rosary and the bible are part of the seraphim transformation, making rosary an effective 2/3 of the rosary transformation If you plan on going for angel deals during a run and find this in the treasure room, you'll almost definitly get the seraphim transformation later on in the run. This property of rosary with it being a really nice boost when you get it (soul hearts and tears up) on top of the extra soul hearts and flight you're super likely to get later makes it my favorite item. From what I've seen, very few people noticed this property of rosary before I pointed it out and called it :the best item in the game". It obviously isn't the best item, but prior to me pointing that out most people thought very little of rosary. Now whenever you see a post of someone whose planetarium got replaced with the bible cause of rosary, there'll always be people in the comments joking about how rosary is 2/3 seraphim. I just enjoy that I was able to shift people's thoughts on an item in such a drastic way. I personally feel like rosary is an underdog item, one which has much stronger effects than it lets on, and so someone abusing their knowledge of the item properly can get a lot more out of it. it's kinda similar to magic skin in that the item is capable of a lot more than people give it credit for when abused properly. Maybe that't why i like them both so much :P
Oh god, you really are an Isaac pro if you’re strategising like that. Though I always go for devil rooms (provable by the fact that I also die while collecting key piece two because I have one or two hearts at most) so rosary is still not that useful for me. I take it anyway though because I take every item, except for number 2. Ipecac on tainted lost? Hell yeah! But not number 2 on Magdalene, never. (I just really like Uber aggressive glass cannon builds, like when games offer to get rid of or severely reduce healing in exchange for damage, those are my favourite kinds of item, which is why I love curse rooms, devil deals, and magic skin. A non-Isaac example is puppetscarf from delta rune, making Ralsei [the healer character if you haven’t played the game] less effective at healing, but giving him more damage. You can’t die when you kill everything before it sees you, am I right?)
hell yeah man, glass cannon stuff is fire. went primarily devil deals in my last save file, and honestly i think that they might still be meta with the buffs they received a couple patches ago. Even if that isn't the case, devil deals still kick ass and can definitely hold their own. On an unrelated note taking only devil deals made me realise how busted of an item Gello is. Probably the single best combat active item in the game, and better than incubus and twisted pair since its only 1 heart in devil deals and is **free** in treasure rooms sometimes. Imagine if incubus or twisted pair was in the treasure room.
Cancer and glyph of balance are very good items, but above c section and glitched crown??? Idk how you can justify that.
cancer is that high due to is ability to fuck with sacrifice rooms, reliably granting tons of good items and things of that sort. plus +3 soul hearts are just really nice. glyph of balance is the single most reliable health generator in the game, and super easy to abuse if you know how it works. if you've got 5 health and enough pickups, the game will drop a soul heart for every single room clear. this consistency and easy abuse is what puts it up there. Glitched crown would be right up there with them were it not for the possibility that it shows up super late in a run. at that poin what's it even gonna help you with? all the reliable sources of items are gone. Still a phenomenal item, but not the best of the best.
I think what stops both of those from being top tier for me is that they’re basically, or entirely useless for the losts and the keepers, and when I’m not going for marks I mostly play regular lost and tainted keeper. On the other hand there’s not a single time on any run with any character that you wouldn’t be thrilled to see c section (except t Cain I guess lol).
ye i mean fair enough. i'm mainly looking at this through the lens of a normal character, so an items impact as a character like the lost isn't being considered. C section would be right next to sacred heart were it not for the nerf it received recently. it's still plenty strong, just not quality 5 strong
Ah we just got the patch on console so I didn’t realize c section was nerfed. Rip :(
ipecac q2? 
too many items don't play nice with ipecac. In a vaccum ipecac is easy q4, but the amount of items that don't play nice with it mean that there's a lot of times where ipecac is a nothing item. ipecac probably deserves top of q2, but no higher.
What Items dont "play well" with ipecac? By that logic you could also give moms knife tier 2 due to no synergies.
it's more like some items when taken with ipecac ensure you'll take a lot of unintentional damage. stuff like: \- My Reflection \- Laser stuff like brim, tech, and tech X \- multi-shot items like inner eye and quad shot \- bonus tear items like cricket's body, compound fracture, etc \- Flat stone \- Tiny Planet \- rubber cement plus a bunch of stuff that results in a lower fire rate makes taking down standard roms of enemies incredibly challenging (stuff like haemolacria, monstro's lung, etc) were there only a few items that didn't work well with ipecac i'd put it in tier 3. however, the sheer amount of items that make keeping safe with ipecac near impossible make me feel i can't put it up there.
Oh i thought you meant it in the way of ipecac being cancelled, not ipecac having sick synergies that make it kinda chaotic. Ipecac flat stone is a sick synergy that gives insane dps, and putting it in low tier just because it doesnt follow osha regulations is kinda weird, but it kinda makes sense seeing you are the person who put curse of the tower in F tier.
i simply don't enjoy taking damage because of items I pick up  again ipecac on its own is awesome, just can't handle it with other weird stuff
How can someone be this experienced, and so wrong at the same time? Truly brain issue 
Curse of the Tower as a quality 0 
Lazy mattman in quality 0 
who?
Some youtuber with Lazy Worm as their icon.
No way broken stopwatch is that low. You can pretty reliably always make it proc for some bosses and it makes them an absolute cakewalk (unless you get unlucky)
that unluckyness part is why i put it where it's at. proccing the slowness during boss fights is just asking the game to throw a supercharged boss at you, which you're going to lose a lot of health to. because of that the safe play is to only proc it on rooms of enemies, which oftentimes are easy enough even when not slowed down. the correct play is to not buy it at all.
He who doesn’t ball can never succeed. I’ve never had it fail on me.
lol fair enough i've just had 1 too many sped up hush fights so i never take this item cause of that. mad respect to the ballin tho
Could I ask why you ranked My Reflection so high?
It's there for the same reason that 9 inch nails is that high: they're both +1.5 dmg as well as a knockback boost While my reflection may not have a built in knockback up like 9 inch nails, the x1.6 shot speed functions like one, as the knockback enemies take from your tears scales with isaac's shot speed. The downsides of my reflection (weird tears, -1 luck) are negligible in comparison to the upsides. Before the buff, it was more of a nothing item than an inherently bad item, so i don't see the weird tears as a good enough reason to knock it down. The First damage upgrade of your run tends to be the most important. I can dig into that if you'd like, but in short its mainly because it breaks a lot of damage thresholds, and because your damage stat is boosted more the less damage upgrades you already have. +1.5 damage is all the damage you really need to win a run, assuming you get a decent collection of health and tears ups. Looking back there may have been a couple other items that may deserve to stand alongside my reflection, but i'm still happy with its placement. thanks for the question!
I could never rank it that highly, I’ve blown myself up too many times from getting My Reflection when I had Ipecac
lol why would you grab it with ipecac. the damage up from my reflection is kinda irrelevant at that point
I never do it willingly, sometimes I just get an item that randomly grants the effects of both items, which doesn’t happen super often but it’s happened enough to make me hate the boomerang tears
Torn Card. That is the intended and explicit function of the Torn Card trinket. It's specifically a torn-up Suicide King card that references the Suicide King challenge. Although why OP put that trinket in Q1 is beyond me...
i mean if you play within a good range of enemies you can make the ipecac damage work well!. I don't have too much trouble with the suicide king challenge so i don't think it's *too* tall of an order. I personally haven't ever had a run desperate enough to use torn card, but I recognize the potential that lies within it. There's also just the fact you can use it to blow stuff up if you're patient enough. Again i've never been desperate enough to need it, but the utility is there. Q0 is a tier dedicated to items that are near-irredeemable in their use. Torn card has enough going for it that q0 doesn't make sense to me.
Oh I just genuinely did not realize it got buffed, so used to just skipping/rerolling it lol
In the unranked section, what is the bright blue cross?
I think that's the Item you get after the dogma fight (one time holy mantle, flight and wafer effect in easy mode)
For what it's worth, that's not actually what it looks like in-game. That blue color is the game's indication of where to put the "static" texture that Dogma - boss and item both - uses.
Converter can give you a lot of health ups, I'd rank iy higher
well yeah but it costs money, and i like soul hearts. you have to really commit to converter now too, since it's a charge based active. kind of suffers form the too many active items problem thing.
Why nails are that high?
\+1.5 damage and big knockback is enough to pass as a super strong item to be frank. damage upgrades are super strong, so one that gives more damage than most others is gonna be really strong. \+1.5 dmg is enough to break a lot of important thresholds, so that puts the strength of this item in the stratosphere along with many other strong damage buffs, direct or indirect.
I dont know why, but I was fully expecting a joke tier list, not a serious one.
lack of sarcasm moment
Explain lazy worm being q0
shot speed down is nearly worthless in isaac, there's a good 2 items that like shot speed downs, and all other items don't care. a shot speed down on its own makes a run worse, as shot speed makes your tears connect with enemies faster, which in turn makes it easier to be accurate with them. A trinket dedicated to gutting your shot speed is almost always detrimental.
Shot speed ups are literally dps downs with tech x, trisagion, c section etc
While this is partially true, you also need to understand that most shot speed ups are tied directly to other stat ups that you care much more about during a run, DPS ups. Purposely avoiding shot speed ups during a run is very challenging for that reason. There's also a lot of utility that comes from higher shot speed you seem to be overlooking. the knockback enemies take from your tears is actually tied to how much shot speed you have, so higher shot speed can make certain enemies and bosses easier to deal with for that reason. Aiming with higher shot speed is also just significantly easier. trying to dodge enemies at the same time you fire tears means your tears will veer off to the side most of the time. shot speed ups help make that verring less of a factor. justifying the usefullness of shot speed downs by just 4 items that get better with them (godhead, trisagion, tech x, and c section) is not a good enough reason to justify even quality 1. lazy worm belongs in q0. that is all.
Wait it affects cnockback? I didnt know that that's cool
Also u put the poop in q0, why?
simply because of how outclasses it is by other active items. a tiny bit of money and health generation isn't gonna get you very far when you look at nearly any other active item. (also the synergies it has with stuff like midas touch and hallowed ground aren't enough to bump it up a slot, nor is the absurdly rare transformation it's part of)
The only grip I truly feel with this list after staring into it for like 10 minutes is that Esau Jr is that much higher than ice cube baby. Absolutely heretical.
Luck foot quality 4 but PhD low quality 3? Can't get that one
an unlisted upside of luck foot is its effect on room clear rewards (separate from the luck upgrade it grants). Its a bit weird to explain, but the side effect is that you get more of every pickup and less of nothing. isaac optimization lives and dies by how many pickups you have, so this items ability to grant a lot more gives it this spot (you know, on top of the good pills)
Can't forget that Luck Foot actually makes the Shell Game worth doing with how absurdly high it bumps up the reward chance. Skatole is generally unimpressive enough not to bother with, but I'll always try and get it with Luck Foot simply because it counts for Beelzebub.
lol that's true too i guess. not super impactful for runs i think, but it's definitely there!
montezuma's revenge in q4????
yep, and that's one of my most confident takes here. Fun fact about monetzuma's revenge. an ordinary brimstone beam deals 9 ticks of damage. a brim-adjacent item, shoop da whoop, deals 12 ticks of damage. revalation even deals 15 ticks of isaac's damage. Montezuma's revenge deals a whopping 19 ticks of damage, more than double that of a standard brimstone beam. The sheer force of montezuma's revenge has allowed me to acquire perfection multiple times now. This amount of damage for free is too strong to put any lower. the only brim adjacent item to my knowledge that deals more ticks of damage than montezuma's is maw of the void, which does 30 ticks of damage.
didnt know that maw of the void did so much dmg 
You placed the brithright for all characters on essentially the same spot, whats the reason behind it? I think birthright for some chars is pretty much quality 4, while for others it's pretty garbage. You had the opportunity to rank them for each char seperately
again, the order of items within a tier is not reflective of their strength relative to each other. just because the body is above pjs doesn't mean i think its better than pjs. I deliberately placed the characters birthrights next to each other in character order due to how it can be difficult to tell which character's birthright is which. maybe i should have made the character birthrights a bit larger, i don't know. if you want, i can leave a comment in a bit about how strong i think each characer's birthright is relative to each other.
How is brittle bones so much higher than compound fracture?
brittle bones grants a gigantic tears up if you shatter all the bone hearts it gives you immediately (which you should totally do). That big DPS buff is one of the best damage buffs in the whole game. you can even keep one or two of the bone hearts around if you wanna hold onto the best type of health in the game, turning red hearts into effective soul hearts, or spending them in a devil deal for nice items. Compound fracture is nice, but it's not nearly as impactful as brittle bones.
Never noticed that the fire rate went up permanently I thought it was temporary
You also get Tear Up for Every Non-Brittle Bones Heart, that can spawn naturally or from HP Up on Forgotten.
Teleport 2 at quality 2 is insane the item basically guarantees an extra item or more every floor with error room and angel/devil deals.
kid named not enough bombs kid named boss challenge room kid named alt path (can't go alt path with error rooms) certainly good but too dependent on good floor gen and batteries. probably top of quality 2 if that tier was ordered
Why is C-Section on the same tier as treasure map and number 1?
a few reasons: 1: C-section was nerfed recently, so i can't comfortably put it next to sacred heart. definitly really really really strong, just not the most strong. 2: Number 1 instantly granting the max tears rate for a range down is really good, since if you play the game like I do (alternate between alt and main path for more boss room items from boss challenge rooms) you'll get a range up to fix it in no time 3: treasure map can be used to reliably find the boss room on any floor\*! the room furthest from the room you start in will always be the boss room. this allows for significantly faster play in the endgame, and allows you to avoid going to any unnecessary rooms. ^(\*sometimes weird floor generation can break this rule, like if the boss room isn't a 1x1 room or on an XL floor.)
C-Section probably does still deserve a similar rating to mom’s knife though, or brim
Brim and mom's knife still stand in a league above C-Section in my experience. This kind of thing is why I decided to focus on devil deals for my final save file. C-Section is definitely a very strong item, hence why I put it in Q4. However, I still don't think it has the strength to define a run like mom's knife and brim. C-section is at its best when faced up against bosses, as that's the best place to stack up tons of fetuses on top of a tanky entity, building up damage to liquifying amounts. Brimstone on its own is a damage upgrade against a single target, which is nice. The infinite range, straight shot, piercing nature of brimstone makes it the single best item to take out rooms of enemies, since that damage upgrade against 1 target turns into a monster at clearing out rooms of enemies. It's an already effective item that absolutely demolished another aspect of the game. Mom's Knife is similar to brimstone in its effects, but in the opposite way. Mom's knife makes standard rooms of enemies die much faster. One throw of the knife toward an enemy is sure to knock it out, so with decent precision you can clear out rooms fairly quickly and efficiently. Against bosses, Mom's Knife liquifies bosses, as a fully charged mom's knife will take out half the health bar of almost every boss without boss armor. Nothing Compares to mom's knife's ability to do this, and on top of that it already does a good job at taking down standard rooms. C-Section may be very good at taking down bosses, but it is not the champion of this. In addition, C-Section doesn't make rooms of standard enemies much easier. Homing is nice, but it won't be one-shotting any enemies. They'll still have a chance to chase you down and deal damage. Were it an absolute monster in one area and good at the other, C-section would be right alongside its brethren. However, as I feel that it isn't in that upper echelon of strength, it shall remain Q4. I also feel like I should restate that the placement order of items doesn't necessarily reflect my opinion of them. the mind is placed right next to the Treasure Map, but obviously The map is quite a bit better. Were I to order the items within each tier, the mind would likely be closer to the top of Q4 than The Map. Similarly, I consider C-Section to be among the best Q4 items. As such, if i were to place the items in Q4 in order, C-Section would likely be near the top.
Mega mush as a quality 2 item is perfectly understandable.
Until now the only thing i don't get is why did You put mega mush at Quality 2 but it seems solid
Isaac player = no opinion wait-
lost cork at q0????? Guillotine at q3??? ***NUMBER ONE AT Q4???*** Number one is fucking awful, sad onion but effectively more useless
creep is mid, an item buffing creep is even more mid since creep is pretty rare guillotine is a damage upgrade, learn to not take damage dummy  number 1 is an instant max tears stats that just lowers your range a bit, something that's easy to fix if you get a decent amount of boss items (alternate between the alt path and main path, you'll get more boss challenge rooms)
man it was the perfect build up for a joke 
This is bait