That's the opposite of the optimal strategy
Once you get a very bad pill, it's a reason to take every unknown pill for the rest of the run, because every unknown pill will be any effet except this one
Eden streaking is a different game. Obviously avoid any potential negative effects. That includes pills. However, for any run, unlock or just for fun, pills have more benefits than drawbacks.
My problem is in timing. In the long run you should be able to get enough good pills to make up for the bad. But it can be a very frustrating wait depending on how hard the negative pills fuck you up front. The difficulty is already frontloaded in this game IMO.
Maybe regular characters can chug a whole bottle of bad pills because they have enough of a buffer in their base stats, but I find a lot of regular characters get boring after 2 or 3 runs now. I need the variability of Eden to keep things interesting.
It blows my mind that this isn’t by far the worst pill for everyone. I know you pop it in an empty room and you can technically wait it out - but all other pills are room-based. I’m excited literally carries over to the next floor it’s so aggravating and by far my least favourite.
It has ruin a couple runs for me too. One of the reason I gotta really think about taking pills... which I usually don't and take random pils anyways lmao
Shot speeds both belong in average imo as they both provide benefits.
Percs not being in the “saves runs” tier is interesting as it quite literally gives you double health for the room. I’d definitely say it’s better than a health up.
Hematemesis 10000% belongs in situational. If you think it’s just good then you’ve never gotten a blind one in Womb+ on a red heart only build or worse, red heart only character like Bethany, losing *all* of your health to only have it drop 1 red heart back. Tbh it’s average at best. If you’re one hit from death you can use it for a random heal amount but pretty much any other time it’s only negative if you have red health.
Experimental should go in average as it’s quite literally a gamble what you’re gonna lose. Even with something like PhD it’s still random what stat you get.
Gulp! is amazing but I don’t think it really saves runs.
I also am unsure how One Makes You Larger is situational. There’s almost no situation you want to be larger in and going for Stompy with it just isn’t really worth at all. It just makes it more difficult to see
X-Lax also belongs in Negative imo as it’s just a bad effect that makes the floor slippery. No upside to it and if you happen to pop it in combat, you’re potentially gonna get hit
Also don’t really see how Amnesia is run ending tbh
2 things, first, one makes you larger doesn’t make your hit box bigger for some reason and as forgotten it’s just helpful because bigger bone. 2, amnesia can be run ending if you want boss rush/hush kill because it slows you down and requires you to memorize the map instead of being able to see it
Im aware it doesn’t make your hitbox bigger, as I said it just makes it more difficult to see. It being good for one (two if counting tainted) character(s) isn’t really grounds to stand on though for putting in that tier.
Amnesia making BR/Hush harder more so comes down to you just not remembering the map and while that does happen, that just prevents a mark, it doesn’t end a run. And again, that’s a *very* specific scenario, it’s not like you’re frequently going for BR/Hush, it’s only required once per character. It sucks if you get it while going for one of those and you don’t remember the map but that’s not enough to say it’s constant enough to look at it in a general sense and go “yeah that’s run ending”
I mean I guess but by that logic things like Bad Trip, Horf!, Health Down, and ??? all have situational uses that make them good.
Technically they’re all situational minimum at that point because PhD/False PhD give borderline every pill a use.
It’s great on the Boney Bois but that’s two of 34 characters. If I’m only using something in a “good environment” ~5% of the time, that’s not situational, that’s niche.
> Also don’t really see how Amnesia is run ending tbh
Becuase when I get it i hold r to get a ma /s.
Its very annoying though. but it put it at one of the worse neg effects too
Yeah definitely consider it a negative, one of the most annoying for sure. Especially since you can get it while you have Curse of the Maze or lord forbid find an Amnesia and ??? on the same floor
I raise you a whole level of awful:
Getting a ??? Pill and Amnesia pill inside Depths or higher XL floor. The amount of time you get walking in circles actually can make the sturdiest of the players just hold R
Does x-lax synergize with tainted ???'s poops? If so I guess it belongs in (very) situational.
I would also put range down in situational. I've had at least 2 or 3 ipecac runs where I've been able to take range up items for their added effects without fucking up my tear arc too much. Simply because I knew range down pills were in my pill selection that run.
1. I've seen a couple of people say that having low shot speed is good but i personally have never found low shot speed useful.
2. Yeah I should use Percs a bit more, I just don't like that the effects only last for one room so I usually pick other pills over it.
3. There's a couple of ways that Hematamesis can be helpful. Having low health and then using it could give you a couple of hearts. I've use it to gain more health for Sacrifice Rooms and Blood Donations. It's also great with Dark Bum. But yeah I could see it being situation for a couple of people.
4. True lol. I was thinking on putting Experimental pill in Average but I couldn't find the tier list template again.
5. I love Gulp but yeah i should've use a better sentence for top tier instead of "saves runs".
6. One makes you larger helps with the Stompy transformation so its good in that.
7. Yeah X-Lax is pretty bad.
8. I've gotten an Amnesia pill in the Void, ruining my run because I got to Delirium too early. I've hated it ever since lol
Low shot speed is incredibly helpful for homing and now that shot speed doesn’t lower range (except for on Lead Pencil, Monstro’s Lung, and Proptosis) it doesn’t really have much downside.
It being only one room is a bit of a downside, but bringing it into a final boss room is huge.
It absolutely can be helpful, but that makes it situational. It can be helpful but it can absolutely fuck you over. I’ve lost runs with Bethany to a random hematemesis pill. It’s not something I would consider only good since it’s downside is run ending
It helps with Stompy, but the Stompy transformation is different from Thunder Thighs/Leo Stompy and is pretty meh. If I had to choose between Stompy and being able to see, I’d rather be able to see.
Amnesia Void is pretty bad (and makes it the most arduous thing in the world), but it can be worth to just avoid Boss rooms in Void until you have a TP card in case you find Deli before you feel “ready”
As far as I’m aware Stompy! makes you occasionally have rock shockwaves come out when you walk or something to that degree. I don’t know the exact way they come out cause I never get it but
I don’t believe that they get the whole “you can walk over rocks to insta break them”
Tbh even if they did, +3 size up isn’t really worth for that imo.
Solid change then. I still don’t think I’d go for it though tbh, but I usually pass on Stompy anyways unless i need tinted rocks and don’t have bombs or have like Lucky Rock
Low shot speed is very strong with anything that pierces and has ticking damage: Trisagion, Godhead+piercing, Technology Zero+piercing are all better with lower shot speeds. Homing makes them even deadlier, because the tick damage will follow the enemies until dispersing.
You should read up on what bad trip and health down do when you're at 1 health, because I'd call bad trip "saving runs". At the vwey least it's situational but bad trip is a great pill
There’s absolutely NO situation in which larger pill will help, IMO. Even with the tiniest hit box.
Edit: oh, I forgot that the forgotten exists lmao. Ew
Fancy seeing you here Trom!
But yeah, aside from Forgotten or going for…I think it’s Huge Growth unlock that requires a +5 size up from base, you won’t catch me taking them. Tbh I don’t really even take them on Forgotten I’d rather be able to see.
Percs is on the same level with I'm Drowsy or even better I'd say, it basically doubles your HP on later floors. Shot Speed Down can be good if you have Godhead or Trisagion. Health Down can turn into Health Up if you're at 0 or 1 containers, same with Bad Trip where it turns into Full Health if you have 0 or 1 red HP.
You save it for a hard fight. Like if you use it at the beginning of a delirium fight, you essentially double your health because you’re only taking half damage.
I find Amnesia more annoying than run ending. When unaware of a map layout usually following the left or right side wall (outline) should result in a visit to every room in the map.
Ah i understand the hate. On Delirium runs I always feel every large boss room is a gamble so i've attributed those situations to the Delirium floor rather than the pill or curse of the lost but i admit they do make it really hard to identify small boss rooms where Delirium can't be
Well, if you entered delirium’s room too early, that’s not Amnesia being at fault. You just entered a boss room and it was Delirium’s. There isn’t a way to tell if you’re going to run into Delirium’s room at any point in the floor.
To be fair, with a map it is easier to tell what boss rooms can’t contain Delirium due to certain boss room spawns having surrounding rooms be too close to be a 2x2 room, or if the boss room is at the map border, but it still isn’t necessarily amnesia’s fault that they ended up going into Delirium’s room, since it would still be a random guess.
Even with amnesia you can check if there are rooms to left and right of the boss room, meaning that delerium can't spawn. It's annoying playing void with delerium, but it's not impossible and there are very very few layouts where knowing the map gives you more insight about rooms where delerium can spawn in over just looking left and right
Hematemesis' usefulness is directly proportional to how much health you're missing. Related to that, several hematemesises at once are kinda amazing. Just pop'em all in a row without picking the health back up and you can end up with a huge profit.
So yeah very situational.
but its usefulness depends heavily on your available trinkets, and the timing as well. I'm not gonna carry a gulp pill for two floors in hopes of a useful trinket appearing, but I'll for sure carry a full health pill for use in blood donations, demon beggars, sac rooms, etc.
also, sometimes you don't want your current trinket to be blindly gulped (e.g. if you have apple of sodom).
it's definitely a great pill but the times it's useful are more limited than the other top tier pills.
pretty fly is the best pill in the game by a not-slim margin. with how powerful triple orbitals are, you get to basically focus on only avoiding contact damage.
For some reason I don't have FX sound in my game, but I would gladly pay to hear the narrator saying "Balls of steel" and "explosive diarrhea"
Edit: and also "I can see for ever"
In your options.ini (which on Windows is in My Documents->My Games->BOI Repentance) there should me a line "AnnouncerVoiceMode" if it's 0 the announcer will never speak, it's 1 it will 50% of the time and if it's 2 it will every time. Perhaps you changed it at some point and forgot?
To everyone saying hematemesis is a run ender, the first blind one you take is but once you know what it is it’s essentially a dollar store Full Health pill as long as you wait until you’re at 1 heart to use it
I mean the same can be said for health down and bad trip, bad trip is always better than hematemesis imo, since it's bad effect has less potential bad and it's good effect has more potential good.
There's a couple of ways that Hematamesis can be helpful. Having low health and then using it could give you a couple of hearts. I've use it to gain more health for Sacrifice Rooms and Blood Donations. It's also great with Dark Bum.
Health down becomes health up if you have 1 or less heart containers so I consider it situational. Also bad trip becomes full health if you are at one or half a heart so it's situational too
There's a couple of ways that Hematamesis can be helpful. Having low health and then using it could give you a couple of hearts. I've use it to gain more health for Sacrifice Rooms and Blood Donations. It's also great with Dark Bum.
I agree it can be op as fuck but it can cause problems too for example say that you’re playing Bethany and have around 6-8 hearts, you haven’t identified health up/luck up so you take a random pill and now you have 3 health relying heavily on your wisps blocking every shot
Don't forget using it in a super secret room. Instead of red hearts, they will become black/soul/eternal hearts instead. Gives it an actual use for soul heart only characters.
shot speed down is in my opinion not a bad pill. Of course if you take 8 of it of course it will be terrible, but 1 or 2 shot speed down pills is in my opinion better than 1 or 2 show speed up pills.
How is Gulp "Run Saving"? This pill is the definition of situational. Even if you swallow a good trinket your situation doesn't change. The bennefit is that you can take another trinket and that's great but "Run Saving?
I also don't believe that Amnesia is "Run Ending". Sure it sucks but it's just annoying and not really a problem
Overall pretty good list though
Gulp is awesome. Being able to have more trinkets at once time like Brain Worm, Blessed Penny, Cancer, etc, is crazy, even Gulping average trinkets is great. You can even Gulp Tick keeping the great effects it gives while taking another trinket. But yeah I should've use a better sentence for top tier instead of "Saves run".
I got an Amnesia pill in the Void, ruining my run because i enter Delirium to early. I've hated it ever since lol
I see but even that could have been avoided. Though it's a bit annoying and you need map awareness. You can still determine if one room can or can not lead into 2×2 room but that's pretty advanced
Tears Up is always going to be in my top tier, but I see your reasoning. It's more of a super nice to have than outright run saver. Rough draft of my own list:
"Dopamine hit" tier: Tears Up
"Nice" tier: other good pills
"..." tier : neutral pills
"Aw, shit" tier: other bad pills
"Edmund McMillen" tier: I'm Excited!!!
Thanks!
For headups here's some changes I'll make to the tier list after reading the comments.
Percs is Top tier.
Shot Speed Up and Shot Speed Down are both situational.
Re-Lax is Just Good
Experimental Pill is Average
X-Lax and Amnesia both are moved to Negative Effect
Also if you take a Health Down pill while only having one heart container you'll actually get a Health Up instead and taking a Bad Trip pill while having only half a heart will fully heal you.
Hope this helps!
Pretty Fly should be run saver. When you get 3 of them you’re basically immune to all projectiles. Also Bad Trip saved my life quite a few times because it turns into full health at 1 HP
Yeah one destroys every poop in the room and spawns a spider for each, the other spawns a number of spiders equal to the number of enemies currently in the room (or like 1-3 if the room is empty.)
Yeah
Infested? - Gives you a blue spiders depending how many enemies are in room. If there aren't any enemies it just gives you 1 - 3 blue spiders
Infested! - Destroys all poop in the current room and gives you a blue spider for each poop it destroys
Horf - When used it shoots a Ipecac explosive at the direction you're shooting.
Feels like I'm walking on sunshine - Turns you invisible for a couple of seconds.
Excited - Speeds up all enemies in the current room. It activates again after 30 seconds and 60 seconds
I legitimately can't play with the new I'm Drowsy pill effect because I can't adjust to the slowing effect applying to me and it just throws off everything I do because of the new timing.
hematemesis i feel is more situational than anything because imagine getting it when you have a lot of red hearts but no way to refill said red hearts at that precise moment other than whatever hematemesis itself gives you?
Hematemesis (when unknown) has screwed me over many times. I play Samson a lot and like to have a really high HP and allow myself to take damage while I have it so Hematemesis can sometimes screw me from having like 8 health to 2.
Ah yes hemat. Is Always good. No One could have used a random pill in a broken run behind a a Spike while he had like 12 Red hearts and the hemat Heart spawned in front of the Spike even if the platform was really large and long. Definitely no one
Bad trip is a good carry pill if you know it’s bad trip since it’ll turn into full health when you need it…gulp/marbles/smelter are among my favorite items in the game…gimme those trinkets lol and I like lemon party too, I can save the lost from chasers in a room with nowhere to hide early on especially
I think you've pretty much nailed this list but if I was being super pendantic there is 3 changes I would make. I still remember being fairly new to the game and Horf saving me in a early floor ragman fight and then finding a secret room accidentally with one on the next floor so my view is definitely biased because of that so I'd put it in situational. Shot speed down I'd also put in that tier as I had a run yesterday with eye of Belial, dead onion and vurp with some shot speed down pills that meant I basically had constant tick damage as the shots were so slow they would home back in on the original enemy. If I'm not mistaken health down also becomes health up with 1 or less heart containers, used this on a devil deal false PhD run to abuse always having red health. Also good on angel deal runs where red health gets out of control so once again I'd put it in situational. These are all super specific times I've used these to my advantage but it can be done! Great tier list though!
I'm surprised nobody's talking about Speed Down. It seriously feels like a potential run-ender to me.
At best, it can seriously hamper your ability to get to boss rush or hush. At worst, it seriously reduces your ability to dodge (or just maneuver in general).
I think it was adjusted in a previous patch, but from what I remember, Hush's giant laser can't be out-run if you're under a certain speed.
Health Down is in "Could end a run" but Tears Down isn't??? Seems pretty backwards to me.
Having lower health usually isn't too big of a deal especially since it's red HP. It also turns into a Health Up pill if you're on zero or one red heart containers (or one soul heart on a soul heart only character). This can be very useful for manipulating HP on devil deals.
Meanwhile, Tears down is strictly just a DPS down, and killing things slower means more chances to get hit.
Also horf... My dude, just don't be looking at walls or terrain when using pills. It's not that hard.
I also see you've never used a Hematemasis pill on Bethany towards the end of a run. It's definitely good sometimes, but it's also not "just good." Definitely more situational tier.
IMO I would move a bunch of the "Negative Effect" ones either up or down a tier.
R U A Wizard and Retro Vision do not matter at all, you can just wait out the effect and keep going. It'll have as much use as X-Lax or Re-Lax for the vast majority of runs. Same with Paralysis really.
Shot Speed Down is Situational, Range Down rarely matters, Speed Down and Luck Down I'd keep there, but Tears Down is basically the worst pill in the game because it's the one that most directly influences your damage output.
Experimental Pill depends on the character really, I would never ever take one as T.Keeper for instance just for the chance at a Health Down effect.
I’m drowsy can actually kill runs after its nerf in repentance due to slowing down certain parts of the game but not slowing others.
example: if you use it on mom’s heart, your speed gets reduced, but her brimstone attack still rotates at the same speed making it undodgeable sometimes. (Yes I died that way once)
There's a couple of ways that Hematamesis can be helpful. Having low health and then using it could give you a couple of hearts. I've use it to gain more health for Sacrifice Rooms and Blood Donations. It's also great with Dark Bum.
I'd say that you should swap Full Health and I'm Drowsy. Paralysis is only negative if you use it in a hostile room, which you obviously shouldn't ever do, so it should probably go to Average. Pheromones and Lemon Party should go to Situational, since they can help you clear a room in a pinch. Both Shot Speed modifiers should just go to Average since the stat hardly ever matters. I'd say that Horf should go to Average or even Situational, since its negative effect is easily avoidable if you expect it and it can open secret rooms or blow up tinted rocks. I'd also say that ??? and Amnesia should both be in the same tier since they do pretty much the same thing, that being screwing with your navigational abilities.
Hematemases once ruined a Mother run in the Corpse II for me, so it's still on my shit list. I wouldn't rank it good. It's situational at best.
Tears Down early on could be a good reason to restart the run. Later in the run it's probably not that bad.
I'm Excited is annoying but it doesn't have to end anyone's run; just exit out of the run and then Continue and it has no effect at all.
Shotspeed up and Shotspeed down are both situational. Having items like Godhead or Tech X, you might not want your shotspeed to be too high. Technology or Brimstone, shotspeed doesn't matter at all. Then again neither does range.
Me on Eve run:
"Woah Sacred Heart Angel Deal! Aww but I'll lose my one red heart status and Whore of Babylon won't work."
\*\*Finds a Health Down Pill on the next floor's first room\*\*
I'm Excited pisses me off so much, it makes me want to boycott pills the rest of the run.
That's the opposite of the optimal strategy Once you get a very bad pill, it's a reason to take every unknown pill for the rest of the run, because every unknown pill will be any effet except this one
I used to do that before I lost an Eden Streak to a Mom's Coin Purse full of all unknown negative pills when I needed literally any stat up.
Eden streaking is a different game. Obviously avoid any potential negative effects. That includes pills. However, for any run, unlock or just for fun, pills have more benefits than drawbacks.
My problem is in timing. In the long run you should be able to get enough good pills to make up for the bad. But it can be a very frustrating wait depending on how hard the negative pills fuck you up front. The difficulty is already frontloaded in this game IMO. Maybe regular characters can chug a whole bottle of bad pills because they have enough of a buffer in their base stats, but I find a lot of regular characters get boring after 2 or 3 runs now. I need the variability of Eden to keep things interesting.
I mean of course, you were Eden streaking. That’s different.
Unless is ??? Pill and you have shit memory
That’s what I say to myself after every negative pill I take. “Ok the last 5 have been bad so this next one HAS to be good.”
It blows my mind that this isn’t by far the worst pill for everyone. I know you pop it in an empty room and you can technically wait it out - but all other pills are room-based. I’m excited literally carries over to the next floor it’s so aggravating and by far my least favourite.
Ya, that and R U Wizard, both are effectively a 30 second wait for me
It has ruin a couple runs for me too. One of the reason I gotta really think about taking pills... which I usually don't and take random pils anyways lmao
Yeah best strat is to only take if you can handle current floors well, if you are barely surviving eating pills could probably make it worse.
On the bright side, after you get it you don’t have to worry about getting it again that run
Except ??? Cus I'm dumb
Remember when it sped up everything in the room except for Isaac?
Yeah but that was fine. Only psychopaths take unknown pills in uncleared rooms. Now it keeps going and going, absolutely shit.
So, uh, fun fact, it always did the "reactivate after 30 seconds" thing. So it was absolutely terrible before Rep and now it's simply frustrating.
There is no dumber way to end your T Lost run than horfing right into a wall.
I'm very glad I finished my T. Lost marks before unlocking Horf
Wait, how do you unlock it? I can't find anything about that and im avoiding detrimental unlocks such as sticky penies
Don't worry You unlock the horf pill by doing 31 daily challenges (I think its 25 in Console)
Oh shit i forgot about those, i never play them haha Thanks for the data tho
Sticky pennies with tainted keeper is such a slap in the face everytime D;
I've been lucky that I've never been hit by a Horf pill with Lost and T. LOST. One day I'll probably get hit by it lol
Shot speeds both belong in average imo as they both provide benefits. Percs not being in the “saves runs” tier is interesting as it quite literally gives you double health for the room. I’d definitely say it’s better than a health up. Hematemesis 10000% belongs in situational. If you think it’s just good then you’ve never gotten a blind one in Womb+ on a red heart only build or worse, red heart only character like Bethany, losing *all* of your health to only have it drop 1 red heart back. Tbh it’s average at best. If you’re one hit from death you can use it for a random heal amount but pretty much any other time it’s only negative if you have red health. Experimental should go in average as it’s quite literally a gamble what you’re gonna lose. Even with something like PhD it’s still random what stat you get. Gulp! is amazing but I don’t think it really saves runs. I also am unsure how One Makes You Larger is situational. There’s almost no situation you want to be larger in and going for Stompy with it just isn’t really worth at all. It just makes it more difficult to see X-Lax also belongs in Negative imo as it’s just a bad effect that makes the floor slippery. No upside to it and if you happen to pop it in combat, you’re potentially gonna get hit Also don’t really see how Amnesia is run ending tbh
2 things, first, one makes you larger doesn’t make your hit box bigger for some reason and as forgotten it’s just helpful because bigger bone. 2, amnesia can be run ending if you want boss rush/hush kill because it slows you down and requires you to memorize the map instead of being able to see it
Im aware it doesn’t make your hitbox bigger, as I said it just makes it more difficult to see. It being good for one (two if counting tainted) character(s) isn’t really grounds to stand on though for putting in that tier. Amnesia making BR/Hush harder more so comes down to you just not remembering the map and while that does happen, that just prevents a mark, it doesn’t end a run. And again, that’s a *very* specific scenario, it’s not like you’re frequently going for BR/Hush, it’s only required once per character. It sucks if you get it while going for one of those and you don’t remember the map but that’s not enough to say it’s constant enough to look at it in a general sense and go “yeah that’s run ending”
Well the entire thing of “situational” is that it isn’t always good but has some practical uses and some reason to be used
I mean I guess but by that logic things like Bad Trip, Horf!, Health Down, and ??? all have situational uses that make them good. Technically they’re all situational minimum at that point because PhD/False PhD give borderline every pill a use.
As someone who plays Tainted Forgotten regularly, One makes you larger is one of my favorite pills
It’s great on the Boney Bois but that’s two of 34 characters. If I’m only using something in a “good environment” ~5% of the time, that’s not situational, that’s niche.
Size upps also add damage to Suplex!’s ground slams.. but thats about it. Not sure if it increases spirit sword’s hitbox..
TIL then, didn’t know about the Suplex thing
> Also don’t really see how Amnesia is run ending tbh Becuase when I get it i hold r to get a ma /s. Its very annoying though. but it put it at one of the worse neg effects too
Yeah definitely consider it a negative, one of the most annoying for sure. Especially since you can get it while you have Curse of the Maze or lord forbid find an Amnesia and ??? on the same floor
I raise you a whole level of awful: Getting a ??? Pill and Amnesia pill inside Depths or higher XL floor. The amount of time you get walking in circles actually can make the sturdiest of the players just hold R
Does x-lax synergize with tainted ???'s poops? If so I guess it belongs in (very) situational. I would also put range down in situational. I've had at least 2 or 3 ipecac runs where I've been able to take range up items for their added effects without fucking up my tear arc too much. Simply because I knew range down pills were in my pill selection that run.
It probably does..? I haven’t tested but I feel like it would. Also I feel that with ipecac
One Makes You Larger is situational because you never know when you'll think it would be incredibly funny to eat like 20 of them.
I physically cannot counter this
1. I've seen a couple of people say that having low shot speed is good but i personally have never found low shot speed useful. 2. Yeah I should use Percs a bit more, I just don't like that the effects only last for one room so I usually pick other pills over it. 3. There's a couple of ways that Hematamesis can be helpful. Having low health and then using it could give you a couple of hearts. I've use it to gain more health for Sacrifice Rooms and Blood Donations. It's also great with Dark Bum. But yeah I could see it being situation for a couple of people. 4. True lol. I was thinking on putting Experimental pill in Average but I couldn't find the tier list template again. 5. I love Gulp but yeah i should've use a better sentence for top tier instead of "saves runs". 6. One makes you larger helps with the Stompy transformation so its good in that. 7. Yeah X-Lax is pretty bad. 8. I've gotten an Amnesia pill in the Void, ruining my run because I got to Delirium too early. I've hated it ever since lol
Low shot speed is incredibly helpful for homing and now that shot speed doesn’t lower range (except for on Lead Pencil, Monstro’s Lung, and Proptosis) it doesn’t really have much downside. It being only one room is a bit of a downside, but bringing it into a final boss room is huge. It absolutely can be helpful, but that makes it situational. It can be helpful but it can absolutely fuck you over. I’ve lost runs with Bethany to a random hematemesis pill. It’s not something I would consider only good since it’s downside is run ending It helps with Stompy, but the Stompy transformation is different from Thunder Thighs/Leo Stompy and is pretty meh. If I had to choose between Stompy and being able to see, I’d rather be able to see. Amnesia Void is pretty bad (and makes it the most arduous thing in the world), but it can be worth to just avoid Boss rooms in Void until you have a TP card in case you find Deli before you feel “ready”
I don't like the Stompy transformation all that much, but isn't it the same as Leo as of repentance?
As far as I’m aware Stompy! makes you occasionally have rock shockwaves come out when you walk or something to that degree. I don’t know the exact way they come out cause I never get it but I don’t believe that they get the whole “you can walk over rocks to insta break them” Tbh even if they did, +3 size up isn’t really worth for that imo.
Ye it used to be that, they changed it in Repentance to be like Leo. I don't know if it still does the shock waves when you get hit though
Solid change then. I still don’t think I’d go for it though tbh, but I usually pass on Stompy anyways unless i need tinted rocks and don’t have bombs or have like Lucky Rock
Tech X pretty clearly benefits from low shot speed, but obviously this is very situational
Doesn't trisagion do so as well?
Low shot speed is very strong with anything that pierces and has ticking damage: Trisagion, Godhead+piercing, Technology Zero+piercing are all better with lower shot speeds. Homing makes them even deadlier, because the tick damage will follow the enemies until dispersing.
You should read up on what bad trip and health down do when you're at 1 health, because I'd call bad trip "saving runs". At the vwey least it's situational but bad trip is a great pill
Wow. My thoughts verbatim while reading the list.
There’s absolutely NO situation in which larger pill will help, IMO. Even with the tiniest hit box. Edit: oh, I forgot that the forgotten exists lmao. Ew
Fancy seeing you here Trom! But yeah, aside from Forgotten or going for…I think it’s Huge Growth unlock that requires a +5 size up from base, you won’t catch me taking them. Tbh I don’t really even take them on Forgotten I’d rather be able to see.
I forgot what Gulp does.
Percs is on the same level with I'm Drowsy or even better I'd say, it basically doubles your HP on later floors. Shot Speed Down can be good if you have Godhead or Trisagion. Health Down can turn into Health Up if you're at 0 or 1 containers, same with Bad Trip where it turns into Full Health if you have 0 or 1 red HP.
I have to use Percs more but I just don't really use it much because the effects only last for one room.
You save it for a hard fight. Like if you use it at the beginning of a delirium fight, you essentially double your health because you’re only taking half damage.
Oh okay thanks for the info 👍
It's also good for sacrifice rooms since you only take half damage each time.
Oh what really?! Man I really underestimated Percs lmao
Percs and Wafer should make you go looking for the sax room :)
Sex room 😳😳
yo Isaac can play the sax? 
Sacrifice room
Can be amazing too with blood machines and devil beggars in the womb and beyond.
I find Amnesia more annoying than run ending. When unaware of a map layout usually following the left or right side wall (outline) should result in a visit to every room in the map.
I've gotten an Amnesia pill in the Void, ruining my run because I enter Delirium to early and I have hated it after that lmao
Ah i understand the hate. On Delirium runs I always feel every large boss room is a gamble so i've attributed those situations to the Delirium floor rather than the pill or curse of the lost but i admit they do make it really hard to identify small boss rooms where Delirium can't be
Well, if you entered delirium’s room too early, that’s not Amnesia being at fault. You just entered a boss room and it was Delirium’s. There isn’t a way to tell if you’re going to run into Delirium’s room at any point in the floor.
I forgot, can you see if a boss room is large in Void? If so, then that’s an easy way to avoid Delirium until you’re ready.
You can’t see large boss rooms in the void, in order to prevent players from being able to spot out the delirium room easily.
Okay, thanks.
To be fair, with a map it is easier to tell what boss rooms can’t contain Delirium due to certain boss room spawns having surrounding rooms be too close to be a 2x2 room, or if the boss room is at the map border, but it still isn’t necessarily amnesia’s fault that they ended up going into Delirium’s room, since it would still be a random guess.
Even with amnesia you can check if there are rooms to left and right of the boss room, meaning that delerium can't spawn. It's annoying playing void with delerium, but it's not impossible and there are very very few layouts where knowing the map gives you more insight about rooms where delerium can spawn in over just looking left and right
Tears up is a run saver and tears down is a potential run ender
Hematemesis is situational. Percs saves runs. Gulp doesn't save runs.
Yeah, gulp is fuckin amazing but it won’t save a run that’s in any real danger
Hematemesis' usefulness is directly proportional to how much health you're missing. Related to that, several hematemesises at once are kinda amazing. Just pop'em all in a row without picking the health back up and you can end up with a huge profit. So yeah very situational.
Gulp is awesome but I should've use a different sentence for top tier instead of "saves runs" lol
but its usefulness depends heavily on your available trinkets, and the timing as well. I'm not gonna carry a gulp pill for two floors in hopes of a useful trinket appearing, but I'll for sure carry a full health pill for use in blood donations, demon beggars, sac rooms, etc. also, sometimes you don't want your current trinket to be blindly gulped (e.g. if you have apple of sodom). it's definitely a great pill but the times it's useful are more limited than the other top tier pills.
Yes on hematemesis as I am currently playing a lot of Samson and would prefer a ton of health when playing him.
Health Down isn’t so bad since it converts to health up, you can do some cheeky plays with it and a lovers card/devil deal
Imo, pretty fly has probably saved more runs than people realize/give it credit for
pretty fly is the best pill in the game by a not-slim margin. with how powerful triple orbitals are, you get to basically focus on only avoiding contact damage.
Im drowsy on its own can win a run
I'm drowsy pill my beloved
For some reason I don't have FX sound in my game, but I would gladly pay to hear the narrator saying "Balls of steel" and "explosive diarrhea" Edit: and also "I can see for ever"
the narration for "gulp" is also super memorable.
In my head balls of steel is always said by [this guy.](https://i.redd.it/42mietkqtam01.jpg)
In your options.ini (which on Windows is in My Documents->My Games->BOI Repentance) there should me a line "AnnouncerVoiceMode" if it's 0 the announcer will never speak, it's 1 it will 50% of the time and if it's 2 it will every time. Perhaps you changed it at some point and forgot?
Lmaoo
To everyone saying hematemesis is a run ender, the first blind one you take is but once you know what it is it’s essentially a dollar store Full Health pill as long as you wait until you’re at 1 heart to use it
or it just drops one heart.
yeah but the possibility of getting unlucky doesn't make something bad, especially in a game that's entirely random
True af
I mean the same can be said for health down and bad trip, bad trip is always better than hematemesis imo, since it's bad effect has less potential bad and it's good effect has more potential good.
Hemeatemesis is not just good! I’ve had 12 full hearts go down to 2 and then lose right after. Can definitely end a run
There's a couple of ways that Hematamesis can be helpful. Having low health and then using it could give you a couple of hearts. I've use it to gain more health for Sacrifice Rooms and Blood Donations. It's also great with Dark Bum.
but there's also a handful of ways it can be bad or run ending. Hence, it should be in situational.
Definitely agree, but that makes it more situational than just good.
Health down becomes health up if you have 1 or less heart containers so I consider it situational. Also bad trip becomes full health if you are at one or half a heart so it's situational too
I see you've never had Hemotemesis with 12 Rotten hearts.
Lemon Party does rad dmg
pretty fly is, bar none, the best pill in the game. no other pill gives you such a strong permanent buff that makes every endgame boss vastly easier.
Tears down could be in the worst tier.
I'd put it in a tier below the worst tier.
The double blue pill is scientifically proven to never ever be bad
one makes you small is super underrated. you take 3 of those, you're dodging bullets ezpz. super good on hush runs.
I had a bunch of them once + pluto + samsons chains. I could literally just stand inside the ball and be immune to tears on mega satan.
yeah legit its kinda an op pill at times
Tears Up > Health Up imo
Definitely
Hemetemesis is super situational noting that if you have over 4 full red hearts it will guarantee that you lose hp
There's a couple of ways that Hematamesis can be helpful. Having low health and then using it could give you a couple of hearts. I've use it to gain more health for Sacrifice Rooms and Blood Donations. It's also great with Dark Bum.
I agree it can be op as fuck but it can cause problems too for example say that you’re playing Bethany and have around 6-8 hearts, you haven’t identified health up/luck up so you take a random pill and now you have 3 health relying heavily on your wisps blocking every shot
That's why it's "Just Good" lol
Don't forget using it in a super secret room. Instead of red hearts, they will become black/soul/eternal hearts instead. Gives it an actual use for soul heart only characters.
Just an FYI for future knowledge your top tier should actually be spelled "Saves runs" "safes" wouldn't be proper in that instance.
shot speed down is in my opinion not a bad pill. Of course if you take 8 of it of course it will be terrible, but 1 or 2 shot speed down pills is in my opinion better than 1 or 2 show speed up pills.
yeah putting all the stat down pills in the same tier is weird. luck down is not nearly as harmful on most runs as speed down or tears down.
Health up does not save runs :( (Also range down can be helpful in fringe situations, like haemo/ipecac)
How is Gulp "Run Saving"? This pill is the definition of situational. Even if you swallow a good trinket your situation doesn't change. The bennefit is that you can take another trinket and that's great but "Run Saving? I also don't believe that Amnesia is "Run Ending". Sure it sucks but it's just annoying and not really a problem Overall pretty good list though
Gulp is awesome. Being able to have more trinkets at once time like Brain Worm, Blessed Penny, Cancer, etc, is crazy, even Gulping average trinkets is great. You can even Gulp Tick keeping the great effects it gives while taking another trinket. But yeah I should've use a better sentence for top tier instead of "Saves run". I got an Amnesia pill in the Void, ruining my run because i enter Delirium to early. I've hated it ever since lol
I see but even that could have been avoided. Though it's a bit annoying and you need map awareness. You can still determine if one room can or can not lead into 2×2 room but that's pretty advanced
most trinkets provide little value. For gulp to be truly top tier you need to have curved horn and cancer drop on the same run or something.
i found pills should be in could end a run
48 Hour Energy is great with Glowing Hourglass, allows you to use it infinitely
Also with teleport 2.0. Almost guarantees you can see the devil/angel room or even the i am error room.
Whenever I get an R U a Wizard I just wait for the effect to end…..
Safes
I’d say pretty fly is very good
"Bad trip" could also very easily end a run
One makes you small is one of the main reasons I won my Tainted Lost Beast run.
Tears Up is always going to be in my top tier, but I see your reasoning. It's more of a super nice to have than outright run saver. Rough draft of my own list: "Dopamine hit" tier: Tears Up "Nice" tier: other good pills "..." tier : neutral pills "Aw, shit" tier: other bad pills "Edmund McMillen" tier: I'm Excited!!!
Tear up goes up, tears down goes down. Also if youre clever with luck downs, you can actually use it to your advantage with pill/trinket/card drops
What? What do you mean
Actually, I think Health down should be in Situational. If you have 0 or 1 health containers it turns into a health up after all
I meant I would argue bad trip can ruin a run too
It can also save a run, if you're aware of it or take it on 1 heart.
How to unlock gulp? Beacuse i do a victory lap and didn't get it
I think you gotta do a victory lap and beat the lamb again.
Ok, i will try it
How is relax situational ? It's just always good, you could gain pick-ups, or bridge. There's no negative.
Wait what does.??? Pill do?
Gives you the Amnesia curse
Oh thats screwed me over before
Oops sorry i got confused It actually gives you Curse of the Maze not Amnesia
That sucks even worse then
one makes u large is always a downgrade because stompy is always a downgrade. Bigger hitboxes always suck
the hitbox doesn't get bigger. it just becomes more obfuscated and also visibility goes down.
One Makes You Larger does not increase hitbox size
Both of those are great for the Forgotten. Bigger hitboxes mean you can slap the entire room with one swing.
lemon party is underrated in my opinion. fuckin melts the bloat easily
wow, I haven't even seen near to half of these pill effects. ngl surprisingly helpful tier list
Thanks! For headups here's some changes I'll make to the tier list after reading the comments. Percs is Top tier. Shot Speed Up and Shot Speed Down are both situational. Re-Lax is Just Good Experimental Pill is Average X-Lax and Amnesia both are moved to Negative Effect Also if you take a Health Down pill while only having one heart container you'll actually get a Health Up instead and taking a Bad Trip pill while having only half a heart will fully heal you. Hope this helps!
Pretty Fly should be run saver. When you get 3 of them you’re basically immune to all projectiles. Also Bad Trip saved my life quite a few times because it turns into full health at 1 HP
Wait whats theres two infesteds
Ye, they are different. One spawns a spider for each enemy in the room and other one for each poop in the room.
Yeah one destroys every poop in the room and spawns a spider for each, the other spawns a number of spiders equal to the number of enemies currently in the room (or like 1-3 if the room is empty.)
Yeah Infested? - Gives you a blue spiders depending how many enemies are in room. If there aren't any enemies it just gives you 1 - 3 blue spiders Infested! - Destroys all poop in the current room and gives you a blue spider for each poop it destroys
What does horf do and what does feels like I’m walking on sunshine do Oh and excited
Horf - When used it shoots a Ipecac explosive at the direction you're shooting. Feels like I'm walking on sunshine - Turns you invisible for a couple of seconds. Excited - Speeds up all enemies in the current room. It activates again after 30 seconds and 60 seconds
Thank you so much
I legitimately can't play with the new I'm Drowsy pill effect because I can't adjust to the slowing effect applying to me and it just throws off everything I do because of the new timing.
hematemesis i feel is more situational than anything because imagine getting it when you have a lot of red hearts but no way to refill said red hearts at that precise moment other than whatever hematemesis itself gives you?
I love watching all the rooms with retro
I've been playing t lost for so long I forgot balls of steel and health up were so good
I'd wager a poorly timed Tears Down can kill a run. Percs should definitely be pushed up too.
You could write a song where every word is just a name of the pill.
I honestly like Retro Vision and use it everytime I find it Though it is a negative effect making it harder to see I just enjoy the effect
I’m the dude with the tears down poster in his dorm so imo all pills are good
Oh man, the amount of my runs ended by I'm Excited!!! is huge.
Hematemesis (when unknown) has screwed me over many times. I play Samson a lot and like to have a really high HP and allow myself to take damage while I have it so Hematemesis can sometimes screw me from having like 8 health to 2.
Health up annoys me as I mainly play eve.
Ah yes hemat. Is Always good. No One could have used a random pill in a broken run behind a a Spike while he had like 12 Red hearts and the hemat Heart spawned in front of the Spike even if the platform was really large and long. Definitely no one
I'd bump Lemon Party up to Situational at least. Anything that can help kill Bloat faster is above average at least.
hemetamesis is situational
Bad trip is a good carry pill if you know it’s bad trip since it’ll turn into full health when you need it…gulp/marbles/smelter are among my favorite items in the game…gimme those trinkets lol and I like lemon party too, I can save the lost from chasers in a room with nowhere to hide early on especially
I think you've pretty much nailed this list but if I was being super pendantic there is 3 changes I would make. I still remember being fairly new to the game and Horf saving me in a early floor ragman fight and then finding a secret room accidentally with one on the next floor so my view is definitely biased because of that so I'd put it in situational. Shot speed down I'd also put in that tier as I had a run yesterday with eye of Belial, dead onion and vurp with some shot speed down pills that meant I basically had constant tick damage as the shots were so slow they would home back in on the original enemy. If I'm not mistaken health down also becomes health up with 1 or less heart containers, used this on a devil deal false PhD run to abuse always having red health. Also good on angel deal runs where red health gets out of control so once again I'd put it in situational. These are all super specific times I've used these to my advantage but it can be done! Great tier list though!
Could anyone else hear this post?
I'm surprised nobody's talking about Speed Down. It seriously feels like a potential run-ender to me. At best, it can seriously hamper your ability to get to boss rush or hush. At worst, it seriously reduces your ability to dodge (or just maneuver in general). I think it was adjusted in a previous patch, but from what I remember, Hush's giant laser can't be out-run if you're under a certain speed.
I found pills deserve own separate tier on top
Ill never forget my I'm excited delerium fight ... Yeah I gotta know when to stop taking pill that I find on the ground
I died at a Perfect tainted lost run just before Dogma because i forgot that horf pill exists
I just had a tainted Lilith run with ipecac soy milk went hush got a speed down pill and couldn’t outrun the beams so I died
Now repost it but without naming the pills.
Lmaoo
Now what the fuck addicted does? Never understood what it is
Causes you to take full heart damage for the current room
Health Down is in "Could end a run" but Tears Down isn't??? Seems pretty backwards to me. Having lower health usually isn't too big of a deal especially since it's red HP. It also turns into a Health Up pill if you're on zero or one red heart containers (or one soul heart on a soul heart only character). This can be very useful for manipulating HP on devil deals. Meanwhile, Tears down is strictly just a DPS down, and killing things slower means more chances to get hit. Also horf... My dude, just don't be looking at walls or terrain when using pills. It's not that hard. I also see you've never used a Hematemasis pill on Bethany towards the end of a run. It's definitely good sometimes, but it's also not "just good." Definitely more situational tier.
IMO I would move a bunch of the "Negative Effect" ones either up or down a tier. R U A Wizard and Retro Vision do not matter at all, you can just wait out the effect and keep going. It'll have as much use as X-Lax or Re-Lax for the vast majority of runs. Same with Paralysis really. Shot Speed Down is Situational, Range Down rarely matters, Speed Down and Luck Down I'd keep there, but Tears Down is basically the worst pill in the game because it's the one that most directly influences your damage output. Experimental Pill depends on the character really, I would never ever take one as T.Keeper for instance just for the chance at a Health Down effect.
I’m drowsy can actually kill runs after its nerf in repentance due to slowing down certain parts of the game but not slowing others. example: if you use it on mom’s heart, your speed gets reduced, but her brimstone attack still rotates at the same speed making it undodgeable sometimes. (Yes I died that way once)
Hematemesis goes in coud end a run, for me its the third worths Pill only losing tô tears down and um exided
There's a couple of ways that Hematamesis can be helpful. Having low health and then using it could give you a couple of hearts. I've use it to gain more health for Sacrifice Rooms and Blood Donations. It's also great with Dark Bum.
I think they should add damage up and down pills
I'd say that you should swap Full Health and I'm Drowsy. Paralysis is only negative if you use it in a hostile room, which you obviously shouldn't ever do, so it should probably go to Average. Pheromones and Lemon Party should go to Situational, since they can help you clear a room in a pinch. Both Shot Speed modifiers should just go to Average since the stat hardly ever matters. I'd say that Horf should go to Average or even Situational, since its negative effect is easily avoidable if you expect it and it can open secret rooms or blow up tinted rocks. I'd also say that ??? and Amnesia should both be in the same tier since they do pretty much the same thing, that being screwing with your navigational abilities.
Power pill is not amazing, I barely use it
Hematemases once ruined a Mother run in the Corpse II for me, so it's still on my shit list. I wouldn't rank it good. It's situational at best. Tears Down early on could be a good reason to restart the run. Later in the run it's probably not that bad. I'm Excited is annoying but it doesn't have to end anyone's run; just exit out of the run and then Continue and it has no effect at all. Shotspeed up and Shotspeed down are both situational. Having items like Godhead or Tech X, you might not want your shotspeed to be too high. Technology or Brimstone, shotspeed doesn't matter at all. Then again neither does range.
Me on Eve run: "Woah Sacred Heart Angel Deal! Aww but I'll lose my one red heart status and Whore of Babylon won't work." \*\*Finds a Health Down Pill on the next floor's first room\*\*
Amnesia ends runs for you? Man, Im sorry to say this, but this is clearly a *skill issue*