Normal pills
The small pill applies the ordinary effect shown in its catalog entry. Take unknown pills in a safe room if you decide to experiment.
Isaac consumables / Pill guide
Repentance pill basics
Pill colors and identification
Pills start unidentified. A color tells you which pill you are holding, but its effect is assigned when the run begins. Learn the effect before assuming the color means healing or a stat increase.
How identification works
1. Start with an unknown
An unidentified pill shows ??? in your pocket slot. Color has no fixed effect across different runs.
2. Learn the effect
Using a pill identifies its color for this run. Identifying items such as PHD can reveal effects without taking that risk.
3. Recognize the next one
Later pills of the same color share that effect within the run. Pill-modifying items can change the assigned effects.
There is also an actual pill effect named ??? that applies Curse of the Maze. That effect is separate from the label on an unknown pill.
Normal, horse, and golden pills
Horse pills
The larger pill uses the same effect assignment as its normal color. Some effects are stronger; others are unchanged. Unlock them by defeating Mega Satan as Tainted Eve.
Golden pills
Each use chooses a random effect and may consume the pill. The result can come from outside the run's normal pill pool. Defeat Mega Satan as Tainted Cain to unlock them.
A Golden Horse Pill combines random effects with the horse versions. Both the golden-pill and horse-pill unlocks must be available.
Original game sprites
Compare all 28 appearances
These are visual comparisons, not a color-to-effect key. The large pill in each pair is the horse version.
Blue / Blue
Normal
Horse
White / Blue
Normal
Horse
Orange / Orange
Normal
Horse
White / White
Normal
Horse
Dots / Red
Normal
Horse
Pink / Red
Normal
Horse
Blue / Cadetblue
Normal
Horse
Yellow / Orange
Normal
Horse
Dots / White
Normal
Horse
White / Azure
Normal
Horse
Black / Yellow
Normal
Horse
White / Black
Normal
Horse
White / Yellow
Normal
Horse
Gold / Gold
Normal
Horse
Look up the effect you learned
All 50 pill-effect entries include the normal effect, horse version, practical tip, and any permanent unlock requirement.
Search pills in the consumables databaseRepentance rules, reviewed October 6, 2026. References: pill identification and horse variants ↗, Golden Pill ↗.