

IPECAC - Ipecac's long travel time allows for increased damage.Sacred Heart - The slow shot speed and homing can allow for a large damage increase with this item.

Caves 1 I got 2 suicide kings, at least one from a sack. A shop on the 2nd or 3rd floor has a Sack Head. But the first floor has a Mom's Knife in the treasure room, and a Dead Cat in the curse room. Magician tarot card or Spoon Bender) and if range has been increased by a large amount. You need the Holy Mantle to make the most of it.

In Rebirth, this is changed so that the tear's damage increases based on its distance from Isaac, an aspect Edmund claims was the original intended use of the item. The size of Isaac's tears is decreased initially, but increases as damage does. Tears turn black and increases damage based on how long tears have been on the screen. Isaac's face becomes dirtied with coal dust.
