Trinkets are a new passive pick-up that are introduced in the Wrath of the Lamb DLC. These items give passive bonuses when held like regular passive items, but unlike those you can only hold one trinket (without Mom's Purse which lets your hold two) and they can be switched (except for the Tick). Also unlike regular items these are not just found in a few places, these can be found by completing a room, found in any chest, secret rooms, Fortune Telling Machines and more.
| Name | Effect | Unlocking Requirements |
| ???'s Soul | When you pick it up you gain a new familiar who moves like The Peeper all acorss the room firing spectral homing tears. If you have other familiars some will follow ???'s Soul instead of you around the room. | Beat the Chest with ??? |
| Ace of Spades | Increases your chance to find both Tarot Cards and Suit Cards. | None |
| Bloody Penny | When you collect any money there is a 50% chance of a half red heart appearing. | Beat the Cathedral with Samson |
| Burnt Penny | When you collect any money there is a 50% chance of a bomb appearing. | Complete Challenge 3: Large Marge |
| Cain's Eye | When starting a new floor there is a 25% chance of having a Compass effect during the floor. | Beat the Chest with Cain |
| Cancer | Doubles your firing rate stat. | None |
| Child's Heart | Increases the chance of finding red hearts when clearing rooms, beating enemies opening chests, ect. | None |
| Counterfeit Penny | When you collect any money there is a 50% chance of increasing the amount of the coin by 1. | Complete Challenge 9: Issac Was Good Today |
| Cursed Skull | If you are brought down to a half a red heart you get teleported out of the room to the previous one. When playing as ??? each time you get hit you get teleported out. Also if you beat a boss but a minon of his brings you down to a half of heart you get teleported out and must start the fight over again. | None |
| Curved Horn | Raises your Damage stat. | Beat the Cathedral with Judas |
| Eve's Bird Foot | Gives a chance of spawning a Dead Bird when attacking a enemy. (When you leave the room the Dead Bird goes away.) | Beat the Chest with Eve |
| Flat Penny | When you collect any money there is a 50% chance of a key appearing. | None |
| Fish Head | When you get hit you spawn a attack fly. | Complete Challenge 5: Lord of the Flies |
| Goat Hoof | Raises your base Speed. | None |
| Isaac's Head | Gives you a familiar that acts and looks like Brother Bobby but has piercing shots. | Beat the Chest with Isaac |
| Isaac's Fork | Each time you clear a room there is a 10% chance of recovering half of a red heart. | None |
| Juads' Tounge | Deals with the devil in Devil Rooms will now only cost 1 red heart or 3 soul hearts. Note this item must be equiped before the Devil Room is found to work. | Beat the Chest with Judas |
| The Left Hand | All normal chests are now red chests and some gold turn red also. | Beat Ultra Pride |
| Liberty Cap | Has a 25% chance of giving the player one of these effects for a room: Mini Mushroom, Odd Mushroom (large), Odd Mushroom (thin) and the Compass. If you get the Odd Mushroom (large) effect while playing as ??? when you leave the room the Spirt Heart you gained from it stays. | None |
| Lucky Toe | Increases the chance to get a drop after finishing a room. | Complete Challenge 2: 7 Years Bad Luck |
| Maggy's Faith | Gives you a eternal heart at the start of each floor. | Beat the Chest with Maggy |
| Match Stick | Increases the chance of finding bombs when clearing rooms, beating enemies opening chests, ect. | None |
| A Missing Page | When you get hit there's a 5% chance of causing a Necronomicon effect. | None |
| Mom's Pearl | Increases the chance of red heart pickup becoming soul hearts by 10%, this does stack with the Mitre. | None |
| Pinky Eye | Gives you a 10% chance of firing a poison tear. | None |
| The Polaroid | This only active if you have a half of red heart or only spirit hearts left. When you get hit when it's active you will get a Book of Shadows effect making you imune to damage while it's up. This item is always dropped by Mom and must be held to make it to the Chest. | Beat the Cathedral six times total. (It can be the same character.) |
| Push Pin | Gives you a 10% chance of firing a spectral piercing tear. | None |
| Red Patch | When hit you can randomly increase your damage in the same way as using the Razor Blade. | None |
| Rusted Key | Increases the chances of getting keys and golden chests dropping after you clear a room. | None |
| Saftey Cap | Increases the rate of finding pills. | None |
| Samson's Lock | Causes the same effect as Bloody Lust which increases the amount of damage by the amount of enemies killed in the room. The effect will reset when you leave the room. | Beat the Chest with Samson. |
| The Tick | When you enter a boss room bosses will have 15% less health and you restore one heart of health. You can't remove the tick when you pick it up thus making it impossible unless you have Mom's Purse to go to the Chest. | None |
| Umbilical Cord | When your health goes to a half of a red heart a Little Steve familiar will spawn and will stay until you gain more health. | None |
