How this tier list is ranked
Two things decide a rank here. Room-clearing power is how well one press handles a crowded room.
Boss value is how much the item adds in a long fight. Charge time and side effects settle the rest.
An active item that clears a room and helps a boss sits high. One that needs a rare setup sits lower.
This list ranks decision value. It answers one question. How often does the space bar change the fight?
The tier list at a glance
| Tier | Active item | Why it ranks there |
|---|---|---|
| S | Tammy’s Head | Fires a ring of tears in every direction and scales with your damage items. |
| S | Blank Card | Repeats your held card or rune, so a doubled one-shot can rescue a floor. |
| S | Book of Belial | Lifts room damage and devil deal odds, a strong button before a boss. |
| S | Guppy’s Head | Releases a cloud of flies that chase and bite nearby enemies. |
| S | The D6 | Rerolls a pedestal item, turning a dead room into a real choice. |
| A | Book of Shadows | Grants a short shield that blocks damage through a heavy hit. |
| A | Book of Revelations | Raises your damage and points you toward a devil room on thin health. |
| A | Mom’s Bra | Freezes every enemy in the room, which gives you space to reposition. |
| A | Necronomicon | Deals heavy damage to everything in the room at the cost of health. |
| A | The Nail | Adds a damage boost and a soul heart on each use. |
| A | The Hourglass | Slows the enemies in the room, so the fight is easier to read. |
| A | The Bible | Grants flight for a room and can end one specific boss outright. |
| B | Mr. Boom | Drops a large bomb that clears a cluster of enemies in one spot. |
| B | Anarchist Cookbook | Spawns a ring of troll bombs that clears a crowd but can trap you. |
| B | Yum Heart | Restores a heart of health, a sustain tool rather than an attack. |
| B | Book of Virtues | Turns your extra actives into a set of fighting wisps. |
| B | Lemon Mishap | Leaves a puddle that damages enemies standing in it. |
| B | The Poop | Drops a block that can stop shots or break for a pickup. |
| C | Razor Blade | Trades your health for damage output, a risky deal on a thin run. |
| C | Forget Me Now | Restarts the current floor, which also undoes the progress you made. |
| C | The Gamekid | Turns you into an invincible arcade form for a short window. |
| C | Breath of Life | Needs precise timing and a full charge to pay off. |
| C | Pinking Shears | Cuts off your body to fight for you, odd to steer at low health. |
S-tier active items
These actives turn a single press into a swing. Each one works with little setup from the rest of the build.
Tammy’s Head fires a ring of tears in every direction. It clears a packed room and grows with your damage items.
Blank Card repeats your held card or rune. A doubled one-shot can rescue a floor or a fight.
Book of Belial lifts room damage and devil deal odds. It is a strong button to press right before a boss.
Guppy’s Head releases a cloud of flies that bite nearby enemies. The swarm handles small enemies while you move.
The D6 rerolls a pedestal item. A dead room becomes a real choice, which protects the whole floor.
A-tier active items
These actives are reliable answers. Each covers one common problem without much cost.
Book of Shadows grants a short shield that blocks damage. The window is small, but it saves a heavy hit.
Book of Revelations raises your damage and points you toward a devil room. It suits a run with thin health.
Mom’s Bra freezes every enemy in the room for a short time. The pause gives you space to reposition.
Necronomicon deals heavy damage to everything in the room. The cost is a slice of your own health.
The Nail adds a damage boost and a soul heart on each use. That mix of power and healing fits most builds.
The Hourglass slows the enemies in the room. A slower fight is easier to read and dodge.
The Bible grants flight for a room and can end one specific boss. Outside that fight it is a narrow tool.
B-tier active items
These actives do one job well. Their value depends on the room and the build you carry.
Mr. Boom drops a large bomb that clears a cluster of enemies. Aim it before the group splits apart.
Anarchist Cookbook spawns a ring of troll bombs. The spread clears a crowd, but it can trap you near a wall.
Yum Heart restores a heart of health. It is pure sustain, so it ranks on survival rather than offense.
Book of Virtues turns your extra actives into a set of fighting wisps. It needs a second active to pay off.
Lemon Mishap leaves a puddle that damages enemies standing in it. The puddle works best in a narrow room.
The Poop drops a block that can stop shots or break for a pickup. It is a small tool for a small moment.
Active items to avoid
These actives cost more than they give in a normal build. Take them only when a plan already fits.
Razor Blade trades your health for damage output. On a thin run, that trade can end the fight early.
Forget Me Now restarts the current floor. The reset also undoes the progress you made on that floor.
The Gamekid turns you into an invincible arcade form for a short burst. The charge is long for the window it gives.
Breath of Life rewards precise timing and a full charge. A mistimed press wastes the whole item.
Pinking Shears cuts off your body to fight for you. The split is odd to steer on a low-health build.
Best active items for bosses
A boss fight rewards actives that add damage or safety over a long window.
Book of Shadows and The Nail both add survivability. Book of Belial adds damage right before the fight starts.
Necronomicon deals a large burst to a boss in one press. Save it for a phase that crowds the room.
The Bible ends one specific boss outright. Carry it only when you expect that fight.
Best active items for clearing rooms
A crowded room rewards actives that hit many enemies at once.
Tammy’s Head and Guppy’s Head both clear a group. Tammy spreads tears, while Guppy releases a chasing swarm.
Anarchist Cookbook and Mr. Boom drop explosives. Both handle a cluster, but they need a clear spot to fire.
Pair a clearing active with damage items. The effect scales with your build, so a strong run lifts it further.
What to remember
An active item is a tool with a short window. The best pick answers the room in front of you now.
Watch the charge time before you commit. A short charge means more uses, which adds up across a floor.
Swap the active when a better one appears. The slot holds one item, so an upgrade replaces the old tool.
Next: Item tier list and Boss patterns.