The Binding of Isaac Items Tier List

A

B

C

D

A Tier

Twisted Pair, Tech X, Mom's Knife, The D6, Pyromaniac, Binge Eater, Mega Mush, Revelation, Crown of Light, Magic Mushroom, Cricket's Head, Brimstone, Incubus, The Wafer, Polyphemus, Ipecac, 20/20, Ghost Pepper, Epic Fetus, Metal Plate, Paschal Candle, Mysterious Liquid, Mutant Spider, Jacob's Ladder, Ocular Rift

B Tier

Mom's Contacts, MEAT!, Mitre, Mr. Dolly, Monstro's Lung, The Nail, Pyro, Mom's Wig, Night Light, Money = Power, Number One, Mom's Perfume, Mom's Purse, Midas' Touch, Mom's Eyeshadow, PHD, My Little Unicorn, Odd Mushroom (Thin), Mom's Bottle of Pills, Odd Mushroom (Large)

C Tier

Mr. Mega, Damocles, Mom's Box, The Mark, Marrow, Lusty Blood, Midnight Snack, Mini Mush, The Pact, Pageant Boy, Bloody Lust, Multidimensional Baby, Judas' Shadow, Eye of Belial, Mom's Key, Mom's Eye, Guppy's Tail, Backstabber, Mr. Boom, Meat Cleaver, Maw of the Void, No. 2, Gimpy, Lil Abaddon, Blood Oath, Guppy's Hair Ball, Pentagram, A Pound of Flesh, Spirit of the Night, Brother Bobby, Whore of Babylon, Brimstone Bombs

D Tier

My Reflection, Match Book, Mom's Coin Purse, Ouija Board, The Book of Belial, Magneto, Mom's Underwear, Notched Axe, Milk!, Mom's Bra, Mom's Pad, Mom's Heels, Mom's Lipstick, Broken Shovel, Monster Manual