Transformation progress of an item will be lost if the passive item is removed in any other way, such as being rerolled with D4, or destroyed by Sacrificial Altar.Transformations are permanent, and the progress towards transformations by passive items remains if it is replaced with a new item.Items or pickups that allow to absorb them ( Marbles, Smelter, Gulp!.) are even more important as absorbed trinkets do not take up an item slot. Therefore any item helping to gain some, such as Mom's Box, will help a lot. Due to the limited amount of items, Trinkets have a more important role with this character.This can make them either extremely useful or dangerous, as high natural stats mean less need to carry stat up items, but Tainted Isaac cannot counteract stat downs with items as easily due to the limited inventory. Stat changes from Pills are permanent.

Using the D4 or D100 or D infinity to reroll passive items then dropping gained health items makes it easier for him to accumulate more health containers.

Rerolled health items makes Tainted Isaac lose the health 'bound'.

Many items not having their effects reverted are listed in Synergies and Interactions section. HP upgrades like Breakfast, and pickup spawners like Pageant Boy can all be left behind immediately.

While most passive items have their effects 'bound' to them, with the changes reverted with the loss of the item, some passive items have a permanent effect that triggers on pickup.

Even if one of the item is a set drop, the other one is still randomly pulled from the current room's item pool.

Note that pickups will be kept regardless of which way they were gained (picked up or directly added to the counters).

Dropping items causes their passive buffs to be removed, however health or pickups will be kept (such as from Breakfast or Pageant Boy).

Swallowed trinkets also do not count towards the 8 item limit.

The Polaroid, The Negative, Key Piece 1, Key Piece 2, Knife Piece 1, Knife Piece 2, Dad's Note, Birthright, the passive item created when Damocles is used (the one with item ID ' 656'), and all activated items are exempt from this limit and do not take up inventory space.

Once an item has been picked up it will no longer cycle between items.

Whichever item is currently visible when the item is picked up will be the one selected. In exchange for this, all rerollable item pedestals, Shop items, and Devil deals will cycle between two items for the player to choose from, essentially a stronger version of More Options + There's Options.The swap key can be pressed to cycle which item is selected. Upon picking up a 9th passive item, the item currently selected, or rather the item currently in the white square, will be dropped on a pedestal in front of Tainted Isaac. Tainted Isaac's current 8 passive items are visible in the top-left corner of the screen, with one highlighted by a white square. Tainted Isaac can only hold 8 passive items at a time.

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