Therefore, taking a pill is a risk although it may help the player (by granting "full health" or a bonus to stats) it could also harm the player (lowering health or stats). There is a possibility to pick up the item "PHD" to know the effects of pills, but it's a rare find and appears in very few playthroughs. Sometimes Isaac can pick up pills, which can have good or bad effects. You may kill enemies easily on one floor and have lots of spare hearts or items, however, once you've descended to the next floor, it's impossible to go back. Bosses are also different too -although there is a limited number of them, it's never possible to guess which one will appear on which floor. Items are never the same in the playthroughs-you may get some great items in one game, and get nothing good in another. There are many different items Isaac can collect, from accessories to improve his tears range (tears are his form of attack), or to improve his speed, to creatures who shoot enemies with you.
Different items and bosses with each playthrough.Each floor has a boss level, a shop and a bonus item room, but these are always in different places, and therefore impossible to learn by heart.
You can't 'memorise' the map because it's different every time.
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