Perhaps you could have cyanide drain health unless you can pick up a health pickup of any type (Normal, soul, black, white, halves, doubles, whatever) and then to balance it out, add a pill that gives you enough soul hearts to max out your health, and make them both INCREDIBLY RARE.

I was thinking a pill that gives almost soy milk fire rate for the current room

Maybe cyanide would slowly drain your health until you find a heart?

I'm open to suggestions for pills, this particular one feels maybe a bit to negative. That's an effect that might prevent me from taking pills, particulary with this item as the pool is smaller.

Are you accepting ideas for pills? if so I have an idea.

Cyanide : health all the way down

Sadly, no. I can do it until a certain point where the current API, to my knowledge, does not let me customize things.

I've pushed an update a few hours ago that slightly change pills on the ground after you take the item : they are fliped on an X axis, a bit darker, and i've added a small rotation but on the sprite but i'll probably remove it, it does not look good. The thing is once Isaac hold a pill, I cannot find a way to change how they are displayed.

Would you be able to replace pills with "pill-like" drops? I mean like how Starter Deck replaces pills with cards, maybe your item replaces regular game pills with another skin of your choosing. That might be a way to get around the pill thing - have your pills drop in place of them.

For those who only want the pills, I've uploaded another mod without the item.

That's a really good idea. I'll see if I can do somthing. This is not easy because we cannot interract with pills directly, only with their effects. But i'll try something.

Would be super cool if the pills gained a unique look to them afterward. Even something as simple as them being horizontal, or a different shape.

Ok, i'll probably make aother mod with pills only.

In the meantime, if you want the pills, I think you can edit the pocketitems.xml file in the mod folder and remove all 'achivement="999"' attributes to let pills appears in pool.

I would like to request a mod that adds these pills standalone, without the need to take the item. I know that you like it being tied to an item, but having more pills on the get go sounds more appealing to me.

Also, a suggestion: Maybe you could make an item that completely reshuffles your pill pool.

I've just fixed a bug where using the "debug_start = true" option was not spawning the item if a save mod data file did not previously exited.

Ah of course, what awareness could mean else in this game, lol. Thanks for the reply!

Sure :
The first time you take it, tinted rocks and secret room will be highlited for the rest of the run
The second time, super secret room ande super secret rocks wil be highlighted for the rest of the run
The third time, crawlspace/black market entrances will be highlighted.

This might change in the future to highight more things but spluit it on 4 steps instead of three.

Can you elaborate on "Awareness Up" ?

I don't know. I like the ideas of this set of pills beeing tied to a prescription, both on a thematic and gameplay level.

The pill pool is already quite large with AB+, I did'nt want to make it more diluted. I want to tunes the effects to be sligtly stronger than the base pills so (but not overpowered), so when you see the item in the shop you might want to by it if your pills are trash in your current run.

i feel like these should just be added to the pool automatically without requiring an item