Black Candle only adds a black heart and does not remove curses.Belly Button and Mom's Purse allow picking up two trinkets in the room, but if another one is picked up outside, one trinket disappears completely along with the extra slot.Alabaster Box will immediately activate without requiring Soul Hearts.Abaddon will not remove red hearts or grant black hearts.1up! and Guppy's Collar give no indication of extra lives, but will still work if you die in the room.

Items that adjust Isaac's size will not do so.Items do not spawn pickups and consumables that they might when picked up normally.Void absorbing passives and granting stats will persist.Magic Skin will give Isaac a broken heart, spawn an item, and count as an activation of Magic Skin, causing future items to have a chance of being replaced by Magic Skin.Damocles will permanently grant the passive version of Damocles.D8's rerolled stat multipliers will persist, D4 or D100 will reroll all items permanently and D Infinity mimicking any of the previous also has the same effects.Cube of Meat granted by Potato Peeler will persist.Health, coins, bombs, or keys that are granted to Isaac directly will persist.It is not clear what is intended and what is a bug. Certain items used by Metronome have permanent, limited/unusual, or no effect.Moreover, active item effects chosen by Metronome are only activated once.Car Battery: Metronome is activated twice at once as expected, but the item chosen for the first activation is shown raised above Isaac's head, instead of the second one that actually remains active.Sometimes, these interactions will even occur without a shield item.Spear of Destiny: does not persist between rooms.Mysterious Liquid: the tear appearance is reset back to normal, but tears will still leave green creep on the ground.Fire Mind: the tear appearance is reset back to normal, but tears can still explode when they hit an enemy.Cupid's Arrow: the tear appearance is reset back to normal, but the tears still travel through enemies.1up!: the mushroom familiar continues to follow Isaac, but doesn't grant an extra life.Items that grant flight: Isaac's appearance is reset back to normal, but he is still able to fly.Some items behave unusually after leaving the room while the Holy Mantle shield was active:.Continuum, Epic Fetus, Eve's Mascara, Godhead, Ipecac, Jacob's Ladder, The Ludovico Technique, A Lump of Coal, Monstro's Lung, My Reflection, Ouija Board, Pop!, Rubber Cement, Sacred Heart, Spoon Bender, Strange Attractor, Technology Zero.Some tear effects from items will remain active between rooms.For example, the tears down applied from The Inner Eye will persist between rooms, but Isaac will not shoot three tears at once. Items that modify your stats and have other additional effects will keep the stats but the effect will be gone after leaving the room. Blanket / Holy Card / Holy Mantle / Wooden Cross: if Metronome is used while the shield is active, any stat changes or familiars/orbitals generated from Metronome will persist between rooms until Metronome is used again or replaced with another active item.Rock Bottom: Isaac keeps any stat upgrades gained by a random temporary item as long as the item brings his stats over their highest value reached on that run.If a passive item was selected, grants any random wisp. Book of Virtues: If an active item was selected, grants the same wisp as that item.Metronome has a reduced chance of activating Genesis (25% success) or Death Certificate (15% success).If Metronome triggers the effect of Genesis, it will disappear from the active slot, just as with the real item.If Metronome triggers the effect of Moving Box, items in the room will be packed away into the box until you either find the Moving Box or Metronome gives you the Moving Box effect again (unlikely).Keep in mind that you can trigger items you haven't unlocked yet, which means you could trigger the effect of items like Death Certificate without having to go through the trouble of unlocking them.Also unable to grant Breath of Life, Clicker, or R Key.Metronome cannot grant the effects of itself, Glowing Hourglass, Plan C.Using this item multiple times in the same room will replace the previous item with a new one.Beware using this as The Lost or Tainted Lost, as it can trigger self-damage items.Grants a random item's effect for the current room.

The city of metronome