Use the consumable button to activate a pill: on keyboard, that’s Q ; on controller, it’s usually RB/R1. Pills share the same slot as cards and runes, and unknown pill colors often start as ??? until you use them once in a run.

How it works

  • Pick up the pill so it appears in your consumable slot.
  • Press the use button to consume it immediately.
  • If you want to remove or swap it, use the drop/swap control instead of the use button.

Safe way to test

  • Try unknown pills in a cleared room, not during a boss fight.
  • Some pills are helpful, but others can lower health, speed, or damage your run.
  • Once a color is identified in that run, that color keeps the same effect for the rest of the run.

Useful items

  • PHD can make pills safer or more rewarding.
  • Lucky Foot and False PHD also affect how pills behave.
  • If you get a bad effect, that’s normal for Isaac’s pill system—it’s part of the risk/reward.

Quick example

If you find a pill right after clearing a room, grab it, move to safety, then press Q to test it. That way, if it turns out to be a bad pill, you are not stuck taking damage in the middle of a fight.

Action| Keyboard| Controller
---|---|---
Use pill| Q| RB / R1
Drop pill| Hold Left Ctrl| Hold RT / R2

If you want, I can also give you a simple “which pills are worth taking” cheat sheet.