Although extremely unlikely, Isaac can shoot a total of 16 blood beams at a time via multi-shot items.Multi-shot effects like 20/20 will increase the number of beams accordingly, with exceptions listed below.His Brimstone's shorter range can be increased with range up items or pills.Without the long-range version, his mini-brimstone won't have enough length to use any homing items. Picking up Brimstone with him will give him the long-ranged version.

Collecting three items from this set will transform Isaac into Leviathan. However after the first damage tick, there is an additional pause for ~0.12 seconds (7 frames). The beam is piercing and spectral, dealing damage to all enemies and ignoring all obstacles in its path.