Many Tears Up items come from the Item Room and Boss Room pools.A Golden Pill can be used if Tears Up is not a part of the current run's Pill pool, where when used repeatedly can grant many Tears Up bonuses, but this is very luck-based.Losing a Tears Up item this way will not count against the achievement. Obtaining a large number of items, then repeatedly rerolling them such as by using D4 can allow Isaac to get more Tears Up items.Tainted Cain can craft items that count towards the achievement.This can be much easier to do in Greed mode, as you can often reroll the shop items until you find these, as well as repeatedly buy pills until another Tears Up one appears. ![]() From there, prioritizing Mom's Bottle of Pills, Placebo and PHD will allow them to generate more of these pills.
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