Upon activation, all enemies in the room are slowed down as well as their projectiles for 7.67 seconds, indicated by a white color effect.
- The Hourglass will cause a myriad of other things than its intented function to happen:
- Krampus, The Fallen, the Blue Champion Variant of Famine, and other circularly shooting enemies will shoot two close tears while slowed for every single tear at normal speed.
- It is noteworthy that this item is extremely detrimential to any player using bombs. It will count your bombs as an entity to be slowed, meaning that you are more likely to hit yourself than an enemy. This applies to Dr. Fetus along with Epic Fetus.
- When used on The Fallen during his 'split' phase, instead of splitting into 2 Fallen, he will split into 4.
- When used on The Duke of Flies, he will spawn double the normal amount of flies at a time (e.g. 6 Attack Flies instead of 3, 2 Large Attack Flies instead of one)
- Death uses this as one of his attacks.