When playing as Jacob & Esau the item, once activated, gives its full benefit while it only has a chance of falling once the character who used it gets hit.

Be warned, however, that losing a life before the sword falls does not de-spawn the sword.

After the sword falls, extra items will no longer spawn. The only way to survive the falling sword is either through extra lives, by using items that would make you invincible, such as Gnawed Leaf or playing as The Lost.In double Treasure Rooms and boss rewards with There's Options, four items will spawn, but you can only take one item from each pair.In Shops, and Devil Rooms, the extra item is free to take.Summary: Where I put some little stories that I wanted to write out. The chance for Damocles to fall is indicated by how far the sword swings back and forth. The Binding Of Isaac One-Shots ProblematicPikachu.Using Blood Donation Machines, IV Bag, or Devil Beggars does not increase the chance for the sword to fall.The more hits Isaac takes, the more likely it becomes for the sword to fall. After getting hit once with the item activated, at any time without warning, the sword may fall, instantly killing Isaac regardless of his health.As long as the sword hangs above Isaac, all item pedestals are doubled, spawning an extra item for every item spawned. Upon use, summons a sword that hangs directly above Isaac.

The binding of isaac pandora's box