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Diseases, gases, poisons, and venoms are types of afflictions, as are some alchemical items, curses, and other effects. An affliction can infect a creature for a long time, progressing through different and often increasingly debilitating stages. The level of an affliction is the level of the monster or item causing the affliction, or, in the case of a spell, is listed in the affliction entry in the spell’s effect.

Affliction Properties

Name and Type

The name of the affliction is given first, followed by the affliction’s traits in parentheses and any unusual details.

Saving Throw

When you’re first exposed to the affliction, you must attempt a saving throw against it. This first attempt to stave off the affliction is called the initial save. An affliction usually requires a Fortitude save, but the exact save and its DC are listed after the name and type of affliction. Spells that can poison you typically use the caster’s spell DC.

On a successful or a critically successful saving throw, you are unaffected by that exposure to the affliction.

You do not need to attempt further saving throws against it unless you are exposed to the affliction again.

If you fail the initial saving throw, after its onset period (if applicable), you go to stage 1 of the affliction and are subjected to the listed effect. On a critical failure, after its onset period (if applicable) you go to stage 2 of the affliction and take that effect instead. See Stages below.


Some afflictions have onset times. For these afflictions, once you fail your initial save, you don’t gain the effects for the first stage of the affliction until the onset time elapses. If this entry is absent, you gain the effects for the first stage immediately upon reaching that stage.

Maximum Duration

If an affliction lasts only a limited amount of time, it lists a maximum duration. Otherwise, the affliction lasts until you succeed at enough saves to recover.


An affliction typically has multiple stages, each of which lists an effect followed by an interval in parentheses.

When you reach a given stage of an affliction, you are subjected to the effects listed for that stage.

At the end of a stage’s interval, you must attempt a new saving throw. On a success, you reduce the stage by 1 and take the effects of that stage again. On a critical success, you reduce the stage by 2. If the affliction’s stage is ever reduced to lower than stage 1, the affliction ends and you don’t need to attempt further saves unless you’re exposed to the affliction again.

On a failure, the stage increases by 1, and on a critical failure its stage increases by 2. If a failure or critical failure would increase the stage beyond the highest listed stage, the affliction instead repeats the effects of the highest stage.

Conditions from Afflictions

An affliction might give you conditions with a longer or shorter duration than the affliction. For instance, if an affliction causes you to be drained but has a maximum duration of 5 minutes, you remain drained even after the affliction ends, as is normal for the drained condition.

Alternatively, you might succeed at the flat check to remove persistent damage you took from an ongoing affliction, but you would still need to attempt saves to remove the affliction itself, and failing one might give you new persistent damage.

Multiple Exposures

Multiple exposures to the same affliction have no effect if it’s a curse or disease. However, for a poison, failing the initial saving throw against a new dose increases the stage by 1 (or by 2 if you critically fail) without affecting the maximum duration. This is true even if you’re within the poison’s onset period, though it doesn’t change the length of the onset period.

Virulent Afflictions

Afflictions with the virulent trait are harder to remove.

You must succeed at two consecutive saves to reduce a virulent affliction’s stage by 1. A critical success reduces a virulent affliction’s stage by only 1 instead of by 2.

Affliction Example

To see how a poison works, let’s look at the effect of the arsenic alchemical item (see page 361 for the full item listing). Note that afflictions use this abbreviated format in spell stat blocks.

Arsenic (poison) You can’t reduce your sick condition while affected by arsenic. Saving Throw Fortitude DC 15; Onset 10 minutes; Maximum Duration 5 minutes; Stage 1 1 poison damage and sick 1 (1 minute); Stage 2 1d4 poison damage and sick 2 (1 minute); Stage 3 2d4 poison damage and sick 3 (1 minute)

For example, if you drank a glass of wine laced with arsenic, you would attempt an initial Fortitude save against the listed DC of 15.

If you fail your save, you advance to stage 1. Because of the onset time, nothing happens for 10 minutes, but once this time passes, you take 1 poison damage and become sick 1. As noted, you’re unable to reduce the sick condition you gain from arsenic. The interval of stage 1 is 1 minute (as shown in parentheses), so you attempt a new save after 1 minute passes. If you succeed, you reduce the stage by 1, recovering from the poison. If you fail again, you move to stage 2, taking 1d4 poison damage and becoming sick 2.

If your initial save against the arsenic was a critical failure, you would go straight to stage 2. After the 10-minute onset time, you would take 1d4 poison damage and become sick 2. Succeeding at your second save would cause you to go to stage 1, taking 1 poison damage and reducing your sick value to 1. Failing the second save would advance you to stage 3.

If you make it to stage 3 of the poison, either by failing while at stage 2 or critically failing while at stage 1, you’d take 2d4 poison damage and be sick 3. If you failed or critically failed your saving throw while at stage 3, you would repeat the effects of stage 3.

Since the poison has a maximum duration of 5 minutes, you recover from it once the 5 minutes pass, no matter which stage you’re at.