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Altered Beast is a side scrolling, platform, beat 'em up game. The player controls the centurion, fighting undead creatures and monsters in a setting resembling Ancient Greece, with originally five levels, in a graveyard, the Underworld, a cavern, Neff's palace and base at the city of Dis. One of the enemies, a white two-headed wolf (blue in the Mega Drive version, and a blue oxen in the DOS version) upon defeat releases a Spirit Ball, a power-up orb which increase the strength and size of the player character. Three orbs turn the centurion into a beast, which in the original version were a werewolf, a thunder weredragon, a werebear, a weretiger, and the more powerful golden werewolf (other beasts can be seen in the Japanese Famicom version and the Game Boy Advance version). Each beast has its own abilities, such as the dragon's flight and lightning, and the bear's petrification. After becoming the beast, the character can face the end-level boss, which upon defeat causes Neff to appear and remove the transformation orbs.