Background. Animal models are well established for studying the effects of alkaloids in preventing myocardial ischemia-reperfusion injury. However, few studies have investigated the therapeutic effects of alkaloids in humans. This meta-analysis and systematic review assessed the efficacy of alkaloids in attenuating infarct size in rats with myocardial ischemia-reperfusion injury. Methods. An integrated literature search including the PubMed, Embase, and Cochrane Library databases was performed to identify studies that evaluated the therapeutic effects of alkaloids on myocardial ischemia-reperfusion injury in rats. The main outcome was infarct size, and SYRCLE’s risk of bias tool was used to assess the quality of the studies. Results. 22 studies were brought into the meta-analysis. Compared with the effects of vehicle, alkaloids significantly reduced infarct size (standardized mean
difference
SMD
=
−
0.45
; 95% confidence
interval
CI
=
−
0.64
to
−
0.26
). In subgroup analyses, isoquinoline alkaloids (
SMD
=
−
0.43
;
95
%
CI
=
−
0.70
to
−
0.16
) significantly reduced infarct size versus the control. Conclusion. Isoquinoline alkaloids can potentially alleviate myocardial ischemia-reperfusion injury. This meta-analysis and systematic review supply a reference for research programs aiming to develop alkaloid-based clinical drugs. This trial is registered with CRD42019135489.