Over the past decades, aspidosperma and kopsia alkaloids have attracted significant interest by the organic synthetic community owing to their intricate fused‐ring structures and broad biological activities. Consequently, numerous strategically distinct total syntheses have been accomplished, among which tetracyclic pyridocarbazoles have seen widespread adoption as versatile building blocks. In this review, we elaborate and discuss the synthesis of such tetracyclic pyridocarbazoles according to the different approaches for the establishment of the all‐carbon quaternary center at C5. This includes (1) classic synthetic reactions (cycloaddition, Michael addition, nucleophilic substitution, and Claisen rearrangement), (2) palladium‐catalyzed asymmetric decarboxylative allylation reactions, and (3) thiourea‐catalyzed asymmetric Michael addition reactions. Furthermore, we also describe the late‐stage key transformations in the realm of the total syntheses of aspidosperma and kopsia alkaloids.