The First Tsar: Ivan the Terrible is a thematic sequel to Rurik: Dawn of Kiev. Players lead rival boyar families competing for power and prestige in the 16th-century Tsardom of Russia during the reign of Ivan the Terrible.

The game is played over four rounds, each representing approximately a decade of the Tsar's reign. At the beginning of every round, players send their boyars to the Kremlin chambers to select the actions they will perform during that decade.

Throughout the game, players collect income from cities and estates, equip troops, trade with foreigners, fortify cities, complete construction, trade, and military projects, exchange goods, and acquire new titles and estates.

At the end of each round, the players with the greatest influence in the four regions receive additional rewards. An important part of the game is the Tsar's Favor, which is used to resolve all ties.

The player with the most victory points at the end of the game wins.