As his father's only surviving legitimate child, Alexander IV inherited the throne of the Macedonian Empire after him, however he was murdered in his early teens, never wielding actual power.

[7] Because Roxana was pregnant when Alexander the Great died on 11 June 323 BC and the sex of the baby was unknown, there was dissension in the Macedonian army regarding the order of succession.

While the infantry supported Alexander the Great's half-brother Philip III (who had some unknown cognitive disability present throughout his life[8]), the chiliarch Perdiccas, commander of the elite Companion cavalry, persuaded them to wait in the hope that Roxana's child would be male.

After a severe regency, military failure in Egypt, and mutiny in the army, Perdiccas was assassinated by his senior officers in May or June 321 or 320 BC (problems with Diodorus's chronology have made the year uncertain[9]), after which Antipater was named as the new regent at the Partition of Triparadisus.

He brought with him Roxana and the two kings to Macedon and gave up the pretence of ruling Alexander's Empire, leaving former provinces in Egypt and Asia under the control of the satraps.

When Antipater died in 319 BC he left Polyperchon, a Macedonian general who had served under Philip II and Alexander the Great, as his successor, passing over his own son, Cassander.