BACKGROUND: Scorpion envenomation is a worldwide problem, especially in tropical and subtropical areas like Egypt. Scorpion envenomation is responsible for the high mortality rate all over the world, which makes much research carried out to see the efficacy of other drugs as supportive treatment in addition to antivenom. AIM: To see the efficacy of prazosin drug with scorpion antivenom compared to antivenom alone. METHODS: It is a prospective randomized comparative study between two groups from February 2023 to July 2024. Each group is 50 cases to compare the efficacy of prazosin with antivenom (group 1) and the antivenom alone (group 2) in scorpion stings cases. RESULTS: The median age of the 100 cases was 7 years old. 54% of the study population were males. 46% of cases were females. Most of the cases were from rural areas. There was no significant difference in age, sex, and the patients' residence between the two groups. There was no significant difference between the 2 groups regarding the duration of stay in the hospital till mortality or discharge, with a median of 3 days in each group. However, there was a significant difference in the antivenom received in each case between the 2 groups, with a median of 6 vials in group 1 and 9 vials in group 2. Mortality and complications were observed to occur more in group 2 than in group 1 despite the insignificant p values. The study's mortality rate was 14%, 4/50 (8%) in group 1 and 10/50 (20%) in group 2. The number of antivenoms significantly increased with an increase in duration of stay, heart rate, respiratory rate, troponin level, and mortality outcome. While the number of antivenoms significantly decreased with the rise in systolic and diastolic blood pressure. CONCLUSION AND RECOMMENDATIONS: The study concluded that prazosin can be added to antivenom to increase its efficacy and decrease the number of needed antivenoms. Prazosin is a safe drug when used with precautions to avoid the first-dose phenomenon. Prazosin decreases complications and mortality when added to antivenom, but not significantly. The study recommends using prazosin with precautions for all manifested scorpion cases with antivenoms to increase the efficacy of the antivenom and treat the adrenergic manifestation.