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What is already known: Irritable bowel syndrome (IBS) has 3 subtypes, including constipation-predominant, diarrhea-predominant and mixed, each with distinct pathophysiology Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for diabetes, obesity and cardiometabolic risk, but are often associated with gastrointestinal side-effects, influencing treatment adherence Real-world data on how patients with IBS tolerate GLP-1RAs are scarce What the new findings are: One-third of IBS patients prescribed GLP-1RAs for different indications switched from their initial agent, suggesting potential challenges in terms of tolerability or efficacy IBS-M showed the highest GLP-1RA discontinuation and switching rates in real-world practice Liraglutide was associated with better tolerance compared to semaglutide, with early discontinuations driven by coverage-related issues, while later discontinuations owing to side-effects or non-response In individualized GLP-1RA therapy, accounting for IBS subtype, patient-related factors are crucial for better adherence and outcomes We thank and appreciate the University of Missouri Kansas City IT department and the Department of Gastroenterology for providing their support that made this research possible