Irritable bowel syndrome (IBS) is a common disorder resulting from disturbances in gut‑brain interactions, with a worldwide prevalence of 4.1 % to 10.1 % in adults. Although IBS is not life‑threatening, it is associated with a significant disease burden, including reduced quality of life, increased rates of comorbid psychological disorders, and high economic costs. One of the main subtypes of IBS is IBS with diarrhea (IBS‑D). Recently published guidelines of the American Gastroenterological Association (AGA) for pharmacologic treatment of patients with IBS‑D have just been released, based on evidence from a systematic and comprehensive review of the literature, while considering only randomized controlled trials conducted in adults with IBS. A positive diagnosis of IBS‑D can be made on the basis of medical history and physical examination, evaluation of gastrointestinal symptoms (especially presence or absence of worrisome features), limited diagnostic testing, and use of symptom‑based Rome IV criteria. The presence of alarming signs, such as the onset of new symptoms after age 50 years, rectal bleeding not associated with hemorrhoids or anal fissures, unintentional weight loss, iron deficiency anemia, nocturnal diarrhea, a family history of colon cancer, inflammatory bowel disease, or celiac disease, requires a thorough evaluation. In the treatment of IBS‑D, drugs with different mechanisms of action and different effectiveness are used. According to the latest AGA recommendations, most of the drugs, widely used in the treatment of IBS‑D (in particular, antispasmodics, loperamide, antidepressants), have a low reliability of efficacy evidence. Drugs with significant evidence of effectiveness include rifaximin‑a, eluxadoline, and alosetron, but the last two are not registered and are not used in Ukraine. Thus, until now, the only drug available in Ukraine for the treatment of IBS‑D and its relapses with well‑proven efficacy, is rifaximin‑a (Alfa Normix, Xifaxan). Selective serotonin reuptake inhibitors are not recommended for patients with IBS‑D.