International organizations (IOs) have developed into important policy venues beyond the state. Yet our understanding of the broader dynamics of IO policy-making is limited. This article offers the first comparative analysis of macro patterns in IO policy-making. Theoretically, we draw on punctuated equilibrium theory to develop hypotheses about stability and change in the orientation of IO policy agendas. Empirically, we examine novel data on the policy output of five general-purpose IOs between 1980 and 2015, combining statistical analysis and comparative case illustrations. The analysis yields two central results. First, the policy agendas of all five IOs display patterns of punctuated equilibria, with longer periods of stability interrupted by shorter periods of dramatic change. Second, the level of institutional friction in decision-making contributes to variation in punctuations across IOs and within IOs over time. The results suggest four broader implications: (1) punctuated equilibrium theory applies to a broader empirical domain than previously thought; (2) patterns of change in IOs are more complex than conventionally expected; (3) institutional friction matters for IOs’ responsiveness to societal demands and problem pressures; and (4) deeper integration of punctuated equilibrium theory into the study of IOs can pave the way for a promising IR research agenda.