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The most likely cause is telogen effluvium a temporary form of shedding triggered by rapid weight loss and nutritional stress rather than a direct drug effect

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Exercise provides independent appetite-suppressing effects through PYY and GLP-1 release, partially compensating for the medication gap

Medication classes used in all IBS subtypes Antispasmodics We assessed mortality rates in patients prescribed dicyclomine or hyoscyamine

However, if the purpose of the drug is to be taken up by the liver, then first-pass metabolism may be irrelevant (the drug is still metabolized into hepatic glutathione, which is what matters)