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Monitor Carefully (one)pentobarbital will reduce the level or influence of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Observe Carefully. Coadministration of fentanyl with CYP3A4 inducers may lead to the lower in fentanyl plasma concentrations, not enough efficacy or, quite possibly, advancement of