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Watch Carefully (one)pentobarbital will lower the extent or impact of fentanyl transmucosal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Check Closely. Coadministration of fentanyl with CYP3A4 inducers could lead to a reduce in fentanyl plasma concentrations, lack of efficacy or, maybe, advancement of the withdrawal sy