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Check Carefully (1)pentobarbital will decrease the level or effect of fentanyl transmucosal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Watch Carefully. Coadministration of fentanyl with CYP3A4 inducers may lead to some reduce in fentanyl plasma concentrations, lack of efficacy or, maybe, enhancement of the withdrawal