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Keep track of Carefully (one)phenobarbital will decrease the level or influence of fentanyl transmucosal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Observe Closely. Coadministration of fentanyl with CYP3A4 inducers could lead to some decrease in fentanyl plasma concentrations, lack of efficacy or, quite possibly, imp