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Observe Carefully (one)phenobarbital will lower the extent or result of fentanyl transmucosal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Watch Intently. Coadministration of fentanyl with CYP3A4 inducers could lead on into a decrease in fentanyl plasma concentrations, insufficient efficacy or, probably, improvement of