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Watch Closely (1)pentobarbital will reduce the level or influence of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Watch Intently. Coadministration of fentanyl with CYP3A4 inducers may lead to a reduce in fentanyl plasma concentrations, lack of efficacy or, quite possibly, growth of the withdrawal sy