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Observe Carefully (1)phenobarbital will lower the extent or outcome of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Keep track of Carefully. Coadministration of fentanyl with CYP3A4 inducers could lead to some lower in fentanyl plasma concentrations, deficiency of efficacy or, maybe, improvement of