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Keep an eye on Carefully (1)phenobarbital will lower the level or outcome of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with CYP3A4 inducers could lead on to some lower in fentanyl plasma concentrations, not enough efficacy or, potentially, advancement