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Monitor Intently (one)pentobarbital will decrease the level or impact of fentanyl transdermal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Keep track of Closely. Coadministration of fentanyl with CYP3A4 inducers could lead into a lower in fentanyl plasma concentrations, not enough efficacy or, possibly, advancement of