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Monitor Carefully (1)phenobarbital will lessen the extent or result of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Watch Closely. Coadministration of fentanyl with CYP3A4 inducers could lead to the decrease in fentanyl plasma concentrations, not enough efficacy or, quite possibly, advancement of th