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Keep an eye on Carefully (1)phenobarbital will lower the level or influence of fentanyl transmucosal by impacting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Keep an eye on Intently. Coadministration of fentanyl with CYP3A4 inducers may lead to a decrease in fentanyl plasma concentrations, insufficient efficacy or, perhaps, advancem