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Watch Carefully (1)phenobarbital will lower the level or impact of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Check Closely. Coadministration of fentanyl with CYP3A4 inducers could lead to your decrease in fentanyl plasma concentrations, not enough efficacy or, maybe, development of the withdrawal