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