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pentobarbital will reduce the extent or influence of methadone by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Keep an eye on.pentobarbital will lower the level or impact of tramadol by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Check. Decreased AUC of tramadol plus the active metabolite (O-desmethy