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pentobarbital will decrease the level or effect of tamoxifen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Keep track of.pentobarbital will minimize the extent or effect of tramadol by impacting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Watch. Lowered AUC of tramadol plus the active metabolite (O-desmethyltram