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pentobarbital will reduce the level or outcome of netupitant/palonosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Prevent or Use Alternate Drug. Netupitant is especially metabolized by CYP3A4; steer clear of use in patients that are chronically applying a robust CYP3A4 inducerPhenobarbital has long been demonstrated to shorten the