pentobarbital will lower the level or effect of netupitant/palonosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Netupitant is principally metabolized by CYP3A4; avoid use in sufferers who will be chronically employing a robust CYP3A4 inducerpentobarbital will minimize the level or result of ramelteon b