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Observe Carefully (1)pentobarbital will decrease the level or effect of fentanyl intranasal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with CYP3A4 inducers may lead to some lower in fentanyl plasma concentrations, not enough efficacy or, maybe, enhancement of a withdrawal