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Watch Closely (one)pentobarbital will decrease the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Keep track of Intently. Coadministration of fentanyl with CYP3A4 inducers could lead to a lessen in fentanyl plasma concentrations, insufficient efficacy or, probably, development of a wi