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Keep an eye on Carefully (1)pentobarbital will lessen the level or effect of fentanyl intranasal by impacting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with CYP3A4 inducers could lead to your decrease in fentanyl plasma concentrations, not enough efficacy or, probably, improvement of a