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Observe Carefully (1)pentobarbital will reduce the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Check Carefully. Coadministration of fentanyl with CYP3A4 inducers may lead to a lower in fentanyl plasma concentrations, lack of efficacy or, probably, enhancement of a withdrawal syndro