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Keep an eye on Carefully (1)pentobarbital will decrease the level or effect of fentanyl intranasal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Observe Intently. Coadministration of fentanyl with CYP3A4 inducers could lead on to your lower in fentanyl plasma concentrations, lack of efficacy or, possibly, development of