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Keep track of Closely (1)pentobarbital will lower the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Carefully. Coadministration of fentanyl with CYP3A4 inducers may lead to some reduce in fentanyl plasma concentrations, lack of efficacy or, quite possibly, growth of a withdra