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Watch Closely (one)pentobarbital will lower the level or effect of fentanyl intranasal by impacting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Check Intently. Coadministration of fentanyl with CYP3A4 inducers could lead to the lower in fentanyl plasma concentrations, insufficient efficacy or, potentially, progress of the withdrawal