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Keep track of Closely (1)pentobarbital will decrease the level or effect of fentanyl intranasal by impacting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Carefully. Coadministration of fentanyl with CYP3A4 inducers could lead to a decrease in fentanyl plasma concentrations, deficiency of efficacy or, perhaps, progress of the