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Watch Carefully (1)pentobarbital will lessen the extent or effect of fentanyl intranasal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Watch Intently. Coadministration of fentanyl with CYP3A4 inducers could lead on to the lower in fentanyl plasma concentrations, not enough efficacy or, perhaps, development of the withdr