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Monitor Carefully (one)pentobarbital will lower the extent or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Observe Closely. Coadministration of fentanyl with CYP3A4 inducers may lead to a lessen in fentanyl plasma concentrations, lack of efficacy or, potentially, advancement of the withdrawa