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Keep track of Intently (1)pentobarbital will lower the level or effect of fentanyl intranasal by influencing hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with CYP3A4 inducers may lead to the reduce in fentanyl plasma concentrations, not enough efficacy or, probably, growth of the withdraw