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pentobarbital will decrease the extent or effect of fentanyl intranasal by impacting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Keep track of Closely. Coadministration of fentanyl with CYP3A4 inducers could lead on to a lessen in fentanyl plasma concentrations, lack of efficacy or, quite possibly, development of a withdrawal syndro