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Monitor Carefully (1)pentobarbital will lower the extent or effect of fentanyl by impacting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Observe Intently. Coadministration of fentanyl with CYP3A4 inducers could lead to a decrease in fentanyl plasma concentrations, insufficient efficacy or, quite possibly, development of the withdrawa