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pentobarbital will lower the level or outcome of midostaurin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Prevent or Use Alternate Drug. Powerful CYP3A4 inducers could lessen midostaurin concentrations causing lowered efficacy.pentobarbital will lessen the level or result of fentanyl by impacting hepatic/intestinal enzyme CYP3A4 metabo