pentobarbital will reduce the level or effect of midostaurin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Prevent or Use Alternate Drug. Potent CYP3A4 inducers might lower midostaurin concentrations leading to decreased efficacy.Just after halting a CYP3A4 inducer, because the effects from the inducer drop, the fentanyl plasma focus wi