Observe Carefully (one)mitotane decreases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Keep track of. Mitotane is a solid inducer of cytochrome P-4503A4; watch when coadministered with CYP3A4 substrates for achievable dosage changes.topiramate will lower the level or influence of diazepam by impacting hep