Thioridazine interacts with purified cardiac cytochrome oxidase altering both the activity of the enzyme and the optical spectrum of the drug. Cytochrome oxidase activity, as measured by oxidation of cytochrome c, exhibits a biphasic response to changing drug concentration. Lower concentrations of thioridazine increased cytochrome oxidase activity up to 20% at 65 microM and higher concentrations inhibit activity until almost complete inhibition is observed. Both the activation and the inhibition of cytochrome oxidase by thioridazine follow Michaelis-Menton kinetics with Vmax changing but Km remaining constant. The analysis of the 2 nm shift in the UV absorption spectrum of the thioridazine suggest that the binding of thioridazine to cytochrome oxidase involves multiple (535) binding sites on the enzyme with an average dissociation constant of 20 microM.