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Carbon monoxide inhibits mitochondrial respiration by binding the ferrous heme a3 in the active site of COX, effectively shutting down oxidative phosphorylation .

Aerobic respiration is a process that utilizes the electron transport chain in order to oxidize glucose into energy. If a chemical were added that inhibited the electron transport chain, the cell would no longer be able to fully oxidize glucose. Carbon monoxide specifically inhibits cytochrome c oxidase of human mitochondrial respiratory chain.CO inactivates cytochrome oxidase. This leads to decreased ATP production, especially in tissues with high metabolic demands (brain, heart). The electron transport chain continues, generating superoxide radicals, leading to further damage.

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