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Practitioner protocol
10-Pass Ozone Therapy Protocol
How 10-Pass (high-dose multistep IV ozone) is commonly done, with the Madrid Declaration's position on it.
Quick answer: 10-Pass draws 200 mL of blood, mixes it with 200 mL of ozone at 70 µg/mL plus heparin, returns it, and repeats ten times (about 140 mg of ozone in all). MediSkill does not advise this protocol; standard IV ozone (MAH) is the method it teaches.
Practitioner-only procedure. 10-Pass is a blood procedure. This sheet is a reference for trained, licensed clinicians. It is not a self-treatment guide and not medical advice.
Warning
MediSkill does not advise this protocol
The Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 16.3, says high-dose multistep methods should not be used. Madrid gives these reasons:
- There is no preclinical or clinical evidence for it.
- Combining heparin with ozone increases platelet activation and aggregation. This is why standard IV ozone (MAH) uses a citrate-based anticoagulant instead.
- The total ozone dose is very high, about 140 mg over ten passes.
- Reported side effects are vision loss, lung problems and blood in the urine from red cell breakdown. Madrid calls these anecdotal reports from patients and practitioners, and says they point to the toxicity of high ozone doses.
MediSkill teaches standard IV ozone (major autohemotherapy) and recommends it instead: see standard IV ozone. We describe 10-Pass below, as it is commonly done, for reference only.
What is 10-Pass ozone therapy, and how is it commonly done?
- 10-Pass (also written 10 pass or ten-pass) is a blood method. Blood is drawn, mixed with ozone in a pressurized glass bottle, and returned to the patient. The cycle repeats ten times, which gives the method its name.
- Madrid describes each pass as withdrawing 200 mL of blood and adding 200 mL of ozone at 70 µg/NmL plus 20,000 to 24,000 IU of heparin. Madrid does not say whether the heparin figure is per pass or for the whole session.
- Madrid puts the total at 140 mg of ozone, plus the heparin dose. Madrid files it under the hyperbaric multistep (HBO3) methods at high dose.
- MediSkill's cost article gives 200 to 300 mL of blood per pass. The pressure is inside the bottle. It is not a hyperbaric chamber the patient sits in.
- Sessions run long and need a nurse or practitioner watching the patient the whole time.
- Patients typically pay about $700 to $1,500 per session in the US, against $200 to $300 for standard IV ozone (MAH).
Sources: Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 16.3; MediSkill's 10-Pass ozone therapy cost and equipment and comparing IV ozone therapies. Paraphrased.
What settings are commonly used for 10-Pass?
| Item | Madrid's description | MediSkill articles |
|---|---|---|
| Blood per pass | 200 mL | 200 to 300 mL |
| Ozone per pass | 200 mL at 70 µg/NmL (14 mg) | Not stated |
| Passes | 10 | 10 |
| Total ozone | 140 mg | Not stated |
| Anticoagulant | 20,000 to 24,000 IU heparin | Heparin |
| Container | Not stated | Pressurized glass bottle |
The 14 mg per pass is 200 mL times 70 µg/mL. Where the two sources differ, the table shows both. For comparison, Madrid says the authors of the one 10-Pass study used at least 15 times the ozone amount usual in MAH.
What should practitioners know before considering 10-Pass?
- Madrid warns that heparin together with ozone raises platelet activation. MAH avoids this with a citrate-based anticoagulant that acts in the tube without affecting the clotting cascade.
- Madrid lists the heparin side effects that a very high heparin dose can make worse: low platelets, mild pain, bruising, bleeding, local irritation, redness, higher liver enzymes, anaphylaxis and allergic reactions.
- MediSkill's comparison article says there are no good studies comparing 10-Pass with MAH, so it is unclear whether the extra passes add benefit, although some practitioners report good results.
- Use medical oxygen from a tank and regulator. An oxygen concentrator is not for blood work.
- If you are new to IV ozone, start with standard IV ozone. It is a fraction of the cost, takes about 20 to 40 minutes, and has far fewer complications.
Equipment (generic)
- Medical ozone generator with an ozone-resistant gas path (quartz glass, titanium, silicone)
- Medical oxygen tank and regulator
- Ozone-resistant pressurized glass bottle system
- Sterile lines and catheters, heparin and saline
- A nurse or practitioner to watch the patient for the whole session
Makers do not publish prices for 10-Pass bottle systems, so clinics get quotes. See 10-Pass cost and equipment.
What are the precautions for 10-Pass, and who should avoid it?
- Never breathe ozone gas. Keep the room ventilated.
- Sterile technique for every draw and return. Every part that touches blood or gas must be ozone-resistant and single-use or properly sterilized.
- Watch for the side effects Madrid lists: vision changes, breathing problems, dark or bloody urine, and bleeding.
- Report any side effect with the ISCO3 adverse event form, as Madrid asks.
Contraindications
The Madrid Declaration lists these contraindications for systemic ozone:
- Direct inhalation of ozone gas. The fluid lining the lungs has no antioxidants to buffer it, so inhaled ozone is toxic.
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency (favism, acute hemolytic anemia). Madrid lists it as a contraindication and recommends testing, but whether it is absolute is debated. MediSkill protocols start low and go slow; see the contraindications article. MediSkill treats it as an absolute contraindication for high-dose methods (10-Pass, EBOO, HiDose).
- Toxic hyperthyroidism (severe Graves' disease)
- Thrombocytopenia (platelets under 50,000) and severe coagulation disorders
- Severe cardiovascular instability
- Acute alcohol intoxication
- Recent acute myocardial infarction
- Acute massive hemorrhage
- Convulsive states
- Hemochromatosis
- Patients receiving intravenous copper or iron therapy
Pregnancy. Madrid advises avoiding ozone therapy in the first trimester (weeks 0 to 13) and reserves its use in pregnancy for specialists in gynecology and obstetrics.
More detail
What the studies used
Madrid mentions one published study of 10-Pass, and it measured lab markers in blood cells, not how patients did.
- In 6 adults aged 55 to 74 who came for preventive ozone therapy, two 10-pass sessions a week apart (200 mL of blood and gas at 70 µg/mL per pass, 140,000 µg per session) raised a lab measure of mitochondrial function in blood cells (bioenergetic health index 1.19 before, 1.88 after the second session, P=0.045). After the first session it was 1.58 (P=0.19). There was no comparison group, patient outcomes were not measured, and side effects were not reported (König and Lahodny 2022).
Madrid's reading: four of the six had no acute or chronic illness, the study did not look at clinical outcomes, and recruitment was poor, so it cannot show that 10-Pass treats patients. Madrid adds that high ozone doses are known to damage mitochondria, and asks how the authors saw an improvement at 15 times the usual MAH amount.
Learn more
Instead: IV ozone (MaH) protocol and the MAH article. Cost and equipment: 10-Pass ozone therapy cost and equipment. Comparison of MAH, HiDose, 10-Pass and EBOO: Comparing IV ozone therapies.
Related protocols: IV Ozone Protocol: Major Autohemotherapy (MaH), Minor Autohemotherapy (MiAH) Protocol, EBOO Protocol.
Other protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.