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Practitioner protocol
IV Ozone Protocol: Major Autohemotherapy (MaH)
Equipment, step-by-step directions, dosing and titration for IV ozone by major autohemotherapy (MaH).
Quick answer: IV ozone by major autohemotherapy (MaH) uses 200 mL of blood and 200 mL of ozone gas. It is given 1–2 times a week at most, titrated up to a maximum of 70 gamma. It is a practitioner protocol.
Not the same as minor autohemotherapy (MiAH), which uses 5 mL of blood given as a shot into the muscle. MaH uses 200 mL of blood given back through an IV.
Warning
Requires hands-on training
IV ozone (MAH) should only be performed by a practitioner trained in it by an experienced practitioner.
Setting up the generator: How to set up a generator for IV ozone.
What are the basics of IV ozone (MaH)?
This is the MaH protocol of Thomas Levy, MD. Dr. Levy sits on our medical board, and this is the protocol we train clinics on.
Heparin dose: the range is 1,000–5,000 units. 2,000 units is standard. As low as 1,000 works for many patients, and up to 5,000 can be used for patients more likely to clot.
What equipment is needed for IV ozone?
- Ozone generator
- Oxygen tank regulator
- Oxygen tank (medical)
- Syringe fill system
- IV pole
Disposables required
- 20g or 22g IV catheter
- IV start kit
- IV administration tubing without a filter (a filter in the drip chamber slows the blood and can cause clotting)
- 60 cc silicone ozone syringe x4
- Safety scalp vein set: 23g butterfly needle with 12 in extension tube (used to add ozone gas to the IV bag after blood collection)
- Sodium chloride 0.9% saline (120 mL)
- Option A: use a 500 mL normal saline bag; infuse 380 mL to the patient, leaving 120 mL in the bag for IV ozone
- Option B: transfer 120 mL normal saline into a 500 mL or 1,000 mL TPN compounder bag
- Heparin, 1,000–5,000 units (2,000 standard)
- 1 mL syringe with needle
- Drape cloth / chux
- Gloves, alcohol pads, gauze 2x3, Coban
How is IV ozone given, step by step?
Prepare the blood collection bag
- Option A: 500 mL normal saline bag
- Prime IV tubing with normal saline
- Obtain IV access
- Attach tubing to the IV catheter
- Infuse 380 mL of NS into the patient
- Stop the infusion with 120 mL remaining in the saline bag
- Add heparin 1,000–5,000 units (2,000 standard)
- Go to step 3
- Option B: transfer 120 mL of 0.9% normal saline into an empty 500 mL or 1,000 mL TPN compound bag
- Add heparin 1,000–5,000 units (2,000 standard)
- Prime IV tubing
- Obtain IV access
- Attach tubing to the IV catheter
- Go to step 3
- Place the saline-heparin bag on a clean surface (drape/chux) below the patient's heart.
- Open the clamp on the IV tubing and let blood backfill by gravity to collect a total of 200 mL.
- Make sure the line is clear and blood is flowing throughout.
- Once 200 mL of blood is collected (320 mL in the bag: 120 mL saline + 200 mL blood), clamp the IV tubing and hang the bag on the IV pole.
- Collect 200 mL of ozone gas from the generator using 60 mL ozone syringes at the planned gamma dose (see the dosing guide below):
- Make sure the ozone generator is plugged in.
- Attach the oxygen regulator to the oxygen tank and open the tank with a cylinder key.
- Connect silicone tubing from the oxygen tank to the back of the generator.
- Find the desired gamma on the chart on top of the generator, and set the regulator flow (L/min) and the generator dial to match. Example: 41 gamma = regulator at 1/4 L/min and generator dial at 7 (matches the chart).
- Collect a total of 200 mL of ozone gas (4 syringes: three at 60 mL and one at 20 mL).
- Keep full syringes upright so the gas doesn't escape.
- Turn the regulator back to 0 and the generator dial off.
- Infuse the ozone gas into the bag with the 200 mL of blood: attach the butterfly set to the 60 cc ozone syringe, insert the needle into the bag's administration port, slowly infuse all 4 syringes, then gently rock the bag for 30–60 seconds. The contents should turn a brighter red.
- Unclamp the IV tubing and let the blood mixture return to the patient by gravity. It should take no longer than 30 minutes.
- Make sure the line is clear and blood is flowing throughout. If blood is not flowing: flush the line with normal saline toward the patient and toward the bag. If clotting is suspected and flushing doesn't restore flow: obtain IV access at another site, disconnect the bag from the current tubing, attach and prime new tubing, connect it to the new site, and discontinue the original site.
- When finished, discontinue the IV and apply a pressure dressing.
How often is IV ozone given, and how is it titrated?
- New to IV ozone: a suggested series of 4–8 infusions; 1–2 IVs per week maximum. If the patient is sensitive (for example a Herxheimer response), reduce frequency and dose.
- Titrating the gamma dose: after a positive or neutral response, increase 5–10 gamma each treatment to a maximum of 70. After fatigue, headache, achiness or a Herxheimer response, reduce 5–10 gamma and/or keep the dose and lower the frequency.
- See the recommended schedule by indication below.
- For what clients can expect afterward and when to call, see what's normal after a session.
What dose is used for IV ozone (MaH)?
| Ozone IV | Normal saline | Blood volume | Ozone gas volume | Ozone concentration |
|---|---|---|---|---|
| Sensitive / beginner | 120 mL | 200 mL | 200 mL | 30 gamma |
| Intermediate | 120 mL | 200 mL | 200 mL | 55 gamma |
| Full dose | 120 mL | 200 mL | 200 mL | 70 gamma |
Recommended reference guide for IV dosing and frequency
Follow-up titration in order of visits: increase 5–10 gamma each treatment to a maximum of 70.
| Indication | Baseline / initial (gamma) | Follow-up titration (gamma) | Initial frequency | Suggested series | Maintenance |
|---|---|---|---|---|---|
| Prevention (biohacking / anti-aging) | 55 | 60, 70 | 1–2 / week | 4–8 | 1 / month |
| Sport performance | 55 | 60, 70 | 1 / week | 4 | Every other month, repeat series |
| Acute pathogenic (infections, COVID, respiratory) | 30 | 35, 45, 55, 70 | 2 / week | 4–6 or until resolved | 1 / month |
| Acute non-pathogenic (post-surgery, post-injury, unknown) | 45 | 55, 65, 70 | 1–2 / week | 4–6 or until resolved | 1 / month |
| Chronic pathogenic (Lyme, EBV, mold, long-haul, fungal, autoimmune) | 30 | 35, 40, 45, 55, 70 | 1–2 / week | 12–14 | Ongoing |
| Chronic non-pathogenic (diabetes, fibromyalgia, chronic fatigue, cancer, neuro, respiratory, vascular) | 55 | 60, 70 | 1–2 / week | 10–14 | 1–2 / month |
| Pre-conditioning (pre-chemo, pre-surgery) | 45 | 50, 60, 70 | 1–2 / week | Leading up to the event | Move to the matching indication |
Who should not have IV ozone?
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.
- Toxic hyperthyroidism (severe Graves' disease)
- Thrombocytopenia (platelets under 50,000) and severe coagulation disorders
- Severe cardiovascular instability
- Recent acute myocardial infarction
- Acute massive hemorrhage
- Acute alcohol intoxication
- Convulsive states
- Hemochromatosis
- Patients receiving intravenous copper or iron therapy
MediSkill also advises against
- Allergy to heparin
- Pregnancy
- Heart disease that has not been reviewed with a physician
Considerations
- 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.
- Patient on blood thinners (provider discretion)
- High blood pressure
- Low blood pressure
Learn more
Background, benefits and research: Major autohemotherapy (MaH), full article. Comparing routes: Comparing home ozone therapies.
Related protocols: Minor Autohemotherapy (MiAH) Protocol, EBOO Protocol, Bladder (Vesicourethral) Ozone Instillation Protocol.
Other protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.
