Veterinary Ozone Protocol: Horse Conditions

What Madrid lists for hooves, joints, tendons, back, skin, foals, wounds, reproduction and performance in horses, with concentrations, volumes and schedules.

Quick answer: This sheet lists what Madrid gives for hooves, joints, tendons, back, skin, foals, wounds, reproduction and performance in horses. Examples are 10–15 mL at 6–12 µg/mL for hoof and heel points and 3–8 mL at 20–35 µg/mL for joints.

Doses from the Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), Addendum BStudy details from the published veterinary literature

For veterinarians. Ozone use in animals should be done or directed by a licensed veterinarian. This sheet is a reference for them. It is not a guide for treating your own animal and not veterinary advice. Check your licensing board and local rules before using any route.

Hoof and heel points10–⁠15 mLat 6–12 µg/mL

Joint (equine table)3–⁠8 mLat 20–35 µg/mL

Papilloma blood30–⁠60 mLat 45 µg/mL

Chronic endometritis1 Lat 40–45 µg/mL per infusion

What are the basics of ozone therapy for horse conditions?

Madrid's equine table (Table 6) lists 39 uses. This sheet covers the ones that give a concentration, volume or schedule, grouped by body area. Systemic doses for horses (MAH, MiAH, rectal) are on the horses and cattle sheet.
Many of the protocols place small amounts of gas at acupuncture points (ozone acupuncture), such as Stomach 36, Bladder 60, Governor Vessel 14 and Lung 1. Madrid gives the points and volumes, and a veterinarian trained in this technique picks them.
Ozonated saline is part of several of Madrid's protocols (lavage, drip, uterine wash). Those parts are left off this sheet because MediSkill does not advise ozonated saline.

Sources: Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), Addendum B (Veterinary Medicine), paraphrased, plus the published studies listed under More detail.

What dose and settings are used for ozone therapy for horse conditions?

Hooves, joints, tendons, muscle and spine

Concentrations in µg/mL (µg/NmL in Madrid).

Condition	What Madrid gives
Laminitis	Rectal insufflation at 20–25 µg/mL, 0.5 to 5 mL/kg. Local at the heel (Qian Ti Men point, or the palmar digital nerve area): 10–15 mL on the lateral and medial side at 6–12 µg/mL. Acupoints at 6–12 µg/mL: Small Intestine 3 (5–20 mL), Bladder 60 (30–60 mL), Stomach 36 (20–40 mL), Gallbladder 34 (23–45 mL). Warning: injection into the hind hoof above 10 µg/mL causes intense pain at once and resistance for days.
Navicular syndrome	Heel points: 10–15 mL each side at 6–12 µg/mL, once a week for 3 months. Navicular bursa, under ultrasound: 2–3 mL at 10–14 µg/mL, weekly for weeks 1 to 4, then every 2 weeks for weeks 5 to 8.
Joint (intra-articular)	3–8 mL depending on the joint, 20–35 µg/mL. With hyaluronic acid: 5 mL gas plus 2 mL hyaluronic acid. Madrid's general horse-and-cattle joint doses are lower (10–12 µg/mL for degenerative joints, 15–20 for inflammatory); the equine table is higher. Start at the low end.
Septic arthritis	Gas, after the joint is flushed: 3–8 mL at 40–45 µg/mL. Rectal insufflation every other day at 25–35 µg/mL. Gas at acupoints near the joint. Madrid's protocol also flushes the joint for 3 to 4 days with ozonated saline, which is not covered here.
Desmitis and tendinitis	12–15 µg/mL around or into the lesion, 2 or 3 times a week, ultrasound-guided with small volumes. Bandage and rest afterward.
Low back pain and spine	Deep paravertebral: 5–8 mL per point at 20–25 µg/mL, points 8 cm apart along the back muscle, ultrasound-guided. Subcutaneous: 20 mL every 20 to 30 cm, spread by massage. Kissing spines: 1 mL per point at 2 or 3 points between the spinous processes, on both sides. Along the bladder meridian: 20–60 mL at 10–20 µg/mL. Whole-body route (MAH or rectal) twice a week; raise the dose every 1 to 2 weeks.
Myositis	MAH for the first 3 days (Madrid prints 40–50 µg/mL and 1–5 mL/kg of blood for this row; both are above Madrid's own horse MAH rule of 2% of total blood volume, about 1.6 mL/kg, and the 45 µg/mL maximum, so stay within the horses-and-cattle MAH limits), then rectal for 1 to 2 weeks. Into the muscle: 3–4 mL at 10–15 µg/mL, 5 to 8 cm from the tight muscle, with a 23 or 25 G scalp-vein set. Subcutaneous: 20–60 mL at 12–20 µg/mL every 20 to 30 cm, spread by massage.
Muscle atrophy	Into the muscle: 3–4 mL at 10–15 µg/mL, 5 to 8 cm apart along the fibers. Subcutaneous: 20 mL at 10–20 µg/mL every 20 to 30 cm, spread by massage.

Skin, wounds and infection

Condition	What Madrid gives
Wounds (bagging)	Infected wounds: 40–60 µg/mL for 5 to 10 min. Non-infected wounds: 10–30 µg/mL for 5 to 10 min. Clean and debride first. After the generator is off, keep the bag closed 5 more minutes. Higher times and concentrations produce more granulation tissue. Madrid gives two time ranges for wound bagging (5–10 min in the equine wound table, 20–30 min in the general section). Start with the shorter time and lower concentration.
Pythiosis	Bagging at 60 µg/mL on alternate days for the first 3 weeks, lowering the concentration as the lesion fills in. Around and into the lesion: 35–45 µg/mL after a nerve block, once or twice a week, or 20–25 µg/mL around the lesion without a block. Remove dead tissue before infiltrating. Ozonated oil once or twice a day after cleaning.
Papillomas (skin and ear)	Ozonated oil on small papillomas; in the ear, once a day for 2 weeks after the ear plaques heal. Skin: 0.1 mL under the skin at the base of each papilloma. Minor autohemotherapy: 45 µg/mL, 10–20 mL per 100 kg, once a week for 3 to 4 weeks, spread across acupoints. Ozonated blood: 30–60 mL (blood and gas 1:1, gas at 45 µg/mL; Madrid does not say whether 30–60 mL is the total or the blood part) at Governor Vessel 14, the thyroid extra point and Lung 1, weekly for 10 weeks.
Dermatitis and allergies	Minor autohemotherapy as above. MAH twice a week, starting at 20–25 µg/mL with 1 mL/kg, raising by 5 µg/mL a week if needed. Ozonated blood at the same acupoints weekly for 10 weeks. Subcutaneous gas at 15–20 µg/mL, 20 mL every 20 to 30 cm. Ozonated oil on the skin. Bagging for large areas.
Pododermatitis	Gas in bags over the whole hoof, plus ozonated oil on the affected area. Leave space between the hoof and the ground with rigid protectors or a high shoe so the gas can act.
Subsolar abscess	After opening the drain point: gas directly under the sole after blocking the palmar digital nerves, for 4 to 7 days, plus a gauze poultice with ozonated oil. Madrid also flushes the space first with ozonated saline, which is not covered here.
Abscess drainage and tooth extraction	After draining or extracting: ozonated oil in the space. Gas at acupoints Stomach 2, 6 and 7, Triple Heater 17 and the extra point Bao-sai: 10–20 mL at 6–20 µg/mL.
Dental fistula	50–60 µg/mL gas straight into the fistula daily for the first week. Ozonated oil on the inner and outer openings. Same acupoints, 10–20 mL at 6–20 µg/mL. Take care with a link between the jaw and the nasal sinus.
Eye surface inflammation (keratoconjunctivitis)	Ozonated sunflower oil eye drops, PI 120–180, with ozonated saline washes daily (not covered here). Oil with a high PI can burn and irritate.

Foals, reproduction, stomach and performance

Condition	What Madrid gives
Newborn low oxygen (neonatal hypoxemic syndrome)	Rectal insufflation, 1–1.5 mL/kg at 25–30 µg/mL, during the first 3 days of life, preferably after the foal has passed meconium.
Foal pneumonia	Rectal insufflation or MAH, daily if needed. Minor autohemotherapy as an immune booster: 30–60 mL of blood and gas at 45 µg/mL (1:1) at Governor Vessel 14, the thyroid extra point and Lung 1, 1 or 2 times a week for 5 weeks.
Herpes virus and viral encephalomyelitis	One systemic route (MAH or rectal) daily until 3 to 5 days after signs go. Ozonated blood at the same acupoints weekly for 10 weeks.
Vaginitis	Gas at 42–45 µg/mL by continuous flow for 4 to 7 minutes. Madrid does not state how many days.
Chronic endometritis	After the uterine lavage: gas at 40–45 µg/mL, 1 L per infusion, two infusions over the next 3 days. Volume depends on how far the uterus can stretch. Madrid's lavage is ozonated saline, which is not covered here.
Testicle and epididymis (peritesticular)	Into the scrotal sac: 5–50 mL at 10–15 µg/mL, twice a week for at least 60 days (sperm take 54 to 60 days to form).
After castration (fistula or wound)	Gas at 40–45 µg/mL, continuous flow for 3 to 5 min; ozonated oil once a day. Small fistulas: 10–20 mL of gas.
Vulva, perineum and rectovaginal fistula surgery	Ozonated oil on the suture lines, inside and out. Small volumes of gas at 15–20 µg/mL on the stitched area after each suturing step. Use thread that does not react with peroxides.
Stomach or duodenal ulcer	Ozonated oil by mouth, PI 400–450: 10 mL per 100 kg once a day on an empty stomach for 15 days, then 5 mL per 100 kg for another 15 days. Feed only about 30 minutes after the oil, once the stomach has emptied.
Athletic performance	Minor autohemotherapy at 45 µg/mL, 10–20 mL per 100 kg, weekly for 3 to 4 weeks, spread across acupoints. MAH weekly, starting at 20–25 µg/mL with 1 mL/kg and raising 5 µg/mL a week, for at least 6 weeks before the race, to a maximum of 45 µg/mL. Three times in the week of the competition. Never on race day, and at least 2 days between sessions. Ozone acupuncture: 30–60 mL at 15–30 µg/mL at Gallbladder 27, Gallbladder 28 and the extra point DTC. Always paired with oxidative stress checks (G6PD and MDA). Do not give intravenous vitamins or minerals on the same day.
Fertility (egg and sperm quality)	Systemic ozone (MAH or rectal) over long periods. Madrid says controlling oxidative stress improves gamete quality and that stress was checked with G6PD and MDA.

What are the best tips when using ozone therapy for horse conditions?

Check G6PD and MDA where Madrid does (performance horses, breeding animals), and start low and go slow. MediSkill treats G6PD as debated, not as an absolute rule.
Use ultrasound for joint, bursa, tendon and deep spinal injections, as Madrid does.
Give nerve blocks before injecting painful areas such as a hoof abscess or a pythiosis lesion, and do not exceed about 10 µg/mL in the hind hoof.
Madrid prints some terms and numbers loosely (for example, a few typos in the oil section and acupoint names). Treat this sheet as a summary and check the Declaration for the full table.

What are the precautions for ozone therapy for horse conditions, and who should avoid it?

Race day: Madrid says not to give ozone to a horse on race day.
Hoof: injecting into the hind hoof above 10 µg/mL causes severe pain and fear for days.
Peroxides: use suture material that does not react with peroxides after ozonated oil is used in a wound.
Gas pressure: in a fistula, abscess or other closed space, make sure gas can escape and that there is no link to the airway.
Sterility. Madrid asks for maximum sterility. Hair removal is mandatory, because hair carries germs into blood, joints and other tissue. Get signed informed consent from the owner.
Never let anyone inhale the gas. Madrid says ozone must not be inhaled during any procedure, and calls nasal inhalation absolutely prohibited. Ventilate the room and use a destruct unit or suction where gas is vented.
Materials. Madrid says to use materials made for each technique: latex-free, and PVC-free for some procedures. Use ozone-resistant (silicone) catheters and silicone-coated syringes.
Routes Madrid says never to use: nasal inhalation, intra-arterial injection (air embolism), direct intravenous ozone gas, ozonated glucose or Lactated Ringer's by vein, and saline "ozonated" by beating a plastic bag with a syringe (phthalates, uncontrolled dose). It also does not recommend injecting ozonated distilled water into a joint or a vein.
Go low and slow. For blood and rectal routes Madrid starts low and raises the concentration by 5 µg/mL every 2 to 3 sessions. In animals with chronic disease or high oxidative stress it suggests cofactor and antioxidant supplements and a low-dose lead-in. Inject gas slowly to avoid a vagal reflex, and consider sedation for painful methods.
Contraindications. Madrid's veterinary addendum does not publish its own list of conditions that rule ozone out, and it gives no pregnancy rule. It states that the principles of the human Declaration apply, so the closest reference is Madrid's human list (section 2.1), shown below. The veterinarian decides animal by animal. Take extra care in a pregnant animal: for people, Madrid advises avoiding ozone in the first trimester and reserves later use for specialists, and the same caution is sensible before any blood, rectal, vaginal or uterine route in a pregnant animal.
MediSkill does not advise ozonated saline. Madrid also describes ozonated saline (a drip, bladder and wound irrigation, uterine lavage). Those routes and doses are left off this sheet.

Closest reference: Madrid's human contraindications

From the Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 2.1. This list is written for people and is shown as the nearest published reference, not as veterinary guidance.

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.
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

More detail

Equipment

Ozone generator with an ozone-resistant gas path (quartz glass, titanium, silicone) and a way to check the output concentration
Medical oxygen tank and regulator (not an oxygen concentrator) for any gas given by rectum, vagina, injection or blood
Latex-free, silicone-coated syringes, silicone catheters and ozone-resistant tubing; ozone destruct unit or good ventilation
Ultrasound for guided injections; 23 or 25 G scalp-vein sets for muscle and acupoint work; 60 mL syringes for the larger acupoint volumes
Ozone-resistant bags for hoof and limb bagging; ozonated oil of the stated peroxide index

What the studies used

Study doses are listed as printed in each paper. They are not Madrid dosing.

In 15 mares with mixed bacterial endometritis, womb ozone (42 µg/mL at 0.25 L/min for 5 min, 3 days in a row) cut the median bacterial count from 65,000 to 0 CFU/mL, while the oxygen control stayed near 51,000 to 55,000 (p < 0.001). By the next heat all treated mares were culture-positive again, though with fewer bacteria (Campos 2026).
In 29 mares, two womb insufflations of 240 mL ozone-air at 80 µg/mL, 48 hours apart, gave positive cultures in 4 of 9 mares a week later, against 3 of 10 on an oral antibiotic and 6 of 10 on air. The groups did not differ (Front Vet Sci 2023).
In 15 Quarter Horses with back pain, 3 perispinal injections of ozonized PRP (10 mL at 50 µg/mL, 15 days apart), plus exercise and shoeing, ended with no pain response in all 15 at 60 days and no relapse over 6 months. There was no control group (de Melo 2021).
In 8 horses with chronic leg wounds that had not healed in 1 to 7 months, bagging at 50 µg/mL for 30 min every 48 hours closed all wounds in a median of 66 days. There was no control group (Vet Sci 2025).

The evidence is thin: the only controlled trials are on the womb in mares; the rest are case series and reports.

Learn more

Background on the methods: bagging, autohemotherapy and ozone oil. These articles are written for people, so use them for how the method works, not for animal doses.

Other veterinary protocols

Dogs and cats Horses and cattle

For veterinarians. Educational reference only, not veterinary advice. Follow your scope of practice and local regulations.