Safety Aspects of Ozone Therapy

General Information

Since ozone is used as a medicine, like for any other therapeutic agent you should know precise ozone concentration, total dose and exposure time in order to minimize the toxic effect of ozone on the organism and to increase its therapeutic efficiency. Of great importance is ozone concentration in ozone/oxygen gas mixture. Extremely low ozone concentrations do not produce a toxic effect since radicals have been quickly and completely neutralized, but at the same time they are not always as much effective as necessary. On the other hand, extremely high ozone concentrations induce biological activity, but imply cytotoxicity.

The fundamentals of ozone therapy are based on the known properties of ozone as follows:

• high ozone concentrations have a wound cleaning effect;
• low ozone concentrations have a wound healing effect;
• high doses of ozone suppress immune reactions (immunosuppression);
• low doses of ozone have an immunostimulating effect;
• high doses of ozone have a blood-stopping effect;
• low doses of ozone have a stimulating effect on blood circulation;
• in any case you should follow the principle - always start with lower ozone concentrations and only after observing the patient's reaction gradually increase ozone concentrations.

According to the above mentioned the doctor should be confident that it is expedient to prescribe ozone therapy exactly for this patient. For each clinical case it is advisable to develop the individual program of ozone treatment including the optimal daily dose of ozone, frequency of procedures, duration of treatment course, methods of ozone therapy.

One of the important treatment parameters is the dose of ozone that should not exceed the potential of antioxidant enzymes. The scientifically determined total dose per day is 3000 mcg of ozone. The total daily dose includes quantities of ozone received by the patient during different procedures of ozone therapy within a day. For example, rectal ozone insufflation 900 mcg + subcutaneous ozone injections into the biologically active points 50 mcg. So, the patient received 950 mcg of medical ozone.

Dose of ozone (mcg) = ozone concentration produced by ozone generator (mcg/l) x volume of ozone (l)

1. Example of dosage for minor AHT with ozone in acneiform eruption. The patient should receive 100 mcg of ozone. For this purpose take into a syringe the ozone/oxygen gas mixture at ozone concentration of 10000 mcg/L and volume of 10 ml.

2. Example of dosage for major AHT in bronchial asthma. The patient should receive 1000 mcg of ozone. For this purpose add into the container with autoblood 100 ml of ozone/oxygen gas mixture at ozone concentration of 10000 mcg/L.

As an exception is considered the use of high doses of ozone 4000-6000 for major AHT to achieve immunosuppression in viral hepatitis, rheumatic diseases, herpetic infection.

The frequency of procedures can be different. Intravenous infusions of ozonated saline should be performed daily or every two days. Major AHT should be performed every 2-3 days, minor AHT usually every two days. An exception is made for generalized infection of different genesis when different methods of ozone therapy can be used within one day. For example, locally can be performed a treatment with ozone/oxygen gas mixture or ozonized water in a special chamber plus intravenous infusion of ozonated saline for systemic effect. The duration of treatment course depends on the severity grade, kind of disease etc. In spite of existing treatment protocols the frequency and number of procedures should be if possible determined individually.

The achieved positive results of treatment after ozone therapy can be kept on average from 5 to 7 months depending on the kind, form and stage of disease. That means it is recommended to repeat treatment courses 2-3 times a year to support the received therapeutic effect.

Ozone therapy is characterized by prolonged or after-effect that means patients notice changes in their state some time later after the end of treatment course. This phenomenon can be explained so that the increased point of oxyhemoglobin reduction time decreases very slowly, within several weeks. Thus, the high level of oxygen in the blood exerts a therapeutic influence even after the treatment course has been finished.

For patients with somatic pathology before ozone therapy it is necessary to collect the complete anamnesis on availability of any chronic infection. The matter is that ozone is able to aggravate these processes. In this situation it is necessary to continue ozone therapy that facilitates the arrest of inflammation. In some cases it can be necessary to use additional medicines.

Contraindications

Contraindications for ozone therapy are the following:

• Acute and chronic tendency to bleedings;
• thrombocytopenia;
• hyperthyroidism;
• cramps in the anamnesis;
• individual intolerance to ozone;
• blood coagulation disorder.

Ozone should be used most carefully in case of decompensated conditions:

• In decompensated heart insufficiency;
• In severe acute toxication (incl. alcohol);
• In hypoglycemic conditions;
• In extremal sympathicotonic and parasympathicotonic reactions.

After myocardial infarction ozone therapy can be used not earlier than after 6 months, in patients with hemorrhagic insult in the anamnesis ozone therapy is not recommended for use.

Side Effects & Adverse Reactions

Numerous clinical investigations have confirmed that ozone therapy if properly indicated, dosed, performed etc. is well-tolerated by patients and very seldom can cause any side effects without inducing any adverse reactions in the human body. During and after the procedure the patients can complain about weakness, slight dizziness, sleepiness that last for a short time. Possible are allergic skin reactions (like nettle rash) to local applications of ozone (very seldom).

The reason for extraordinary reactions to ozone therapy is considered a misbalance between the intensity in the formation of active oxygen forms and the activity of the organism's antioxidant defense system. The therapeutic doses of medical ozone act like "stress-stimulators" on the defense system enzymes, so, to prevent exhaustion of endogenic antioxidants it is necessary to start a treatment with small doses of ozone by gradually increasing them up to required values. At the same time (or if possible a few days before ozone therapy) it is advisable to give the patients natural or synthetic antioxidants. For individual adjustment of ozone dosage it is recommended to use the biochemiluminescence method.

According to available statistic data, in the past (Oepen, 1985) the frequency of side effects was 1:1000 - 1:2000. They were related to improper technique of administration - intra-arterial and intravenous injections of ozone/oxygen gas mixture that led to gas embolism. Nowadays, such procedures are practically not used any more.

Through ozone therapy after first procedures in some patients it can come to an increase in leucocytes in peripheral blood and at the same time a decrease in thrombocytes. These changes have a transient character and do not need any additional correction.

Ozone therapy has many methods that allow optimizing the treatment and use it as a monotherapy. But in most of cases ozone therapy is used in a complex with other methods, particularly within a chronic, permanent course of disease as well as in situations when stimulation of sanogenesis mechanisms is required.

Ozone can be used in a complex with different therapeutic agents to potentiate their effect as well as with physiotherapy, nutritional additions. On this way efficiency of treatment is increased, and possibility of side effects is reduced to minimum.

It is important to mention that ozone therapy increases sensitivity of microorganisms to antibiotics. Ozone is able to intensify the effect of hypotensive, analgesic, sedative, homeopathic remedies that allows reducing their dosage. On the other hand, if ozone is used in combination with hormone therapy, it is necessary to increase the dose of ozone to receive a good therapeutic effect.

By using ozone the following points should be taken into consideration:

• An ozone/oxygen gas mixture should be never introduced through the airways. Owing to the toxic influence of ozone on the respiratory epithelium it is important to prevent leakage of ozone into work room air. Maximum allowable concentration (MAC) of ozone in work room within 8 hours of working day is 0,2 mg/m3.
• Do not use ozone along with ether and its derivates;
• Do not add any other medicinal agents into the bottle with ozonated solutions of crystalloids;
• Ozonation of antiseptics leads to a loss of their antibacterial properties due to structural changes of molecules;
• At the beginning of treatment it is necessary to perform a trial procedure with ozone in order to observe the patient's state.