Medical Ozone Therapy in Northern Cyprus

The pathways most prominent in the scientific literature for medical ozone are summarised below. Many of these mechanisms have been demonstrated in vitro and in animal studies; the strength of human clinical evidence varies by indication.

• ROS-mediated immune modulation: When ozone contacts blood, small amounts of reactive oxygen species (ROS) and lipid oxidation products form. These signals stimulate the Nrf2 pathway in immune cells, increasing the cell's own production of antioxidant enzymes (SOD, catalase, glutathione peroxidase).
• Improved oxygen delivery: An increase in 2,3-diphosphoglycerate (2,3-DPG) within red blood cells facilitates haemoglobin's release of oxygen to tissues. This effect has been observed in peripheral circulation disorders — particularly in diabetic foot and peripheral vascular disease.
• Antimicrobial and antiviral action: Ozone's ability to disrupt bacterial, viral and fungal wall and envelope structures through oxidation has been documented in local applications (wounds, infected ulcers).
• Anti-inflammatory modulation: There is evidence that ozone regulates cytokine profiles in chronic low-grade inflammation (particularly within the joint environment in osteoarthritis).
• Mitochondrial and energy metabolism support: A contribution to the efficiency of oxygen utilisation in cellular respiration has been proposed.

Important note: "A mechanism exists" and "clinically proven benefit exists" are two separate questions. The existence of a mechanism does not imply an equivalent level of clinical effect for every indication. During your consultation we discuss honestly which indication has which quality of evidence.

Medical ozone is administered via different routes according to the target indication. Each operates within a different dose range and biological effect profile.

• Major autohemotherapy (MAH): The most widely used method and the one with the richest clinical evidence base. 50–200 ml of venous blood is drawn from the patient, exposed to a medical ozone-oxygen mixture at a specific concentration and duration in a closed-system bag, and returned intravenously to the same patient. The entire process takes place in a closed system; one patient's blood is used exclusively for that patient. Typical session duration is 30–45 minutes.
• Minor autohemotherapy: 1–5 ml of venous blood is ozonated and then returned to the patient intramuscularly. Lower dose, predominantly targeting immune modulation; clinical data is more limited than for MAH.
• Rectal insufflation: An ozone-oxygen mixture is delivered in gas form via the rectal route through a fine cannula. Systemic effect is achieved through mucosal absorption; used as an alternative in patients for whom intravenous access is unsuitable, those with needle phobia, or in elderly patient groups. Duration: 5–10 minutes.
• Local applications: Ozonated olive oil (chronic dermatitis, minor wounds), ozonated water (oral and skin washing), and the bag method (extremity infection — for example, contact with a bag around a diabetic foot ulcer).
• Intra-articular: Injection of a low-concentration ozone-oxygen mixture into the joint, primarily for knee osteoarthritis and other degenerative joint conditions. The strongest clinical evidence in the medical literature is available for this application in knee osteoarthritis.
• Paravertebral / intradiscal: Applied as paravertebral injection in lumbar disc herniation; intradiscal (within the disc) ozone is a more invasive radiological intervention and is performed only at suitably equipped centres.

The choice of route is determined at consultation according to the indication, the patient's clinical status, and suitability for intravenous access.

The legal and scientific status of ozone therapy is a matter we discuss transparently with every patient:

• US FDA: The FDA has not approved medical ozone as a treatment. The FDA's position describes ozone as "a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy." In the United States, ozone therapy is practised as an in-office complementary application and is not covered by insurance.
• Turkish Ministry of Health: Under the "Traditional and Complementary Medicine Practices Regulation" dated 27 October 2014, ozone therapy is a defined complementary medicine practice; it may only be performed by certified physicians at certified centres. It holds complementary medicine status and does not replace primary treatment.
• Europe: Clinical use is widespread in Italy (SIOOT — Italian Scientific Society of Oxygen-Ozone Therapy guidelines), Germany, Spain, Russia, and Cuba; guidelines have been published in several of these countries. There is no single EU-wide approval.
• Northern Cyprus (TRNC): It is a complementary medicine practice requiring certified application under physician responsibility.

The practical implication of this framework: ozone therapy is a supportive approach to be considered alongside your primary treatment, not instead of it. If you are under the care of an oncologist, cardiologist, rheumatologist, or any other specialist, we ask that you inform that physician before starting treatment.

Consultation takes place in person at our clinic or online via WhatsApp or Zoom. The initial assessment covers:

• Target indication: Is it chronic fatigue, knee osteoarthritis, diabetic foot wound management, or post-viral recovery? The indication determines the route of administration and the number of sessions.
• Medical history: Active cancer treatment, cardiovascular disease (particularly a recent history of MI or stroke), uncontrolled hyperthyroidism, clotting disorders, pregnancy or breastfeeding, current medications (especially ACE inhibitors and anticoagulants).
• G6PD enzyme deficiency screening: Individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency face a risk of haemolysis (red blood cell destruction) from ozone. For this reason, a G6PD test is requested before the first MAH session; this test is particularly critical for patients with a family history or of Mediterranean, Middle Eastern, or African descent.
• Full blood count and basic biochemistry: Requested to establish baseline values.
• Expectation management: That ozone therapy is a complementary application, that it does not replace primary treatment, that results vary between individuals, and the limitations of clinical evidence are shared openly. Results cannot be guaranteed.

At the end of the consultation, the chosen route of administration, number of sessions, scheduling intervals, and estimated total cost are provided in writing. You have the right to take time before deciding; there is no obligation to begin on the same day.

A typical MAH session follows these steps:

• Preparation: The patient is positioned in a reclined chair; the arm vein is disinfected and the closed-system MAH bag (anticoagulated, single-use, CE-marked kit) is integrated.
• Blood draw: 50–200 ml of venous blood is drawn from the vein into the bag within the kit. The dose is determined according to the patient and protocol.
• Ozonation: A calibrated concentration of ozone-oxygen mixture (typically 20–40 µg/ml) is delivered from the medical-grade ozone generator into the bag via a closed system. The bag is gently rotated to ensure homogeneous contact between the blood and ozone. This typically takes 5–10 minutes.
• Return: The ozonated blood is returned to the same patient via the same venous line at a controlled rate. At no stage does any other patient's blood come into contact; the kit is single-use.
• Observation: 10–15 minutes of clinical observation follow the session. Mild fatigue or, conversely, a brief feeling of increased energy (euphoria) may be experienced during the first sessions; this resolves on its own.

Total clinical time is 30–45 minutes. No anaesthesia is required, there is no sedation, and no overnight stay is needed. You can drive on the same day and return to normal daily activities. For patients with needle phobia or unsuitable venous access, rectal insufflation is selected as an alternative; this method involves a 5–10 minute gas-form application.

Local applications (ozonated oil, ozonated water, bag method) are performed in the treatment room and take 15–30 minutes. Intra-articular applications are carried out under sterile field conditions, as a low-volume injection via a fine needle into the target joint.

A single session of ozone therapy is not expected to produce durable long-term outcomes. Standard initial protocols vary by indication:

• General complementary use (chronic fatigue, immune support, post-viral recovery): 10–15 sessions, two to three times per week. Total programme: 4–6 weeks.
• Knee osteoarthritis (intra-articular): Typically 5–10 sessions, one to two times per week.
• Diabetic foot and chronic wounds (local): Two to three local applications per week according to wound characteristics, continuing until healing.
• Lumbar disc herniation (paravertebral): 5–10 sessions, one to two times per week.

Maintenance: Once the initial programme is complete, a maintenance programme of 5–10 sessions per year may be recommended for patients in whom benefit has been observed. Maintenance is not mandatory; some patients retain the benefit from the initial course for an extended period.

Session intervals are not kept short; spaced loading gives the body's antioxidant response system time to "learn". The logic of "more frequent sessions equals better results" is not supported by clinical evidence and can, in some cases, produce the opposite effect (oxidative overload).

The effects of ozone therapy vary noticeably between individuals, by indication, and by route of administration. A general framework:

• Sessions 1–3: Some patients report increased energy, improved sleep quality, or conversely, temporary fatigue. This early response reflects collective clinical observation; it does not occur in every patient.
• Sessions 4–8: The first tangible changes in the target indication tend to be observed in this window — reduction in joint pain, increased rate of wound healing, improvement in fatigue scores.
• Sessions 10–15 (programme completion): Maximum cumulative effect is assessed at this stage.
• 3–6 months later: How long the programme's effects last depends on the indication and the individual; in some patients benefit is maintained for 6–12 months, in others maintenance sessions are required.

Accounts of "I was completely transformed after one session" are not realistic. Ozone therapy is a biological supportive treatment; its effect is cumulative and gradual. If there is no discernible change after 4–6 sessions in a clear indication, it is more appropriate to consider other approaches rather than continuing the programme. These exit criteria are always established at consultation.

The following are listed with the strongest evidence first, followed by those with more limited data that are considered for complementary support only:

• Knee osteoarthritis (intra-articular ozone): Systematic reviews and meta-analyses have demonstrated meaningful improvements in pain and function scores; this is one of the indications with the strongest clinical evidence.
• Lumbar disc herniation (paravertebral / intradiscal): Particularly in Italian studies, intradiscal ozone as a radiological intervention is considered a minimally invasive alternative to surgery.
• Diabetic foot ulcer and chronic wounds (local + systemic): Reduction in wound healing time and benefit in infection control have been reported.
• Peripheral vascular disease (systemic MAH): A contribution via 2,3-DPG increase has been reported in settings of impaired tissue perfusion.
• Chronic fatigue syndrome and post-viral recovery: Data is observational and patient-reported; randomised controlled trials are limited. Considered as a complementary approach.
• Rheumatological conditions (fibromyalgia support): Limited evidence; high variability in individual response.
• Certain viral infections (Hepatitis B/C — complementary): Does not replace primary antiviral treatment; appears in the literature as complementary support only.
• Immune modulation (general support): For use as supportive therapy where training the immune response is the aim.
• Skin anti-ageing (off-label intradermal): Clinical evidence is limited; we do not recommend this as a primary treatment for cosmetic anti-ageing. Alternatives with stronger evidence — such as platelet-rich plasma (PRP) and mesotherapy — are discussed together at consultation.

Special note on use in cancer: Ozone therapy cannot treat cancer and is not a curative method. Some oncology centres have reported its complementary use alongside standard cancer treatment (surgery, chemotherapy, radiotherapy) for the purpose of reducing side effects and supporting general wellbeing; even for this use, oncologist approval is mandatory, and at Nis Clinic ozone therapy is not administered to an active cancer patient without oncologist approval. Claims that "ozone defeats cancer" have no medical basis.

In the following circumstances, ozone therapy is not administered or requires special assessment:

• G6PD enzyme deficiency: Absolute contraindication. Creates a risk of haemolysis. Treatment is not started without a G6PD test before the first MAH session.
• Pregnancy: Contraindicated. Clinical safety data is insufficient.
• Breastfeeding: Deferred until breastfeeding has ended due to insufficient safety data.
• Uncontrolled hyperthyroidism: Ozone's metabolic effects on the thyroid may produce unpredictable outcomes; it is not administered if thyroid function is not stable.
• Recent myocardial infarction (MI) or stroke: Contraindicated in the acute phase and the weeks immediately following; in stable patients, assessment is possible with cardiology approval.
• Active bleeding, thrombocytopaenia, coagulopathy: Intravenous procedures carry risk in patients with clotting disorders; MAH is not administered or is deferred with physician approval.
• Acute alcohol intoxication: Not administered due to metabolic interaction.
• History of favism (a marker of G6PD deficiency): Patients with a history of haemolysis after eating broad beans must have a G6PD test.
• ACE inhibitor use: May increase the risk of hypotension during initial sessions; dose adjustment is made.
• Administration by inhalation: Ozone is never administered via the respiratory route — it causes pulmonary toxicity. Domestic "ozone purifiers" used to clean rooms must not be confused with medical ozone.
• Active oncological treatment: Not administered without oncologist approval; curative use is not accepted; considered for supportive use only under oncologist co-ordination.
• Under 18: Standard adult protocols are not applied directly to children; paediatric application requires a different medical framework.

Saying "no" to an unsuitable candidate is not a lost case for us — it is how the safety profile of ozone therapy is upheld. Not treating the wrong patient is as important as treating the right one.

Ozone therapy is a complementary medicine practice regulated under the Turkish Ministry of Health's "Traditional and Complementary Medicine Practices Regulation" dated 27 October 2014. In TRNC practice, the same framework is applied under physician responsibility. At Nis Clinic, ozone therapy:

• Is planned and administered under the supervision of Op. Dr. İbrahim Meyzin; physician responsibility is a core principle in complementary medicine practice. For the full profile, visit our dedicated Op. Dr. İbrahim Meyzin profile page.
• If you are under the care of another physician (oncologist, cardiologist, rheumatologist, endocrinologist), co-ordination with that physician before starting treatment is requested.
• Is planned alongside your primary treatment, not instead of it. The approach of "let me just do ozone and stop my medication" is declined.

This framework is the foundation of both safety and ethics; it ensures that ozone therapy delivers benefit where it genuinely can — and is not applied where it carries risk.

The safety of ozone therapy is largely determined by the correct equipment. At Nis Clinic:

• A medical-grade ozone generator is used — a CE-marked medical device with a concentration calibrated in µg/ml, with manufacturer-tracked calibration. Aquarium or domestic ozone machines are entirely unsuitable for medical use; their presence in settings claiming to offer ozone therapy is a serious warning sign.
• The closed-system MAH kit is single-use per session; CE-marked, anticoagulated, opened for each individual patient. The kit's batch number and expiry date are shared with the patient on request.
• Pure medical oxygen supply is used — not air or industrial oxygen.
• Calibrated concentration and duration: Each indication is treated at the doses defined in the literature; there is no "dose negotiation".
• Sterile field: Antiseptic preparation, single-use gloves, and sterile equipment for intravenous procedures are standard.

These standards are not a marketing claim — they are the minimum requirements for safe administration of ozone therapy. We cannot state that these standards are met everywhere in Northern Cyprus; we share the details openly so that you can make an informed choice.

Nis Clinic ozone therapy pricing is determined by route of administration, number of sessions, and target indication. Rather than per-session pricing, we offer open programme-based packages.

Approximate price ranges (Nis Clinic — 2026):

The confirmed price for each patient is given after physician assessment and G6PD deficiency screening; the figures above are indicative and intended for advance planning. Per-session cost within a package is noticeably lower; this discount reflects planning clarity, not a change in standards. There are no hidden charges.

Ozone therapy is a day-treatment procedure; no overnight stay is required. For patients planning medical tourism, a serial protocol may require a stay of several weeks; a schedule aligned with your travel plans is arranged at consultation. Alongside ozone therapy, a glutathione treatment to support the body's antioxidant capacity, PRP for skin renewal, or a health check-up programme for a general health assessment can be planned. For further details, please visit our contact or booking pages.