EBOO therapy side effects are usually mild and short-lived: tiredness for a day or two, a mild headache, a metallic or “fizzy” taste during the session, and occasional lightheadedness or bruising at the IV sites. Serious complications are rare when the procedure is performed as a closed extracorporeal circuit under physician supervision and after proper screening. EBOO is not covered by health insurance in the United States — major payers classify ozone therapy as experimental and investigational, and there is no CPT code for it, so it is a self-pay service.
That is the short version. The longer version matters more, because most of what you will read online about “ozone therapy risks” describes a completely different procedure from the one performed at Robertson Wellness & Aesthetics in Beverly Hills. The route of administration is the single biggest safety variable in this field, and conflating routes is how a therapy with a very low complication rate acquires a frightening reputation.
What EBOO actually does to your blood
EBOO stands for extracorporeal blood oxygenation and ozonation. Blood is drawn continuously from a vein in one arm, passed through a gas-permeable filter where medical-grade ozone and oxygen diffuse across a membrane, and returned to a vein in the other arm. At RWA the circuit also passes the blood in front of an ultraviolet light source — the same principle used in ultraviolet blood irradiation (UBI).
Mechanistically, ozone dissolved in plasma reacts almost instantly with water and lipids to form hydrogen peroxide and short-lived lipid oxidation products. These act as signalling molecules that upregulate the cell’s own antioxidant defences, primarily through the Nrf2 pathway. In plain terms: a small, controlled, deliberately transient oxidative challenge that prompts your cells to increase their own protective machinery. The ozone itself does not persist — it is consumed within seconds of contacting plasma.
Velio Bocci, the University of Siena physiologist who did more than anyone to define modern ozone dosing, framed the therapeutic principle exactly this way: the goal is “a calculated, transitory, acute oxidative stress that is rapidly corrected by the antioxidant system.” That framing is also the key to understanding the side effects — almost all of them are the felt experience of that transient stress, not evidence of injury.
Common EBOO side effects and how long they last
The following are the effects patients most often report. None of them are unique to EBOO; they overlap heavily with what people experience after any systemic ozone or high-volume IV procedure.
| Effect | When it appears | Typical duration | What helps |
|---|---|---|---|
| Tiredness, heavy limbs | Same evening | 12–48 hours | Light day after, early night |
| Mild headache | During or shortly after | A few hours | Hydration before and after |
| Metallic or effervescent taste | Minutes into the session | Minutes | Resolves on its own |
| Lightheadedness, cool sensation | During return of blood | Minutes | Slowing the flow rate |
| Bruising or tenderness at IV sites | Same day | 3–7 days | Pressure, then cold compress |
| Transient flu-like feeling | Within 24 hours | 24–36 hours | Fluids, rest, lower next dose |
Two notes on the fatigue, because it is the effect patients ask about most. First, it is dose-related: it shows up most often after the first one or two sessions and tends to diminish as the protocol continues. Bocci’s own clinical series documented this pattern — roughly 20–30% of patients reported feeling tired for about a day after their first several systemic ozone treatments, while about half reported a feeling of wellness instead. Second, “detox reaction” is a popular explanation for it online. That framing is not established physiology, and we do not use it. The more defensible reading is a transient inflammatory and antioxidant-system response to the oxidative challenge.
Rare but serious risks — and why route of administration is everything
This is the part most clinic pages skip, and it is the part an informed patient should actually read.
The frightening case reports that circulate about “IV ozone” almost never describe EBOO. They describe two other practices:
- Direct intravenous injection of ozone gas. Pushing ozone gas into a vein with a syringe. This is the practice responsible for the deaths in the historical safety literature — Bocci’s review attributes four fatalities in an early German survey of ozone practitioners to direct IV gas injection, with further deaths from malpractice since. EBOO does not do this. In an extracorporeal circuit, ozone crosses a membrane into blood that is outside the body, and the blood returning to you carries no free gas.
- Ozonated saline infusion. Bubbling ozone through saline and infusing it. Ozone reacting with chloride in saline generates hypochlorous acid; a 1999 study by Foksinski and colleagues found a sharp rise in the DNA oxidation marker 8-hydroxy-2′-deoxyguanosine in the lymphocytes of patients infused with ozonated saline. Bocci concluded the findings “should absolutely preclude” the use of ozonated saline. RWA does not offer it.
The most serious documented complication of any extracorporeal ozone technique is cerebral gas embolism. A 2025 case report in Archives of Academic Emergency Medicine (Wong et al.) described a previously healthy 36-year-old woman in Australia who had a seizure within minutes of a private-clinic session in which 150 mL of her ozonated blood was reinfused, and who was subsequently found on MRI to have multiple small embolic infarcts. Echocardiography revealed a previously undiagnosed patent foramen ovale — a small opening between the heart’s upper chambers, present in roughly a quarter of adults — which allowed gas to bypass the lungs and reach the brain. She had lasting cognitive symptoms at nine months.
Three things are worth stating plainly about that case. It involved major autohemotherapy, a batch technique in which blood is ozonated in a container and reinfused — not a continuous EBOO circuit. The clinic setting was described by the authors as unregulated. And the outcome was an outlier: most published cases of ozone-related gas embolism resolve with minimal lasting deficit. But the mechanism is real, it is not exclusive to batch techniques, and it is precisely why circuit integrity, air detection, controlled flow rates, and an operator trained in basic life support are non-negotiable rather than optional.
For the broader picture: the same review that catalogues ozone’s toxicity also reports an overall complication incidence for ozone therapy of roughly 0.0007% across the surveyed practice — among the lowest in medicine — with the caveat that this figure is only meaningful for properly administered routes. Numbers like that are not a reason to be casual. They are a reason to be specific about which procedure is being discussed.
Who should not have EBOO?
EBOO is not appropriate for everyone, and a clinic that does not tell you this is not screening you properly. The contraindications below come from the established ozone-therapy safety literature.
| Condition | Why it matters |
|---|---|
| G6PD deficiency (favism) | Red cells lacking this enzyme cannot generate the reducing equivalents needed to neutralise an oxidative load, creating a risk of haemolysis. This is the single most important screen before any systemic ozone therapy. |
| Pregnancy | Systemic ozone is avoided in pregnancy, particularly early pregnancy, as a precaution. |
| ACE inhibitor therapy | Marked sudden hypotension has been observed on reinfusion of ozonated blood in patients taking ACE inhibitors, attributed to bradykinin-pathway activation. Requires medication review and a slowed return rate. |
| Thrombocytopenia and bleeding tendencies | The circuit requires anticoagulation, which is unsafe when platelet counts or clotting are already abnormal. |
| Hyperthyroidism | Uncontrolled thyroid overactivity is listed as a situation that precludes or limits systemic ozone use. |
| Serious cardiovascular instability | Moving several litres of blood through an external circuit imposes a haemodynamic load that an unstable cardiovascular system may not tolerate. |
| Severe anaemia, poor venous access | Practical limits on safely running the circuit. |
| Known right-to-left cardiac shunt | A patent foramen ovale or similar shunt is the anatomical route by which gas can reach the cerebral circulation. Worth raising if you have a history of unexplained stroke or migraine with aura. |
Before a first EBOO session at our Beverly Hills clinic, we review your medication list, your history, and your recent labs, and we discuss whether EBOO is the right starting point at all. For some patients it is not — a single-pass or 10-pass ozone protocol, or UBI on its own, is a more sensible entry point. Our comparison of EBOO vs 10-pass ozone vs UBI walks through how those three differ in blood volume, session length, and intensity.
How to reduce your chance of side effects
- Start low. The modern dosing principle is “start low, go slow” — beginning at a conservative ozone concentration and scaling up across sessions rather than starting at full dose. Most first-session fatigue traces back to starting too high.
- Arrive hydrated and fed. Not fasted. Low blood sugar plus a large extracorporeal volume shift is the most common reason someone feels faint mid-session.
- Disclose every medication and supplement, ACE inhibitors and anticoagulants above all.
- Get the G6PD question answered before your first session rather than after.
- Keep the day after light. Schedule the session so you are not presenting at 8 a.m. the following morning.
- Report symptoms during the session. Taste changes, chest tightness, or visual symptoms should be voiced immediately, not after.
(310) 407-0542Is EBOO covered by insurance?
No — not at Robertson Wellness & Aesthetics, and not at any clinic in the United States. EBOO is a self-pay service everywhere it is offered. It is worth knowing why before you spend time on the phone with your insurer.
Major payers including Aetna and Cigna list ozone therapy as experimental and investigational in their complementary-medicine coverage policies, which means an appeal has no policy language to rely on. Medicare has no national coverage determination for it. There is no CPT or HCPCS code for extracorporeal blood ozonation, so a claim could only go out under an unlisted code and would be denied at processing. And the federal regulation governing ozone-generating devices, 21 CFR 801.415, states that “ozone is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy” — which is why medical ozone is not FDA-approved for any indication. Physicians in California may still offer complementary treatments under the informed-consent framework of the state Medical Practice Act. Legal to offer and covered by insurance are separate questions.
The same applies to HSA and FSA funds: ozone therapy does not appear on standard eligibility lists, reimbursement is at your plan administrator’s discretion, and it would generally require a letter of medical necessity tying the treatment to a diagnosed condition. Confirm with your administrator rather than assuming — we cannot make that determination for you.
In practical terms, budget for EBOO the way you would for any elective wellness service. At RWA, EBOO + UV Light is $799 per session, or $699 per session in a four-session package. Our breakdown of EBOO treatment cost and what is included covers how that compares nationally and what drives the price differences you see advertised.
Frequently asked questions
Who should not do EBOO?
People with significant G6PD deficiency, pregnant patients, anyone on ACE inhibitors without a medication adjustment, those with thrombocytopenia or a bleeding tendency, uncontrolled hyperthyroidism, serious cardiovascular instability, severe anaemia, or a known right-to-left cardiac shunt. Candidacy is determined individually at consultation, not from a checklist online.
How do you feel after an EBOO treatment?
Most people feel normal to mildly tired on the day of treatment. A minority feel noticeably fatigued or mildly flu-like for 12 to 48 hours, most often after the first session. Some report feeling clear-headed or energised the following day. All three responses are within the expected range.
How long does EBOO therapy last?
A session typically runs 60 to 90 minutes including setup. How long any subjective effect lasts varies widely between individuals and depends on the protocol, and we do not publish outcome timelines we cannot substantiate.
What are the pros and cons of EBOO blood treatment?
On the one side: it is the highest-volume systemic ozone technique available, it is performed as a closed circuit under supervision, and reported complication rates for properly administered ozone therapy are very low. On the other: it is not FDA-approved, the clinical evidence base is far thinner than the marketing around it suggests, it is not covered by insurance, and it is not appropriate for everyone. Anyone presenting it as risk-free or as a treatment for a named disease is overselling it.
Is EBOO the same as the “blood oil change” people post about?
“Blood oil change” is a social-media nickname, not a clinical description, and it badly misrepresents what happens. Nothing is removed from or exchanged out of your blood. The blood that leaves your body is the blood that returns to it, having been exposed to ozone, oxygen and ultraviolet light along the way.
Does EBOO remove heavy metals or toxins from the blood?
The filter in an EBOO circuit is a gas-exchange membrane, not a chelating or dialysis filter. Claims that EBOO extracts heavy metals, microplastics or “toxins” are not supported by the way the equipment works, and we do not make them.
Important medical disclaimer
These statements have not been evaluated by the Food and Drug Administration. EBOO and ozone therapy are not FDA-approved and are not intended to diagnose, treat, cure or prevent any disease. This article is educational and is not medical advice or a substitute for evaluation by a qualified clinician. Ozone therapy is provided only after medical consultation, and candidacy is determined individually. If you have experienced neurological symptoms, chest pain or breathlessness following any infusion procedure, seek emergency care immediately.
Sources referenced
Bocci V. “The Potential Toxicity of Ozone: Side Effects and Contraindications of Ozonetherapy.” In: OZONE. Springer, 2010:75–84. · Wong CYY, Saxena K, Meneer J, George K, Keijzers G. “Neurological Crisis Following Intravenous Ozone Therapy; a Case Report.” Archives of Academic Emergency Medicine, 2025;13(1):e31. · Foksinski M et al., on DNA oxidation markers following ozonated saline infusion, 1999. · U.S. Code of Federal Regulations, 21 CFR 801.415, “Maximum acceptable level of ozone.” · Aetna Clinical Policy Bulletin 0388, “Complementary and Alternative Medicine.” · Cigna Coverage Policy, “Complementary and Alternative Medicine,” 2026. · California Business and Professions Code § 2234.1.
Medically reviewed by Biana Borchenko — Robertson Wellness & Aesthetics, Beverly Hills. [AUTHOR BIO — credentials required before publish]
