Post-COVID asthenic syndrome (PCAS) is still the subject of active study. The study was aimed to assess the effects of systemic ozone therapy used to complement drug therapy on plasma levels of TNFα, IL1β, IL6 and parameters of mental status in patients with PCAS. Two randomized groups of patients with PCAS (n = 140, age 18–45) were assessed and treated: patients of the index group (n = 70) received systemic ozone therapy in addition to drug therapy; patients of the comparison group (n = 70) received drug therapy without systemic ozone therapy. Plasma levels of TNFα, IL1β, IL6 were measured and the patients’ mental status was assessed using the MFI-20, MoCa, ISI, HARS, and CGI-S scores before and after treatment. After the end of therapy (on day 30) the TNFα, IL1β, IL6 levels reported for the index group showed no significant differences from the values reported for the control group (р > 0.05) and were lover, than the values of the comparison group by 39% (р = 0.003), 33.3% (р = 0.022), and 36.1% (р = 0.012), respectively. The changes in mental status were also more pronounced in the index group, than in the comparison group: the average final MFI-20 score was lower by 36.7% (р = 0.001), ISI by 50.5% (р < 0.001), HARS score by 45.8% (р = 0.001), while MoCa score was higher by 10.9% (р = 0.046), respectively. In the index group, the number of patients with “no disease” based on CGI-S was 94.2%, while in the comparison group it was 62.9% (р = 0.001). In our study adding systemic ozone therapy to drug therapy in patients with PCAS allowed us to achieve normalization of the TNFα, IL1β, IL6 levels and complete reduction of PCAS clinical manifestations in 94.2% of cases. Thus, the use of systemic ozone therapy can be considered as one of the effective and pathogenetically substantiated strategies for combination treatment of patients with PCAS in outpatient settings.