If you are like us and many other people, you will arrive in Cusco by air from Lima, putting you at risk for altitude sickness. Unfortunately, there's no way to predetermine if you are vulnerable to coming down with it -- fitness, age, weight and other factors have no known association with altitude sickness. It can be either sever or mild, but it seems to strike at random.
So, don't assume it won't happen to you. One person I know didn't heed the warning signs and had to stay in bed on the only day he could have visited Machu Picchu. Who wants that? If you want a first-person account, read jadedmuse's VT page -- that opened our eyes. So, build your schedule with altitude sickness in mind. Fly to Cusco and ascend immediately to the Sacred Valley and save your city visit until the trip's end. Allow relaxation time on your first afternoon at altitude. Drink coca tea. And we recommend a prescription of diamox, which you must start taking two days before flying to altitude. Don't eat too heavily or drink (much) alcohol. If you do take the diamox, you can probably get away with a pisco sour at dinner (we did) but if you don't take the pills, skip the drink.
If you're like some people, you may be tempted to ignore this advice -- especially if you are young and fit. But altitude sickness can rob you of a precious vacation day in a unique and beautiful place, so I wouldn't say the chance was worth it.
By the way, even if you don't get sick, the altitude will make you tired. Climbing out of the Moray terraces at 2800m/11000ft was exhausting. Sarah, with all the youth of a 16-year-old, collapsed in a vulnerable heap at the top, where she was devoured by a hungry dog, as you can see in the photo.
I have found 2 ways to avoid altitude sickness, other than spending many days ascending which is not often possible.
1. Get a prescription from your doctor for a few 250mg tablets of diamox. This diuretic accelerates acclimatization by ~2x. You only need to take one tablet a day, so break each tablet in two and take half in the morning and half in the evening. 3 or 4 tablets should be enough: one for the day before and 3 after you arrive in Cusco. When I take whole tablets my side effects from diamox are a tingling of the fingers and frequent urination - but at half strength I did not notice anything. It is a prescription drug, so consult your doctor.
2. Take 2 ibuprofin every 4 hours to avoid the headache and nausea of altitude sickness. This does not just suppress the symptoms, it has been proved in a double blind trial
to provide some changes to the blood that reduce altitude effects. If you do a one day ascent/descent then diamox does not have time to do anything and you will have to
rely on ibuprofin. Some folks say asprin works just as well. On Kilimanjaro I took ibuprofin and diamox 24/7 for about a week.
My friends and I have used this strategy many times when mountain climbing. We have done lots of 14,000 ft peaks up/down in one day in the US where we used to always feel terrible and now we can have a picnic at the top. Using this strategy, last year I trekked over 16,000 ft passes in Ladakh, and the year before I go to the top of Kilimanjaro (19,000 ft), all without altitude problems.
When I was in Cusco and on the MP trail I tried coca tea and coca leaf but I did not like the buzz it gave me.
Of course, your mileage may vary.
For medical references, search for "altitude sickness ibuprofen" etc. at
Yes, it can be avoided ... we´re living proof. I´m sitting in Cuzco as I write ... hoping to benefit others planning to do a fast Machu Picchu trip like we are doing.
Planning a quick visit: Unlike many stronger-younger visitors, we´re 60. And, we only have 3 days. So we decided to fly into Cuzco (from Vancouver) and go directly to Aguas Caliente (which is about 2K+ ft lower). Stay the night and visit Machu Picchu in the morning, return to Cuzco in the afternoon, spend the next day in Cuzco-areas, and fly out early the following morning.
First, we got the prescription meds (Acetazolamide as suggested by 53nana) and started taking it (3 x per day) as soon as we get on the plane at 1 pm. About 18 hours later, we´re in Cuzco.
Next, we had pre-arranged a car service pick us up (from the Cuzco airport) to take us to the Ollantay train station. It takes about 1.5 hours. We arrived 30+ mins before the train departs. 1.5 hours later, we´re in Aguas Caliente, before 4 pm.
Yes, I find I get out of breathe sooner than usual ... only because I feel good enough to not realize that I´m at a high altitude and go my usual pace. Other than that, drink lots of water, I had 2 coca tea so far, and had little alcohol and meat - i.e. no steak meals.
So, we´ve avoided it altogether, with no symptoms (that so many others talked about)
We´re now all done and ready to fly out of Cuzco at 7 am tomorrow morning to continue our 7 week vacation.
Cuzco is located very high in the Andes (3326 m) so for average people it may be a little difficult to breath here. You can feel that you have fewer air in your lungs and climbing a little stair may seem an impossible mission. You can also have headaches and general sickness the first days: don't worry, this is called "altitude sickness" and normally disappears in 2-3 days.
You just have to take it easy, walk slowly, don't do extra efforts... and you can drink coca tea, or chew coca leaves, it helps too. There is also some specific pills, but that's only for extreme cases.
If you are doing the Inca Trail you have to be in Cuzco 2-3 days before the trail begins, so you can get used to the altitude.
We had read all about the altitude sickness and figured that with a 7:30 am flight arrival in Cusco, we'd be able to rest until the afternoon and then see some of the local sights.
But we arrived already a bit sick (diarrhea - I'm not ashamed to admit) and very tired, drank our coca tea and went to bed, our hearts racing. A tip: bring food with you (we did) or buy it as soon as you get there so you have something to snack on right next to your bed. Getting up is a chore.
At about 6 pm I was feeling well enough to go downstairs to get dinner. I carried a tray with eggs, bread and tea upstairs, and almost passed out waiting for hubby to open the door!
The worst for me was dizziness and nausea, no vomiting. Hubby had a bad headache and threw up twice. We opted out of taking Diamox, it seemed so strong. We heard afterward about something called Sorochill, which some people we met from Amsterdam had taken with good results.
Either way, we wished we'd planned an extra day in Cusco as we only had a little time in the morning to sightsee before heading out into the Sacred Valley (and still didn't get to Ollantaytambo before the Backpacker sold out - see separate tip under Machu Picchu).
Now, although it's different with every person, you shouldn't be too scared about soroche AS LONG AS you follow the basic rules!! When you arrive to Cusco, don't do any great efforts on the first day, take it easy, walk slowly, drink your coca tea (mate de coca, which btw I absolutely loved!!), don't eat too much, nor have any heavy meals, and drink plenty of water. Also it's recommended that you take lots of lemon candy with you (sugar helps) and have one every once in a while. If you do all these things you should be fine, but if you're not, and you start feeling sick, contact a doctor so you can get soroche pills.
The most important thing is that you don't have to be scared, you have to be CAUTIOUS!!
Take this seriously because it can really slow you down. Drink the tea, take a dieretic and eat properly so you won't miss out on the sites. Beware of any water that is not bottled since a stomack virus with altitude would have you wanting to be put out of your misery!
Any hike you do around Cusco will put you up another 1,000 easy. My wife turned white for about 30 minutes on one of our hikes and I thought I would have to carry her down!
Cusco is 11,000ft(3,360 metres) above sea level so there is a possibility you may experience altitude sickness your first day or two. Some symptoms are fatigue,shortness of breath upon exertion, headaches,loss of appetite, nausea and frequent urination.If your symptoms worsen or you instantly develop a harsh cough seek medical attention immediately as this could be pulmonary edema and it could be deadly.
Anyone can experience altitude sickness regardless of age or physical condition although people with lung or heart conditions and anemia are more prone.
Some things that may help are taking it easy the first day or two,drinking lots of fluids,avoiding alcohol and refraining from smoking.
Some hotels have oxygen available to guests who are experiencing these syptoms.
Mate de coca (coca -leaf tea) is said to help curb the syptoms of altitude sickness. It is perfectly legal and it will not make you high. It has a pleasant taste of a light green tea and is also supposed to aid in digestion. I really liked it and drank it everyday.
If you are going on a hike and can't bring tea with you, you can bring coca leaves to chew on. They are available everywhere and a bag is about 1 sole(30 cents). They won't make you high either, but they are very bitter and taste awful.
If you come from sea level, arriving in Cuzco will be quite a shock on your system. At 3300+ meters, you're into thin air! First, respect your body. Rest, take it easy and hang out for a couple of days before getting into more physical activities. A headache or upset stomach is the first sign of altitude sickness. I got out of breath just climbing one flight of stairs to go to my hotel room! Then I needed to lay down because my legs felt like Jello! Diamox, or altitude sickness pills, will prevent you to get the HACE or HAPE . (High altitude cerebral oedema or swelling, and high altitude pulmonary oedema) but the best way to cure it is to go lower. Machu Picchu is lower than Cuzco at 2880 m. Or there is also sea level! Coca tea is believed to help sorroche (altitude sickness) but I haven't noticed anything different...
I was in Cusco last june and I have "soroche". People told me that Coca tea will be useful but, it was worse, because coca's tea hide the problem but dont help. Finally I fall in the street and ending in a Hospital. Doctor gave me Dexametasona, aspirine and other drugs that I dont remenber., and he told me go to Macchu Pichu inmediatly, because it is lower than Cuzco. When I arrive to Machu Pichu I feel very well and went to the excursion without problem. When I returned Cuzco 4 days later I was fine and could enjoy the wonderful Cuzco without problem. The secret is (Doctor told me) to go firts to Machu Picchu and after that to Cuzco. I'm 55 age, but it is the same..nobody know who could have "soroche", but Cuzco is so beautiful that I'm going to Perú as soon as I can. (I hope you can understand my english) good luck. Diana
Just some food for thought regarding Diamox and sulfa allergies...
I arrived Cusco via a plane from Lima and the quick ascent made me very worried about altitude sickness. I didn't think that diamox would be a possibility because I have had mild to moderate reactions to sulfa based antibiotics in the past. That said, I didn't want soroche to limit my time in Peru so I did some online research regarding Diamox (the only medicine that actually accelerates acclimatization). As it turns out, people who have had reactions to sulfa based antibiotics are only slightly (4 times) more likely to have a reaction to diamox. (Apparently the chemical make up is different). Armed with this info, I asked my doctor to give me a trial dose. He reluctantly agreed after consulting a colleague. About two weeks prior to my trip I tried my luck. I started by taking 1/4 of a tablet and gradually increased it to 1/2 then to a whole (500) tablet for 3 days. I didn't have a reaction (only mild and expected side effects). I took the recommend dosage starting 2 days before my arrival to Cusco and all went well. *I am not recommending that anyone with severe sulfa allergies try this method. I just wanted to share my experience*
Be very careful when arriving by air especially into Cusco. Do not attempt to do anything that do as you will need to rest and drink nothing but water. I have seen people fainting at tourist sites who have arrived the same day and have tried to do too much.
Drink coca tea which is meant to help your body aclimitise, rest and drink lots of water. All hotels will have a doctor on call with oxygen etc if you need it. Don't wait if you do.
If you're going to do the Inca trail, wait at least 2 days in Cusco before you try it. There's plenty to see anyway.
My mother was severely affected by the altitude. We had to call the doctor who gave her oxygen and some injections to help her stop throwing up, ease the headache and replenish her oxygen levels. Her level was at 70%. Normal is 95%. Be careful!!
We flew from Lima at sea level to Puno at 4000 m and were taking Diamox and drinking lots of coca tea. We're both very fit - this is irrelevant with altitude sickness. Don't make the mistake of thinking you're super fit and healthy and you won't be affected. Your body must maintain adequate blood oxygen levels and that's not within your control.
We had shortness of breath, slight nausea, headaches. I had no problem sleeping, but did notice that I was breathing faster and shallower. We were extremely out of breath with any form of exertion, even climbing 5 or 6 steps in our hotel, so plan on lots of time to get places, strolling not rushing. I was sick to my stomach the first night and then felt great although I did have 10 mins of oxygen in our hotel. I also have asthma and had no problems at all with this. Just take it easy, keep hydrated, and be familiar with warning signs of problems. After 3 days in Puno, we were in Cusco and had no problems as we had apparently acclimatized at the higher elevation. However we continued to take the meds and drink coca tea until we left Cusco. We are in the 50-55 age range.
This is very real and can be extremely dangerous if you don't take care.
Most people will get mild symptoms including breathlesness and tiredness. The first day may also give you a headache and nausea. One symptom I had which is not usual but also not uncommon was not being able to breath well when lying down. I had to sleep with a number of pillows like you do when you have a severe head cold.
There are various forms of medication available which have their different directions and side effects. You need to discuss these with your travel doctor. I chose not to take medication and managed quite well by drinking cocoa leaf tea, staying well hydrated and taking it easy.
This can be difficult when climbing ruins like Ollantaytambo but take a few steps at a time, stop, take a few photos, and keep going.
For medical references, search for "altitude sickness ibuprofen" etc. at
Aviat Space Environ Med. 1994 Jan;65(1):19-20.
High altitude headache: treatment with ibuprofen.
Broome JR, Stoneham MD, Beeley JM, Milledge JS, Hughes AS.
Royal Naval Medical Service, Middlesex, England.
Up to half of those who ascend rapidly to altitudes of over 3,000 m may experience symptoms of acute mountain sickness (AMS) and of these some 95% may suffer from high altitude headache. We report the first controlled trial specifically to assess an oral drug therapy for this common symptom. Subjects were 21 members of mountaineering expeditions to similar altitudes in the Bolivian Andes and the Himalayas in Nepal. The study was of a randomized, placebo-controlled, double-blind, within-patient crossover design. Ibuprofen was significantly superior to placebo both in reducing headache severity and in speed of relief (a mean difference of 94 min in time to no/minimal headache). Only 14% of subjects who initially took ibuprofen felt the need for further medication compared to 83% of those who took placebo first (p = 0.02). Of the 11 subjects completing both phases of the crossover, 8 (73%) favored ibuprofen while the remainder had no preference (p = 0.004). No attributable adverse effects occurred. The results suggest that ibuprofen is a safe and effective treatment for high altitude headache.
There are similar references for the use of asprin and acetaminophen.
We always take lots of ibuprofen when going to high altitude and it
has greatly reduced our headache and nausea!