How to Deal with Altitude Sickness in Cuzco, Peru (and Elsewhere)

The first time I visited Cuzco, I didn’t feel any altitude sickness. I remember thinking it was a bit of a myth, until I saw one woman pass out cold while touring the ruins of Saksaywaman just outside of Cuzco; clearly this ailment was real.

How To Stay Healthy In Peru: Preventing & Dealing with Altitude Sickness

What is altitude sickness?

Altitude sickness, also known as soroche in Peru, is a condition that occurs when you climb to a high altitude too quickly. Because the air is “thinner” at higher altitudes, when you ascend too quickly, your body struggles to get the oxygen it needs. This can result in symptoms like: constant headache which may feel like a migraine, tiredness, nausea or vomiting, loss of appetite, feeling unsteady, difficulty sleeping, upset stomach, shortness of breath, increased heart rate, and generally feeling unwell.

Altitude sickness in Cuzco is common, especially for travellers who have flown in from Lima without time to acclimatize to the change in altitude. Going from sea level to 3,400 meters is a lot for your body to handle. Some feel the effects mildly while others feel quite ill, but it’s hard to predict how your body will react until you get there.

The thing about altitude sickness is that there’s really no magical cure aside from descending to a lower altitude, however, there are a few ways to help lessen the effects of it. Here are a few tips to consider for anyone visiting Cuzco:

Head straight to bed and rest

The first things you should do once you arrive is get to your hotel and go straight to bed! Your body will need plenty of rest while it tries to acclimatize to the altitude, so take it easy. Have a nap, watch TV, or read a book, just don’t run out and start sightseeing right away because the altitude could hit you like a sack of potatoes when you least expect it.

Avoid strenuous physical activity

While you’ll obviously want to start your trip and begin visiting attractions around town, you should still avoid strenuous physical activity for the first few days. Of course you can still go out sightseeing, but just remember to take plenty of breaks, go easy on the steep hills, and take a taxi when necessary. On that note, you’ll also want to keep your daypack as light as possible. Only bring what you need for a day out sightseeing: water, camera, map, etc. There’s no need to wear yourself out.

Stay hydrated

Drink lots and lots of water! Because humidity is lower in higher altitudes, that means sweat evaporates quickly and you may not realize how much water you are losing. The lower oxygen levels also cause you to breathe faster, which means that you lose more water through respiration. You should be drinking plenty of water throughout the day, while also avoiding beverages with alcohol and caffeine which cause dehydration.

Try coca leaves

Coca leaves have been used for thousands of years by the people of the Andean region for their ability to help prevent altitude sickness. Mate de coca is a tea infusion made with coca leaves and it’s a popular drink that you’ll find available in hotel lobbies and restaurant menus. Alternatively, you can buy coca candy at the market or get a bag of loose coca leaves to chew on. If you decided to chew coca, you’ll want to grab a wad of leaves, break the stems off, wrap them into a little ball, and place them on the inside of your cheek. You can then bite down on the leaves every once in a while to help release the juices.

Be mindful of your meal sizes

Digestion occurs at a much slower rate here so you don’t want to go hog wild with your meals. You’ll notice that larger meals are eaten at lunchtime, while lighter meals are served at dinnertime. Having a light dinner will also help you avoid sleepless nights as your body inevitably struggles to digest all the food. Carbohydrates allow you to use oxygen more efficiently and to maintain your energy levels, so pastas, breads, soups and potato-based dishes are recommended.

Take bottled oxygen

Most hotels in Cuzco that are 4-5 stars have oxygen tanks at hand for any guests who are feeling unwell. You’ll also notice that pharmacies around Cuzco carry bottles of OxyShot, which are small oxygen canisters that you can carry with you.

Talk to your doctor about taking medication

I’m clearly not a doctor here, so if you want to get some medication to help fight altitude sickness and you have any pre-existing conditions you’ll want to talk to your physician about that. That being said, acetazolamide is the most common pill used to prevent and reduce the symptoms of altitude sickness. You can either buy it at home with a doctor’s prescription or pick it up at a pharmacy in Cuzco (much cheaper if you ask me). I took it as a precaution on my most recent trip to Cuzco, but it caused me tingling hands and feet which drove me crazy. That’s not to say you’ll experience the same side-effects, but I ended up ditching the medication after one pill and stuck to coca tea instead.

Get travel insurance before you go

This should go without saying as you should always be covered when you travel, but even more so when dealing with high altitude; this coming to you from someone who ended up in a hospital due to high altitude sickness – albeit in Argentina and not Peru. Lesson learned: always be prepared. You can get a quote from World Nomads travel insurance for your Peru trip here.

Building an Altitude-Smart Itinerary: Practical Steps for Cuzco, Machu Picchu and the Sacred Valley

The tips above cover how to manage symptoms day to day. This section covers the bigger picture — how to sequence your itinerary so your body has the best possible chance of acclimatizing before you put it through anything demanding.

Step 1 — Climb in Stages, Not in One Hop

Think of elevation as a staircase, not an elevator. The most common mistake is flying from Lima (sea level) to Cuzco and jumping on the 5 am train to Machu Picchu the next morning. Your body hasn’t had time to produce the extra red blood cells it needs, and even mild exertion will feel brutal. A gentler approach:

• Days 1–2: Fly to Arequipa (2,335 m) or base in Sacred Valley towns like Ollantaytambo (2,800 m). Spend 48 hours there.
• Days 3–4: Move up to Cuzco (3,400 m) for museums, cafés and short strolls.
• Day 6+: Tackle high points such as Rainbow Mountain (5,200 m) or Salkantay Pass (4,650 m).

That 600–1,000 m gradual ascent gives your body time to acclimatize safely before the hard work begins.

Step 2 — Sleep Low, Hike High

If you plan to hike the Inca Trail or higher-altitude routes like Lares, choose operators who camp below 3,800 m on night one, even if the trail crosses a loftier pass during the day. Sleeping high is what triggers severe AMS; day hikes with lower camps significantly reduce the risk.

Step 3 — Build In a Buffer Day After Arrival

Your flight lands at 9 am? Resist the urge to head straight out on a city tour. Pre-arrange an early hotel check-in, drink two mugs of coca or muña (Andean mint) tea, and take a nap. The adrenaline of travel often masks early symptoms; a quiet first afternoon lets you monitor your body before committing to non-refundable tours.

Step 4 — Know the Red-Flag Symptoms

Mild headaches and light fatigue are normal. Seek medical help immediately if you experience any of the following:

Cuzco has clinics with 24-hour emergency oxygen facilities — ask your hotel front desk for the nearest one before you need it. Don’t wait out serious symptoms in your hostel.

Step 5 — Use the Local Pharmacies (Boticas)

Peru’s boticas function as mini-clinics. Pharmacists can check your blood oxygen saturation with a fingertip oximeter — usually free with any purchase. A reading below 85% at rest is a signal to descend or seek oxygen therapy. If you’re trekking remote routes, buy a cheap oximeter on Amazon before you leave home.

Step 6 — Fuel Wisely: The BEANS Approach

A useful way to remember altitude-friendly nutrition:

• Bananas — potassium combats altitude-induced fluid loss.
• Eggs — lean protein for muscle recovery without taxing digestion.
• Andean grains (quinoa, kiwicha) — complex carbohydrates that use oxygen more efficiently to metabolise.
• Nuts — magnesium helps relax blood vessels.
• Soups — hydration and electrolytes in one bowl. Peru’s caldo de gallina is exactly right for this.

Street-stall chicharrón will smell extraordinary, but save heavy fried food for when you’re back at sea level.

Step 7 — Rethink Alcohol and Nightlife

Pisco sours flow freely around Cuzco’s Plaza de Armas, but alcohol dilates blood vessels and worsens headaches at altitude. Most travel doctors recommend limiting intake to one drink during the first 48 hours. If you do toast the Andes, alternate each drink with a glass of water.

Step 8 — What to Know About Sorojchi Pills

Sorojchi pills are Peru’s widely available over-the-counter altitude remedy. They contain aspirin, salophen (an aspirin derivative) and a small amount of caffeine. They work on symptoms — headache, nausea, fatigue — and are not the same as acetazolamide (Diamox). They do not prevent or treat AMS at the cause; they help you feel more comfortable while your body acclimatizes. Typical use is one tablet every eight hours with food and water during the first day or two at altitude. They’re available at any pharmacy around Cuzco’s Plaza de Armas and along Av. El Sol.

Acetazolamide (Diamox) is a separate prescription medication that works differently — it actually speeds up acclimatization and is taken before and during ascent. This is the one where checking for sulfa drug allergies matters. As noted in the core section above, it caused me tingling hands and feet; I switched to coca tea after one pill. Your doctor is the right person to advise on whether Diamox is suitable for you.

Step 9 — Sightsee Slowly and Strategically

Cuzco’s historic centre sits in a bowl, so use gravity. Stroll downhill from the San Blas artisans’ quarter to the cathedral and take a taxi back up rather than walking. The 10-site Boleto Turístico is worth buying, but spread the ruins over several days rather than racing through four sites in one morning. A good pace:

• Day 1: Sacsayhuamán at sunrise (10-minute taxi), then rest and a museum in the afternoon.
• Day 2: Qenqo, Puka Pukara and Tambomachay by colectivo, with a picnic lunch between stops.

Cramming all four sites into one morning — common on mass tours — spikes your heart rate and AMS risk considerably.

Step 10 — A One-Week Altitude-Smart Peru Itinerary

This stair-step model significantly reduces AMS cases compared with flying directly to Cuzco and rushing to Machu Picchu the following day.

Where to Stay: Acclimatization-Friendly Bases

Since the single most important variable is where you sleep, choosing your base wisely is as important as any medication or remedy. Two properties worth knowing about:

• El Albergue, Ollantaytambo — positioned right at the Ollantaytambo train station in the Sacred Valley at around 2,800 m — lower than Cuzco and ideal as your first night or two in the region. 15 rooms in chic rustic style, lush gardens, buffet breakfast, and the option of packed lunches for Machu Picchu. Widely praised and confirmed on Booking.com.
• Aranwa Cusco Boutique Hotel — a 5-star property in Cuzco’s historic centre, notable for this specific article because the hotel maintains an on-site altitude oxygen system for guests who need it. If you’re going to sleep at 3,400 m and want that backup available in the building, this is the right choice. Confirmed on Booking.com.

FAQs: Dealing with Altitude Sickness in Cuzco and Beyond

What is altitude sickness and why does it happen?

It’s your body’s reaction to lower oxygen pressure at elevation — formally called Acute Mountain Sickness (AMS). Typical symptoms include headache, nausea, poor sleep, fatigue, shortness of breath, loss of appetite and rapid pulse. Symptoms usually appear 6–24 hours after ascent.

What altitude is Cuzco, and who is most at risk?

Cuzco sits at around 3,400 m (11,150 ft). Risk rises if you fly directly from sea level, ascend quickly, over-exert early, or have had AMS before. Physical fitness does not guarantee immunity — anyone can be affected.

How can I prevent AMS when flying into Cuzco?

Use a stair-step itinerary: sleep lower (Sacred Valley or Ollantaytambo at ~2,800 m) for your first one to two nights, keep day one gentle, hydrate consistently, avoid alcohol, and discuss acetazolamide with your doctor if you’re concerned about a fast ascent.

What are the best first 48-hour habits?

Rest, walk slowly, avoid heavy meals, drink water with electrolytes, take taxis uphill rather than walking, keep your daypack light, and make sleep a priority.

Do coca tea or coca leaves actually help?

Many travellers find mate de coca or chewed coca leaves subjectively helpful and they are legal in Peru, widely offered in hotels, and mildly stimulating. Note: coca products can trigger positive drug screens outside the Andes — do not carry them across borders.

Which medications are used, and what are the side effects?

Acetazolamide (Diamox) can prevent or lessen AMS when started before or at ascent. Common side effects include tingling in the hands and feet, frequent urination and an altered taste of carbonated drinks — as I found out firsthand. It’s a sulfonamide drug, so check for sulfa allergies before taking it. Ibuprofen helps with headaches. Sorojchi pills (aspirin, salophen and caffeine, available over the counter in Cuzco) address symptoms like headache and nausea but do not prevent AMS. Discuss all options with your doctor before you travel.

Should I use bottled oxygen or small oxygen cans?

Supplemental oxygen can relieve symptoms temporarily and is available in many hotels and clinics. It is not a cure — rest, fluids, time, and descent (if symptoms worsen) remain essential.

What and how should I eat at altitude?

Light and carbohydrate-forward is the approach — soups, potatoes, quinoa, kiwicha. Heavy or greasy meals and alcohol early in your stay worsen symptoms and disrupt sleep. Small, frequent meals are easier on your system than large ones.

What red-flag symptoms mean I should get help immediately?

Severe headache, persistent vomiting, confusion or trouble walking straight, breathlessness at rest, a dry cough that becomes frothy or pink-tinged, chest tightness, or blue lips and fingertips. These suggest HACE or HAPE — seek medical care, oxygen, and immediate descent without delay.

Can children, older adults or athletes acclimatize safely?

Yes, following the same principles: slow ascent, rest days, hydration and light activity. Physical conditioning does not prevent AMS. Monitor children closely — they may struggle to describe their symptoms accurately.

Is a pulse oximeter worth packing?

Useful for tracking trends, especially on multi-day treks, but not essential. How you feel matters more than a single reading. Very low saturation at rest combined with significant symptoms warrants medical evaluation.

What if I still want to hike Rainbow Mountain or a high pass?

Plan it after several acclimatized days in the region, go with a licensed guide, ascend gradually, and set a firm turn-around rule before you start. If symptoms appear on the way up, stop ascending. No photograph is worth the risk of HAPE or HACE.

Have you ever experienced altitude sickness?
How did you deal with it?