Preventing Altitude Sickness in Cusco and Machu Picchu

Visiting the Peruvian Andes is a bucket-list experience for many travelers, but the fear of Acute Mountain Sickness (AMS), locally known as soroche, is a valid concern. Whether you are hiking the Inca Trail or taking the luxury Belmond Hiram Bingham train, the altitude affects everyone differently. This guide provides concrete medical advice, itinerary strategies, and local secrets to ensure your trip remains memorable for the right reasons.

The Geography of Elevation: What You Need to Know

A common misconception is that Machu Picchu is the highest point of a standard Peru itinerary. In reality, the gateway city of Cusco is significantly higher. Understanding these specific numbers is crucial for planning your acclimatization strategy.

  • Cusco: Approximately 11,152 feet (3,399 meters).
  • The Sacred Valley (Urubamba/Ollantaytambo): Approximately 9,420 feet (2,871 meters).
  • Machu Picchu Citadel: Approximately 7,972 feet (2,430 meters).
  • Aguas Calientes (Machu Picchu Pueblo): Approximately 6,700 feet (2,040 meters).

Most travelers fly directly from Lima (sea level) into Cusco. This sudden jump of over 11,000 feet is where most people experience the onset of symptoms. The air at this altitude contains the same percentage of oxygen as sea level (21%), but the barometric pressure is lower. This means your lungs take in fewer oxygen molecules with every breath.

The "Go Lower" Itinerary Strategy

The single most effective way to prevent altitude sickness does not involve medication. It involves changing the order of your trip. Instead of staying in Cusco immediately after landing at Alejandro Velasco Astete International Airport (CUZ), you should head straight to the Sacred Valley.

The Golden Rule: Spend your first two nights in the Sacred Valley.

By taking a taxi or private transfer from the Cusco airport to towns like Pisac, Urubamba, or Ollantaytambo, you effectively drop 1,500 to 2,000 feet in elevation. This “intermediate” altitude allows your body to adjust much more gently than the harsh height of Cusco.

Recommended Itinerary Flow:

  1. Land in Cusco: Immediately transfer to a hotel in Urubamba (like the Tambo del Inka or Sol y Luna).
  2. Days 1-2: Explore the Sacred Valley ruins and markets.
  3. Day 3: Take the train from Ollantaytambo to Machu Picchu (even lower elevation).
  4. Day 4-5: Return to Cusco. By this time, your body has produced enough red blood cells to handle the 11,000-foot elevation of the city.

Medical Interventions: Prescription and OTC Options

While acclimatization is key, medicine provides a safety net. You should consult a travel medicine doctor before your trip to discuss these specific options.

Acetazolamide (Diamox)

This is the gold standard for AMS prevention. It works by acidifying the blood, which stimulates breathing.

  • Dosage: Doctors typically prescribe 125mg or 250mg to be taken twice a day.
  • Timing: You must start taking it 24 to 48 hours before you arrive at altitude. Taking it after you already feel sick is less effective.
  • Side Effects: The most common complaint is a tingling sensation in the fingers, toes, and lips. Carbonated beverages (like soda or beer) may also taste metallic.

Soroche Pills (Local OTC)

If you did not bring a prescription, you can visit local pharmacy chains in Peru such as Inkafarma or Mifarma. They sell over-the-counter blister packs simply labeled “Soroche Pills.”

  • Ingredients: These usually contain a combination of aspirin (for headaches), caffeine (to stimulate breathing and combat fatigue), and salophen.
  • Effectiveness: These are excellent for treating mild symptoms like headaches but are not as effective as Diamox for actual prevention.

Portable Oxygen

For immediate relief, you can buy “Oxishot” canisters. These look like hairspray bottles and contain a few liters of purified oxygen. They are sold at the Cusco airport and most pharmacies. While they offer quick relief if you feel dizzy climbing stairs, the effect is temporary.

Dietary Adjustments and Hydration

Your digestion slows down significantly at high altitudes. What you eat on your first day matters as much as the medicine you take.

Hydration Rules: The dry Andean air sucks moisture from your body with every breath. You need to drink 3 to 4 liters of water daily. One helpful tip is to buy electrolyte powder packets (like Liquid I.V. or Gatorade) from home and add them to your bottled water.

The First Meal: Avoid heavy proteins like steak or greasy fried foods immediately upon arrival. Your body is prioritizing oxygen for your brain and heart, leaving less energy for digestion.

  • Eat: Quinoa soup (sopa de quinoa), chicken diet soup (dieta de pollo), or simple pasta.
  • Avoid: Alcohol. While a Pisco Sour is tempting, alcohol depresses your respiration rate during sleep, which worsens oxygen saturation. Wait until your third night to indulge.

Natural Remedies: The Power of Coca

You will see coca leaves everywhere in the Andes. It is the traditional remedy used by the Incas and modern Quechua people.

Coca Tea (Mate de Coca): Most hotels provide complimentary coca tea in the lobby. It is a mild stimulant that helps with fatigue and headaches. Drink a cup upon arrival, but avoid it late at night as the stimulant effect can keep you awake.

Chewing Leaves: To consume it like a local, you don’t just chew the dry leaves. You place a small bundle of leaves in your cheek along with a black substance called llipta (alkaline ash). The llipta activates the alkaloids in the leaf. Without it, you are just chewing foliage.

Important Note: Coca leaves contain the alkaloid used to make cocaine, though in minute, natural quantities. It is legal and non-narcotic in leaf form in Peru. However, it will cause you to fail a drug test. If your job requires random drug screening, avoid coca tea and leaves entirely.

Oxygen-Enriched Hotels

If you are worried about sleeping at altitude, several luxury hotels in Cusco pump oxygen into their rooms to lower the “effective” altitude.

  • JW Marriott El Convento Cusco: They offer a supplemental oxygen system in rooms to simulate lower elevations.
  • Belmond Hotel Monasterio: You can request an oxygen-enriched room for an additional fee.
  • Palacio del Inka: Also offers oxygen enrichment services.

This service usually brings the oxygen concentration in the room to roughly 24%, which simulates an elevation of about 7,000 feet rather than 11,000 feet. This can guarantee a better night’s sleep, which is critical for recovery.

Frequently Asked Questions

Is physical fitness a factor in altitude sickness? Surprisingly, no. Being a marathon runner does not guarantee immunity to AMS. It is largely genetic and random. Sometimes, extremely fit people suffer more because they attempt to exert themselves too early.

What are the symptoms of a medical emergency? Mild headache and shortness of breath are normal. However, if you experience confusion, inability to walk in a straight line (ataxia), or a wet/gurgling sound in the lungs, you must seek emergency help immediately. This could indicate HAPE (High Altitude Pulmonary Edema) or HACE (High Altitude Cerebral Edema).

Are there clinics in Cusco for tourists? Yes. Clinics like O2 Medical Network or Clinica Pardo specialize in treating tourists with altitude sickness. They are accustomed to dealing with travel insurance paperwork.

Can I buy Diamox in Cusco without a prescription? While technically a prescription drug in many countries, pharmacists in Cusco will often sell Acetazolamide over the counter if you ask for it by generic name. However, it is always safer to consult a doctor at home first to check for interactions with other medications.