Altitude sickness in Cusco: how to prevent it and what to do

Cusco sits at about 3,400 metres above sea level, and many travellers fly in from the coast in just over an hour. Your body has no time to adapt, which is why altitude sickness — locally called soroche — is one of the most common worries. The good news: in most cases it's mild and preventable with common sense. Here's how.

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What is altitude sickness?

As you climb, air pressure drops and each breath delivers less oxygen. Acute mountain sickness happens when your body hasn't had time to adjust. It can affect anyone regardless of age or fitness — being fit doesn't protect you, and sometimes makes people push too hard on day one.

Common symptoms

They usually appear 6–24 hours after arrival and, in most cases, improve after a day or two of rest.

• Headache (the most common symptom).
• Nausea or loss of appetite.
• Poor sleep or insomnia.
• Shortness of breath on exertion, like climbing stairs.
• Fatigue and mild dizziness.

Warning signs: when to descend and get help

Rarely, altitude sickness progresses to serious forms: high-altitude cerebral edema (HACE) or high-altitude pulmonary edema (HAPE). Both are medical emergencies.

• Confusion, odd behaviour or extreme drowsiness.
• Loss of balance or trouble walking in a straight line.
• Severe headache that painkillers don't relieve.
• Breathlessness at rest, persistent cough or frothy/pink sputum.
• Bluish lips or nails.

How to prevent it

Acclimatize gradually

The key is giving your body time. A great strategy is to start in the Sacred Valley, which is lower (roughly 2,800–2,900 m in Urubamba or Ollantaytambo), spend a night or two there and go up to Cusco afterwards. The valley is also on the way to Machu Picchu.

The first 24–48 hours

• Take it easy: walk slowly, especially uphill and on stairs.
• Drink water steadily through the day.
• Avoid alcohol and smoking for the first days.
• Eat light meals; heavy dinners sit badly at altitude.
• Sleep well and don't plan demanding trips on arrival.

Coca tea and coca leaves

In the Andes, coca leaves are traditionally used to ease the effects of altitude, either as tea (mate de coca) or chewed. Many hotels offer it free at reception. The effect is mild and no replacement for acclimatization, but many travellers find it helps.

Medication and oxygen

Acetazolamide is a medication used to prevent altitude sickness, but it has contraindications and side effects. Only take it if a doctor has recommended it, ideally at a travel clinic before your trip. Ask your doctor which painkiller suits you for mild headaches, too.

Many Cusco hotels keep oxygen for guests and some offer oxygen-enriched rooms. It relieves symptoms but doesn't replace descending if warning signs appear.

High day trips: save them for later

Some of the most popular trips go well above Cusco: Rainbow Mountain (Vinicunca) is around 5,000 m and Humantay Lake about 4,200 m. Do them after at least two or three days of acclimatization, never on arrival day. Machu Picchu is lower (about 2,400 m), so altitude is usually less of an issue there.

Quick summary

1. If you can, sleep in the Sacred Valley first.
2. Go slowly for the first 48 hours.
3. Water yes, alcohol no; light meals.
4. Medication only on medical advice.
5. Trips above 4,000 m at the end of your stay.
6. Warning signs: descend and get medical help.

Before you go

eSIM for Peru

Land connected: install an Airalo data eSIM before you travel and switch it on when you land. Check first that your phone supports eSIM and is unlocked.

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Airport transfer

Book a private Welcome Pickups transfer from Cusco airport to your hotel before you land, with your driver waiting in arrivals. Check the price and cancellation terms when booking.

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Notice: This guide shares advice and recommendations based on research and local experience. Prices, opening hours and rules may change: always check with official sources and operators. Cusco Tips is not responsible for third-party services, bookings or decisions made using these guides; some links are affiliate links (see our affiliate policy).