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How to Manage the Altitude in Cusco and Altitude Sickness at Machu Picchu

Sunrise at Machu Picchu Peru

Peru is on many people’s bucket lists, and for good reason.  The Inca Citadel at Machu Picchu has graced the cover of countless South American guidebooks and travel magazines, and this iconic UNESCO site is certainly a worthy entry in the New Modern Wonders of the World.  However, for many visitors to Machu Picchu and Cusco, altitude sickness can cause unwelcome effects as the altitude at Machu Picchu and the rest of the Andean region of Peru is high enough to cause problems.  After spending several months at high elevation in Peru and Bolivia, I’ve put together these tips and recommendations to help you cope with the altitude in Cusco and reduce the risk of altitude sickness at Machu Picchu.

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I used several sources as well as my own personal recommendations to put together this guide, including the NHS website, Web MD and various other sites.  Please bear in mind that I am not a doctor so before you travel to Peru you should speak to your doctor or a medical professional about the risks of altitude sickness and any recommended altitude sickness medications for you.

Altitude in Cusco Peru

Cusco, or Cuzco, is usually what causes the problem for most visitors to Machu Picchu.  Cusco sits at an elevation of 3,399 m (11,152 ft) above sea-level, and anyone planning to visit Machu Picchu must come through Cusco first, and cope with the altitude in Cusco before going to Machu Picchu. 

To put it in context, Everest Base Camp sits at an altitude of 5,346 m (17,598 ft) so you’re more than halfway to base camp just by being in Cusco!

The altitude in Cusco Peru can be a problem for many visitors
The altitude in Cusco Peru can be a problem for many visitors

Altitude at Machu Picchu

Many people are surprised when they learn that the altitude at Machu Picchu is lower than Cusco.  The elevation at Machu Picchu is *only* 2,430 meters (7,972 feet) above sea level, so markedly lower than Cusco, even though it is still pretty high.

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Altitude on the Inca Trail & other Machu Picchu Treks

The Inca Trail and other treks to Machu Picchu are where you will encounter the highest elevation in Cusco.  Before you start your trip, make sure your travel insurance covers you for high-altitude trekking, as some policies will not cover high altitude hikes unless you add extra coverage.  If something does go wrong up there, you need to know you will be taken care of without issues – being air-lifted to a hospital doesn’t come cheap!

Even though the altitude made trekking to Machu Picchu very tough, it is worth it! Altitude at Machu Picchu
Even though the altitude made trekking to Machu Picchu very tough, it is worth it!

The highest elevation on the Inca Trail is known as Dead Woman’s Pass, which reaches an altitude of 4,215m (13,828 ft).  Dead Woman’s Pass is probably the most feared part of the Inca Trail, partly because of the altitude, partly because you climb it on the 2nd day of the trek (which is the hardest day) and partly because of the gruesome name. 

Don’t worry though, “Warmiwañusca” as it’s called in Quechua is only named Dead Woman’s Pass because when you see it from below, the crest of the pass resembles the form of a woman’s body lying down.

If you plan to hike to Machu Picchu along the Inca Trail, or any of the other treks to Machu Picchu like the Salkantay Trek, I’d highly recommend doing some training in hiking, and/or at high altitude.  You will need to be of reasonable fitness and be fully acclimatized to the altitude in Cusco before you start the trek.  Spend a few days in Cusco before you begin the hike, DO NOT start the Inca Trail immediately after arriving in Cusco.

Trekking to Machu Picchu - Altitude on the Inca Trail reaches over 4000m which can lead to altitude sickness at Machu Picchu
Trekking to Machu Picchu – Altitude on the Inca Trail reaches over 4000m which can lead to altitude sickness

Climbing Huayna Picchu

Huayna Picchu is the mountain that stands directly behind the ruins of Machu Picchu and is what helps to make Machu Picchu so incredibly beautiful. 

You can arrange to climb Huayna Picchu, which is at a higher elevation than Machu Picchu itself.  The peak of Huayna Picchu is 2,693 metres (8,835 ft) above sea-level, which is about 260 metres (850 ft) higher than the altitude at Machu Picchu. 

If you have already hiked the Inca Trail, this extra elevation shouldn’t cause you any additional problems, but it is something to bear in mind if you take the train to Machu Picchu and aren’t fully acclimatized to the altitude in Cusco.

What is Altitude Sickness & What Causes It?

Altitude sickness, also known as acute mountain sickness, happens when your body doesn’t have time to acclimatize properly to high altitude.  At altitudes above around 2,399 m (7,874 ft) above sea level, the air pressure is lower, and the amount of oxygen that you breathe into your lungs and blood is less. 

If you gradually increase altitude or already live in a high-altitude area, your body will naturally adapt or acclimatize to the lower air pressure.  However, if you don’t give your body time to adapt, you may well suffer from altitude sickness as your body struggles to get the oxygen it needs. 

In Cusco, altitude sickness is called “soroche” (from the Quechua language) and usually affects most visitors to Cusco and Machu Picchu who have arrived in the city from a lower elevation.

High altitude affects different people in different ways.  Physical fitness, age, and gender have no bearing on whether you will suffer from altitude sickness. However, people with lung or heart problems are at a higher risk, as these are the main parts of your body which pump blood & oxygen to your brain. 

People with diabetes, asthma, epilepsy, sickle cell disease, or pregnant women are also more likely to suffer the effects of altitude sickness.  Make sure you talk to your doctor about the risks before travelling to Peru.

Machu Picchu - Avoiding Altitude Sickness at Machu Picchu
Machu Picchu – Avoiding Altitude Sickness at Machu Picchu

Can Altitude Sickness Kill You?

In severe cases, yes, altitude sickness is life-threatening.  There have been cases of tourists dying from conditions brought on by altitude sickness, so take action quickly and don’t ignore the symptoms.

High altitude pulmonary oedema (HAPE) is a severe form of altitude sickness, which is a build-up of fluid in the lungs.  High altitude cerebral oedema (HACE) is the most serious and is the swelling of the brain caused by a lack of oxygen.  Both of these conditions are extremely serious and can be fatal.

Altitude Sickness Symptoms

It is common to experience some mild altitude sickness symptoms, and usually, it is nothing to worry about.  A headache, shortness of breath and tiredness are typical in places with a higher altitude than you are used to and most people’s symptoms subside after a day or two, once their bodies acclimatize to the new elevation. 

However, if you experience more severe symptoms such as dizziness, vomiting and disorientation you should seek medical help immediately, to prevent more serious forms of altitude sickness. 

With quick treatment you should recover quickly as well, so don’t let the altitude at Machu Picchu prevent you from booking your trip.  Just be aware of the warning signs, and make sure you tell your travel companions how you are feeling, so they can get help if needed.

Mild altitude sickness symptoms include:

  • A headache
  • Fatigue and loss of energy
  • Shortness of breath
  • Problems with sleep
  • Less appetite

Be wary if you experience these symptoms, and see a doctor as soon as possible

  • Dizziness
  • Nausea
  • Vomiting

More serious symptoms include the following; seek medical attention immediately if you are suffering from any of these:

  • Loss of coordination and trouble walking
  • A severe headache that doesn’t get better with medication
  • A tightening in your chest

If you develop a severe form of altitude sickness like HAPE or HACE, you might have the following symptoms, in which case you should get to the hospital right away:

  • Be confused or disorientated
  • Have shortness of breath even at rest
  • Have a fast pulse
  • Be unable to walk
  • Have a cough that produces a white or pink frothy substance
  • Develop a bluish discolouration of the skin (cyanosis) (for HAPE)
  • Fall into a coma
Llamas are acclimatised to the altitude at Machu Picchu
Llamas are acclimatised to the altitude at Machu Picchu

How to Prevent Altitude Sickness

The best way to prevent altitude sickness is to acclimatize gradually to a higher altitude, slowly increasing the altitude over a few days so your body has time to adjust the flow of oxygen around your body.  If you are on a short trip to Peru though, that may not be possible.

To help your body deal with the higher altitude, keep well hydrated.  Drink lots of water, avoid drinking alcohol and smoking cigarettes if you can.  Hangovers are 10 times worse at altitude, trust me! 

Your whole body slows down as it tries to cope with the altitude, so your digestive system will be sluggish too.  Try to avoid heavy meals, instead eat lighter meals such as soups and vegetarian dishes instead of heavy meals like a huge steak.  Slow-release carbs are good, fat not so much.  Your tummy will thank you for it!

You can help prevent altitude sickness by:

  • Increasing altitude slowly, to give your body time to acclimatize
  • Drinking lots of water & hydration salts
  • Avoiding alcohol
  • Not smoking
  • Eating light meals
  • Drink coca tea

Preventing Altitude Sickness in Cusco

Try to plan your trip so you gradually increase the altitude and can acclimatize slowly, so hopefully, by the time you reach Cusco, altitude sickness won’t be a major problem for you.  For example, I started my journey in Santa Cruz in Bolivia, which has a low altitude, and travelled through the country, stopping at Sucre, La Paz and Lake Titicaca before I arrived in Cusco. 

If you are travelling through Peru, I’d recommended travelling by land from Lima to Cusco, so you can visit various destinations along the way, and increase the altitude stopping off at Arequipa before arriving in Cusco.

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Arequipa is at a lower elevation than Cusco so is a good way to acclimatise to the altitude in Cusco
Arequipa is at a lower elevation than Cusco so is a good way to acclimatise

If you are short on time and fly directly into Cusco, make sure you have at least a day or two in Cusco to take things slowly.  You could take a city tour in Cusco, a cooking class or chocolate workshop, and there are plenty of museums to visit which are a great way to slowly explore the city.  Listen to your body and don’t exert yourself.

Follow the general tips above, drink lots of water, avoid alcohol & smoking, and eat light meals.  Good restaurants to try in Cusco include Mr Soup, which has a range of delicious soups (including a couple of veggie options), and vegetarian restaurants like Green Point.  Most hotels and hostels in Cusco will have coca tea available throughout the day too, to warm you up and to help prevent altitude sickness.

Check out these gentle activities from Get Your Guide to help you acclimatise to the altitude in Cusco or read this guide of things to do in Cusco for more ideas.


Preventing Altitude Sickness at Machu Picchu and on the Inca Trail

If you have taken the time to acclimatize properly in Cusco, if you take a day trip to Machu Picchu you shouldn’t suffer from altitude sickness at Machu Picchu at all, as it is at a lower elevation than Cusco.

If you are trekking to Machu Picchu, the high elevation and physical exertion on the Inca Trail and other treks may well take their toll.  Even if you are fully acclimatised to the altitude in Cusco, the Inca Trail reaches an elevation of +4000 m above sea level, and of course, hiking for several hours a day is hard work at the best of times! 

If you can do some training to get your body used to hiking long distances, especially at high altitude, you should be able to cope better on the Inca Trail.

The trek to Machu Picchu - Emergency Horse to help with altitude sickness on the Inca Trail
Emergency horses help with altitude sickness on alternative treks to Machu Picchu

Listen to your body, and keep your guides informed if you feel unwell or notice any symptoms of altitude sickness.  If you suffer badly on the trek, you may need to take the decision to leave the Inca Trail and come back to Cusco, where you can then take the train to Machu Picchu. 

Hopefully, it won’t come to that, but of course, your health is your priority.  When I hiked to Machu Picchu on an alternative trek, there were horses with us which could be used in case of an emergency.  On the second day of the hike, I was so exhausted I had to ride one of the horses for a while, which definitely helped!  Don’t be afraid to ask for help.

READ MORE: The Day a Horse Named Zaino Saved My Life

Altitude Sickness Medications to Prevent Elevation Sickness

There are some medicines that your doctor can prescribe which may help to prevent altitude sickness, and other over the counter medicines and herbal remedies which may also help.  Before taking any medication, talk to your doctor.

  • Chlorophyll drops or chlorophyll gel tablets may help increase the number of red blood cells in your system, and therefore increase the amount of oxygen in the blood
  • Crystallized ginger may also help with nausea
  • Sorojchi pills are over-the-counter tablets available in Peru which may help with blood circulation and a headache. They also contain caffeine for an energy boost
  • Diamox or acetazolamide is a prescription medication which doctors sometimes recommend to prevent altitude sickness
There are some medications for preventing Altitude Sickness at Machu Picchu
There are some medications for preventing Altitude Sickness

Diamox for Altitude Sickness

In some cases, acetazolamide (often called by the trade name Diamox) can help to prevent altitude sickness, although it is less popular with Doctors in the UK than it is in the US.  When I asked my British doctor about it, she said that due to the side effects she wasn’t willing to prescribe it to me. 

If your doctor will prescribe it, Diamox can help to reduce the effects of altitude sickness symptoms like a headache, tiredness, nausea, dizziness, and shortness of breath.

Treating Altitude Sickness

The obvious and most effective treatment for altitude sickness is to descend to a lower elevation, where the higher oxygen levels will help your body to recover.  Mild altitude sickness symptoms can usually be eased by resting, drinking lots of fluids and taking paracetamol or mild painkiller for the headache. 

Pure oxygen is often used to help treat altitude sickness where descending to a lower altitude isn’t possible, or in treatment for more serious altitude sickness symptoms.  If you are suffering from any of the more serious altitude sickness symptoms then get medical attention as soon as possible, and the doctors will treat you as effectively as they can in hospital.

In the Andean regions of Peru and Bolivia, chewing coca leaves or drinking coca tea is also very common, and a nice hot cup of coca tea is very welcome when it is cold too!  Coca leaves are from the same plant which is used to make cocaine, but the leaves aren’t treated at all, they are in their natural form. 

Coca leaves contain iron, vitamins A, B1, B2 and calcium, and help your bloodstream to absorb oxygen.  Coca also suppresses hunger, relieves fatigue, headaches and can also ease your stomach. Coca leaves are legal to use in Peru and Bolivia, but you cannot take them across any border (even between the two countries). 

Coca sweets and candies are a tastier way to ease the symptoms of altitude sickness too (although I’m not sure how much coca is actually in them), and the added sugar is handy for a quick energy boost too.

Coca Leaves - Preventing Altitude Sickness in Cusco and Machu Picchu
Coca Leaves – Preventing Altitude Sickness in Cusco and Machu Picchu

A popular quick fix in Cusco are oxi-shots, which are small canisters of oxygen that you can buy from shops all around Cusco.  However, some say these are just a gimmick and don’t contain enough oxygen to make a difference to your body.

Treatment for Altitude Sickness

  • Descend to a lower altitude
  • Paracetamol or Ibuprofen can help with a headache
  • Motion sickness medication may help with the dizziness and nausea
  • Coca tea, chewing coca leaves or coca sweets
  • Pure oxygen
  • Hospitalisation

The key thing to remember about dealing with the altitude in Cusco is to take your time.  Give your body time to acclimatize, don’t rush around, and get lots of rest.  If you do suffer from mild altitude sickness it is nothing to worry about, but more serious symptoms should be treated immediately to prevent it from getting any worse. 

Listen to your body and share how you feel with your travel companions to keep an eye on each other.  All being well, you will have a wonderful time, and the memory of seeing Machu Picchu for the first time will stay with you forever.

Do you have any other tips for coping with the altitude in Cusco?  Did you suffer from altitude sickness at Machu Picchu?  Please share your stories and tips in the comments below.

You may also like these Cusco posts:

Or click here to read all of our Peru blog posts.

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Last updated: April 2, 2020

14 thoughts on “How to Manage the Altitude in Cusco and Altitude Sickness at Machu Picchu

  1. Vibha Spalding says:

    Thanks for all the practical tips, as I have booked to go on a trip that includes Machu Pichu from Cusco. The itinerary states 4 day trek up from Cusco to Machu Pichu and return to Cusco. So we will be going down and then up the track. I have suffered mild ashthma in the past and probably still do. I shall be seeing the nurse and doctor and see what they suggest. I had not thought of altitude problem, so these tips are very useful and am now mindful of them. Will check with my insurance as well. Thanks again.

    • Claire says:

      Hi Vibha, I’m so glad this was useful for you – as you said, checking with your doctor is a good idea to see what they recommend for you. I hope you enjoy your time in Peru! 🙂

  2. Kevin Groh says:

    Love the tips. I went to Rainbow Mountain and got severe altitude sickness. Best thing I did was just force food down as the altitude caused me to lose my appetite.

    I didn’t try Diamox but my friend who went was taking it and he didn’t get sick so I bet that helped.

    Finally, when in Peru we definitely drank the coca leaf tea. At the minimum it tastes good, but also probably helps the altitude.

    Loved all the tips on the blog post!

  3. Johanna Read says:

    You missed a key piece of advice — there is no need to acclimate in Cusco if you’re just going to Machu Picchu, as the latter is below the altitude sickness zone. Just go straight to Ollaytaytambo or to Aguas Calientes.

    • Claire says:

      Hi Johanna thanks for your comment – I presumed most people would visit Cusco before going to Machu Picchu, but they could indeed go to Ollantaytambo first. Ollantaytambo is at a lower altitude than Cusco but at 2792m it’s still pretty high – and above the 2400m or so when altitude starts to have an effect, and for people trekking they definitely need to acclimatize, wherever they start from 🙂

  4. Hannah says:

    This is such a useful guide. I didn’t even think about how bad hangovers would be – but it totally makes sense that they’d be worse! Thanks for the tips about food too – slow release carbs and small meals make sense if your body is getting used to the altitude.

  5. Dorene Wharton says:

    I appreciate this post as my husband and I dealt with altitude sickness when we were there. So true that taking time and acclimatizing helps – flying into Cuzco and Puno then going on a trek or heavy activity definitely doesn’t help! I have taken Diamox and it works really well – as long as you take it before. Coca tea is amazing with helping with the symptoms I agree. Great post very thorough.

  6. Rosemary says:

    When we first to to Cusco, we waited for about 2 weeks to acclimatize to the altitude before heading to Machu Picchu. During that time, we stayed hydrated and had tea with coca leaves which helped. Good tips here and perfect for first time visitors to Peru.

  7. Linda says:

    We planned to visit Machu Picchu this year and had to cancel. So I was interested in reading this for when it gets back on the schedule. With several months at altitude, you are certainly qualified to offer some advice. Good point about making sure that travel insurance covers high altitude hiking. We are in less good shape so would definitely want to try to find a location to get a little practice at higher altitudes. And the plan was to stay at Cusco for a few days to acclimatize. Thanks for the great list of symptoms to look for. A good point about staying away from heavy foods! What a great comprehensive guide. I have pinned this for future use.

  8. Christina Pfeiffer says:

    Great tips and essential to consider for those who are prone to altitude sickness. I’ve experienced mild altitude sickness and it’s not comfortable. It’s a horrible feeling to wake up at 3am feeling dizzy and short of breath.

  9. Fiona Maclean says:

    Great tips. I have to confess I hadn’t even thought about altitude sickness, though I am a likely candidate as I get asthma. I will save the post as you have some excellent suggestions if I do try this kind of trip

  10. Jenn and Ed Coleman says:

    I definitely agree with you that acclimation and hydration are the first line of defense for altitude sickness. One thing a lot of people don’t realize is that the atmosphere gets exponentially thinner as you climb up in altitude. Thin air = less oxygen = altitude thickness. At 1300′ you will only have lost %4 oxygen. This is a very gradual training regiment to get you ready for having 20% less oxygen at Machu Pichu. Of course, just getting out and being active should help the cause at any altitude.

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