How to Prevent Altitude Sickness in Cusco and Machu Picchu? The Ultimate Guide Against Soroche

Prepare yourself for the altitude of the Andes. Discover the best tips, natural remedies, and medical treatments to enjoy your trip without dizziness or headaches.

What is Altitude Sickness or Soroche?

Altitude sickness, known locally in Peru as "soroche," is the body's physical reaction to the lack of oxygen at high altitudes. As you ascend, atmospheric pressure decreases, meaning that with every breath, you inhale less oxygen than your body is used to at sea level.

This condition does not discriminate: it can affect people of any age, gender, or physical condition. Being a high-performance athlete does not make you immune to soroche. Your body simply needs time to produce more red blood cells and adapt to this new environment.

Altitude Difference: Cusco vs. Machu Picchu

One of the biggest myths among travelers is thinking that Machu Picchu is the highest point of the trip. It is exactly the opposite!

• Cusco City: Located at 3,400 meters (11,152 feet) above sea level. This is where most tourists feel the impact of the altitude right after stepping off the plane.
• The Sacred Valley (Urubamba, Ollantaytambo): Sits at around 2,800 meters (9,186 feet).
• Machu Picchu: Located in the high jungle at just 2,430 meters (7,972 feet).

For this reason, if you feel unwell in Cusco, the best prescription is usually to descend to the Sacred Valley or Machu Picchu, where the oxygen is denser and symptoms disappear almost like magic.

The Most Common Symptoms of Soroche

Symptoms usually appear between 6 and 12 hours after arriving in the city of Cusco. It is essential to learn to listen to them and not ignore them, thinking it is just travel fatigue. The most frequent symptoms include:

• Throbbing headache or pressure in the temples.
• Shortness of breath during minimal exertion (like climbing stairs).
• Dizziness, nausea, and in severe cases, vomiting.
• Loss of appetite and extremely slow digestion.
• Insomnia or waking up abruptly at night feeling a lack of air.
• Generalized fatigue and an accelerated heart rate.

The Golden Rule: Progressive Acclimatization

The worst mistake you can make in Cusco is to arrive, drop off your luggage, and rush out to do a demanding City Tour or a hike.

Your first day should be for absolute rest. Walk slowly, as if you were strolling in slow motion. Avoid unnecessary physical exertion and take short naps. Many expert travelers plan their itinerary smartly: instead of sleeping their first night in Cusco, they transfer directly from the airport to a hotel in the Sacred Valley to acclimate their body gradually.

The Coca Leaf: The Sacred Remedy of the Incas

The Incas perfectly knew the secrets to mastering the altitude of the Andes. The coca leaf is not a tourist myth; it is a proven, ancient remedy that acts as a mild stimulant and an excellent vasodilator. You can consume it in two main ways:

1. Mate de Coca (Coca Tea): A hot infusion made with dry leaves. It is ideal to drink one or two cups upon arriving at your hotel and after meals.
2. Chacchar (Chewing): This is the traditional way. It consists of taking a handful of leaves, removing the stems, and chewing them to form a small ball on one side of your cheek, allowing your saliva to extract the alkaloids. You do not swallow the leaves.

Note: Avoid drinking coca tea after 5:00 p.m. Since it is a stimulant similar to caffeine, it could cause insomnia.

Agua de Florida and Other Traditional Remedies

In addition to coca, you will find other natural remedies in Cusco's pharmacies and markets. Coca or lemon candies are excellent to carry in your backpack to soothe nausea during bus rides.

Another local secret is the use of Agua de Florida (a herbal and citrus cologne) or medical alcohol. In the event of sudden dizziness, local guides often pour a few drops into the palms of your hands, ask you to rub them together vigorously, and inhale the vapor deeply. This opens the airways and provides instant relief.

Food and Hydration at High Altitudes

As mentioned in the gastronomic guide, human digestion slows down dramatically at 3,400 meters of altitude. Blood flow concentrates on keeping the brain and lungs oxygenated, leaving the stomach in the background.

• The First-Day Diet: Eat small portions rich in carbohydrates (light soups, rice, bread, quinoa). Completely avoid red meat, fried foods, and heavy dairy products.
• Hydration: Drink between 2 and 3 liters of bottled water per day. Mountain air is very dry, and dehydration worsens headaches.
• Zero Alcohol and Tobacco: Toasting with a Pisco Sour on your first night in Cusco is almost a guarantee that you will wake up with the worst possible soroche. Save the celebrations for your final day.

Pills and Medications: What to Buy at the Pharmacy?

If natural remedies are not enough, modern medicine offers quick solutions that you can buy over-the-counter at any drugstore (botica) in the city.

• Sorojchi Pills: This is the most famous commercial medication in Peru. It is basically a combination of acetylsalicylic acid (aspirin), salophen, and caffeine that relieves headaches and stimulates the circulatory system.
• Acetazolamide (Edemox / Diamox): A stronger preventive medication. It works by forcing the kidneys to excrete bicarbonate, which acidifies the blood and stimulates deeper breathing. Many doctors recommend taking half a pill 24 hours before flying to Cusco. Always consult your doctor before self-medicating, especially if you are allergic to sulfa drugs.

Supplementary Oxygen in Hotels and Trains

Cusco's tourism industry is perfectly prepared for these situations. The vast majority of 3, 4, and 5-star hotels have medical oxygen tanks at the front desk, available for free or for a minimal fee for their guests.

If you feel very breathless, asking for 10 to 15 minutes of pure oxygen through a mask can bring you back to normal almost immediately. Likewise, all PeruRail and IncaRail trains heading to Machu Picchu are required to carry oxygen equipment on board in case of emergencies.

When is it Necessary to See a Doctor?

Although 95% of soroche cases are mild and disappear by the second day, it is vital to know when to seek professional assistance. You should call a doctor (clinics in Cusco handle tourist emergencies 24/7) if you or your companion present:

• A headache that does not subside with pain relievers.
• Uncontrollable vomiting that prevents keeping liquids down.
• Mental confusion, extreme lethargy, or loss of balance when walking.
• Bluish or grayish lips or nail beds (under the fingernails).
• Bubbling or rattling sounds in the chest when breathing.