Travel guide
Altitude sickness in Cusco: how to prevent it
Cusco is at 3,400 m above sea level. Flying in from Lima, most travellers notice shortness of breath, a mild headache or poor sleep during the first 24 to 48 hours. It is normal and it passes; the way you plan the first two days makes almost all the difference.
Updated: 2026-09-16
What altitude sickness feels like
Mild symptoms: headache, tiredness, loss of appetite, light nausea, trouble sleeping and breathlessness when climbing stairs. They usually start a few hours after arrival and fade within two days.
Warning signs that need a doctor: confusion, severe headache that painkillers do not touch, vomiting, a wet cough or blue lips. These are rare in Cusco but serious; hotels and guides know the clinics, and oxygen is available in most hotels.
The first 48 hours: what works
Walk slowly and avoid stairs the first afternoon. Drink more water than usual and eat light meals; avoid alcohol and heavy dinners on day one. Coca tea and coca candies help many people with the headache. Sleep with the head slightly raised.
Acetazolamide (Diamox) taken from the day before arrival reduces symptoms for many travellers; ask your doctor before the trip. Ibuprofen or paracetamol treat the headache. Local pharmacies sell Sorojchi Pills, a caffeine-and-aspirin mix that some travellers like.
How to order your tours
Day 1: rest, then the city tour in the afternoon (short walks, vehicle between sites). Day 2: the Sacred Valley, which is lower than Cusco (Ollantaytambo 2,800 m) and helps. Day 3: Machu Picchu at 2,430 m, where most people feel fine. Rainbow Mountain (5,036 m) and Humantay Lake (4,200 m) belong on day 3 or later, never on day 1 or 2.
Who should be careful
People with heart or lung disease, anaemia or high blood pressure should talk to their doctor before the trip. Pregnant women can visit Cusco and Machu Picchu but should skip the high hikes. Children adapt well but tire faster; plan shorter days. Being fit does not protect you from altitude sickness: it is about ascent speed, not fitness.
If you are coming from Nazca
The night bus from Nazca to Cusco climbs from sea level to 4,100 m at the Abancay pass and arrives in Cusco in the morning. Take it easy that first day. Coming via Arequipa (2,300 m) for a day or two is the gentlest way up.
Frequently asked questions
How bad is altitude sickness in Cusco?
For most people mild: headache, tiredness and breathlessness for one or two days. Serious cases are rare and treatable; hotels have oxygen and guides know the clinics.
How long does it take to acclimatise to Cusco?
Two days for the common symptoms to fade. Full acclimatisation takes longer, which is why the high hikes should wait until day three or later.
Does coca tea help with altitude sickness?
It relieves the headache and nausea for many people and is safe in normal amounts. It is not a cure; water, rest and slow walking matter more.
Is Machu Picchu lower than Cusco?
Yes: 2,430 m against 3,400 m. Many travellers feel better at Machu Picchu than in Cusco.
