This guide is continuously maintained and verified by our resident Andean mountain leaders, ensuring accurate permit guidance, altitude protocols, and route recommendations for travelers in Peru.
Table of Contents (14 Sections)
- 1 Altitude Sickness in Cusco: Everything You Need to Know Before Your Trip
- 2 How we handle altitude on our tours
- 3 Why Does Altitude Sickness Occur in Cusco?
- 4 What Is the Altitude of Cusco?
- 5 Common Symptoms of Altitude Sickness
- 6 How Long Does Altitude Sickness Last in Cusco?
- 7 Who Is Most Likely to Experience Altitude Sickness?
- 8 How to Prevent Altitude Sickness in Cusco
- 9 Coca Tea and Traditional Remedies
- 10 Medication for Altitude Sickness
- 11 When Should You Seek Medical Attention?
- 12 Visiting Machu Picchu and the Sacred Valley
- 13 Frequently Asked Questions About Altitude Sickness in Cusco
- 14 Final Thoughts
Altitude Sickness in Cusco: Everything You Need to Know Before Your Trip#
Cusco sits at about 3,400 meters (11,155 feet) above sea level, almost 1,000 m higher than Machu Picchu. Most visitors fly in from Lima, near sea level, and gain more than 3,000 m in a single short flight, so it is normal to feel the altitude on your first day.
Known locally in Peru as soroche, altitude sickness is a temporary condition that occurs when the body has not yet adapted to reduced oxygen levels at higher elevations. While most cases are mild and manageable, understanding the symptoms, prevention strategies, and treatment options can help ensure a safer and more enjoyable visit.
This guide covers everything you need to know about altitude sickness in Cusco, from recognizing the symptoms to learning how to acclimatize properly before visiting Machu Picchu and other high-altitude destinations.
How we handle altitude on our tours#
We recommend two days in Cusco before any trek: one to rest and one for a light visit of the city. Our guides carry portable oxygen and a first-aid kit.
If a traveler feels unwell on a trek, we stop to rest and give coca tea and oxygen; if there is no improvement, we descend or arrange an evacuation. Our advice: eat light, drink plenty of water and coca tea, and avoid alcohol in your first days.
Why Does Altitude Sickness Occur in Cusco?#
Many travelers are surprised to learn that the issue is not a lack of oxygen in the air itself, but rather a decrease in air pressure at higher elevations.
As altitude increases, the atmosphere becomes thinner, meaning each breath contains fewer oxygen molecules than at sea level. Because the body receives less oxygen, it must work harder to perform normal activities such as walking, climbing stairs, or carrying luggage.
When visitors arrive directly in Cusco by plane, they experience a rapid ascent from near sea level to more than 3,400 meters in a matter of hours. This sudden elevation change gives the body little time to adapt, increasing the likelihood of altitude-related symptoms.
What Is the Altitude of Cusco?#
The city of Cusco is about 3,400 m (11,155 ft) above sea level; Wikipedia gives 3,399 m. Some parts of the city are higher: Sacsayhuamán, the Inca fortress above the historic center, is at 3,701 m (12,142 ft).
Cusco altitude compared with nearby places
| Place | Altitude | Compared with Cusco |
|---|---|---|
| Lima, where most flights arrive | near sea level | about 3,400 m lower |
| Aguas Calientes (Machu Picchu town) | 2,040 m / 6,693 ft | 1,360 m lower |
| Machu Picchu | 2,430 m / 7,972 ft | 970 m lower |
| Ollantaytambo, Sacred Valley | 2,792 m / 9,160 ft | about 600 m lower |
| Pisac town, Sacred Valley | 2,972 m / 9,751 ft | about 430 m lower |
| Cusco, city center | 3,400 m / 11,155 ft | – |
| Sacsayhuamán | 3,701 m / 12,142 ft | 300 m higher |
| Lake Titicaca (Puno) | 3,812 m / 12,507 ft | about 410 m higher |
| Humantay Lake | 4,200 m / 13,780 ft | 800 m higher |
| Dead Woman’s Pass, Inca Trail | 4,215 m / 13,829 ft | 815 m higher |
| Abra Málaga, Inca Jungle | 4,300 m / 14,108 ft | 900 m higher |
| Salkantay Pass | 4,630 m / 15,190 ft | 1,230 m higher |
| Rainbow Mountain (Vinicunca) | 5,036 m / 16,522 ft | about 1,640 m higher |
The Sacred Valley towns are 400 to 600 m lower than Cusco, which is why many travelers spend their first nights there and acclimatize more gently. The passes and viewpoints on the treks around Cusco are 800 to 1,600 m higher than the city, so we recommend two days in Cusco before any trek. See the altitude of each day on our Inca Trail map, Salkantay Trek map and Inca Jungle map.
Common Symptoms of Altitude Sickness#
Symptoms can vary from person to person and may develop within a few hours of arrival or during the first day at altitude.
Common symptoms include:
- Headache
- Dizziness
- Fatigue
- Shortness of breath
- Nausea
- Loss of appetite
- Difficulty sleeping
- Increased heart rate
- General weakness
For most travelers, symptoms remain mild and gradually improve within 24 to 48 hours as the body begins to adapt.
How Long Does Altitude Sickness Last in Cusco?#
The duration of altitude sickness depends on several factors, including age, physical condition, hydration levels, and individual response to altitude.
Most visitors begin feeling better within one or two days after arriving in Cusco.
A typical acclimatization timeline looks like this:
| Time After Arrival | What to Expect |
|---|---|
| First 12 Hours | Mild symptoms may appear |
| 24 Hours | Body begins adapting |
| 48 Hours | Most symptoms improve |
| 72 Hours | Many travelers feel fully acclimatized |
Some individuals may experience no symptoms at all, while others require several days to adjust.
Who Is Most Likely to Experience Altitude Sickness?#
Altitude sickness can affect anyone.
Contrary to popular belief, being physically fit does not prevent altitude sickness. Elite athletes and experienced hikers can develop symptoms just as easily as less active travelers.
Factors that may increase risk include:
- Rapid ascent to high altitude
- Dehydration
- Alcohol consumption
- Lack of sleep
- Previous history of altitude sickness
- Strenuous activity immediately after arrival
Because every person reacts differently, it is impossible to predict exactly who will experience symptoms.
How to Prevent Altitude Sickness in Cusco#
The good news is that there are several effective ways to reduce the likelihood of developing altitude sickness.
Allow Time to Acclimatize
The most important recommendation is to spend at least one or two days adjusting to the altitude before participating in strenuous activities.
Many travelers choose to stay in the Sacred Valley before moving to Cusco, allowing for a more gradual adaptation.
Stay Hydrated
Drinking plenty of water helps the body function more efficiently at altitude.
Avoid becoming dehydrated during flights and throughout your first days in Cusco.
Avoid Heavy Meals
Large meals can sometimes worsen symptoms. Light, balanced meals are often easier to digest during the acclimatization period.
Limit Alcohol Consumption
Alcohol may intensify symptoms and interfere with the body’s ability to adapt.
Many travelers avoid alcohol during their first 24 to 48 hours at altitude.
Take It Easy
Allow yourself time to rest after arriving. Walking slowly and avoiding intense physical activity can make a significant difference.
Coca Tea and Traditional Remedies#
One of the most famous traditional remedies in Peru is coca tea.
For centuries, Andean communities have used coca leaves to help combat the effects of altitude. Today, many hotels in Cusco offer complimentary coca tea to arriving guests.
Other traditional remedies include:
- Coca candies
- Coca leaves
- Muña tea (Andean mint)
- Rest and hydration
While these remedies may help alleviate symptoms for some travelers, they should not be considered substitutes for proper acclimatization.
Medication for Altitude Sickness#
Some travelers consult their doctor before traveling and obtain medications such as acetazolamide (Diamox), which can assist with acclimatization.
Medication should only be taken under medical guidance and is generally recommended for travelers who have previously experienced altitude sickness or who plan to visit very high-altitude destinations.
When Should You Seek Medical Attention?#
Although serious altitude-related illnesses are uncommon in Cusco, travelers should be aware of warning signs.
Seek medical attention if symptoms become severe or include:
- Persistent vomiting
- Severe shortness of breath
- Chest pain
- Difficulty walking
- Confusion
- Loss of coordination
These symptoms may indicate a more serious altitude-related condition that requires immediate evaluation.
Visiting Machu Picchu and the Sacred Valley#
Many visitors are surprised to discover that Machu Picchu sits at a lower elevation than Cusco.
Because the Sacred Valley and Machu Picchu are located at lower altitudes, many travelers actually feel better when visiting these destinations after spending time in Cusco.
This is one reason why some itineraries begin in the Sacred Valley before continuing to Cusco and higher-altitude excursions.
Frequently Asked Questions About Altitude Sickness in Cusco#
Is altitude sickness guaranteed in Cusco?
No. Some visitors experience symptoms while others notice little or no effect.
How high is Cusco above sea level?
Approximately 3,400 meters (11,155 feet), almost 1,000 m higher than Machu Picchu. Most travelers feel the altitude on the first day, so take it easy when you arrive.
Is Machu Picchu higher than Cusco?
No. Machu Picchu is significantly lower at approximately 2,430 meters (7,972 feet).
Is the Sacred Valley lower than Cusco?
Yes. Ollantaytambo is at 2,792 m (9,160 ft) and Pisac at 2,972 m (9,751 ft), 400 to 600 m lower than Cusco, so most people feel the altitude less there.
Is Cusco higher than Lake Titicaca?
No. Lake Titicaca is at 3,812 m (12,507 ft), about 400 m higher than Cusco, and Puno, on its shore, is a little higher still. If your trip includes Puno, it is easier to go there after a few days in Cusco.
Should I take medication before arriving?
Consult your doctor before traveling if you have concerns about altitude sickness or previous experience with high-altitude travel.
How many days should I acclimatize before hiking?
Most trekking operators recommend at least two days in Cusco or the Sacred Valley before beginning a trek.
Final Thoughts#
Altitude sickness in Cusco is one of the most common concerns among first-time visitors to Peru, but it should not discourage anyone from experiencing this remarkable destination. With proper preparation, adequate hydration, and a sensible acclimatization period, most travelers adjust successfully and enjoy their time in the Andes without significant problems.
Knowing what to expect before you arrive lets you enjoy Cusco and its surroundings while reducing the effects of the altitude.
Written by Joel Cárdenas Gonzales
Founder & CEOFounder and CEO of Southern Peru Explorers since 2009. Born in Cusco and trained as an official tour guide at Instituto Khipu. About the author
