Cusco sits at 3,400 meters (11,152 feet) above sea level — and if you are flying in from Lima, your body goes from sea level to the high Andes in about one hour. That rapid change is exactly why so many travelers experience what locals call soroche: altitude sickness.

The good news? With a little preparation and the right approach, altitude sickness is entirely manageable. Most travelers feel perfectly fine after 24 to 48 hours. This guide covers everything you need to know — from recognizing symptoms and using local remedies to planning your itinerary so your body adjusts naturally.

Understanding Altitude Sickness in Cusco

Altitude sickness happens when your body does not get enough oxygen at higher elevations. At 3,400 meters, the air pressure in Cusco is roughly 30% lower than at sea level, which means each breath delivers less oxygen to your lungs.

Your body is remarkably good at adapting — it just needs time. The process is called acclimatization, and it involves your heart rate increasing, your breathing deepening, and your red blood cell production ramping up. The trouble starts when travelers try to do too much too soon, before their bodies have caught up.

Cusco is unique because most visitors arrive by plane from Lima (at sea level) or from other low-altitude cities. Unlike trekking destinations where you gain elevation gradually over days, in Cusco the altitude change is instant — and that is why preparation matters.

Elevation Comparison: Cusco and Nearby Destinations

Not all destinations in the Cusco region sit at the same altitude. Understanding the differences can help you plan a smarter itinerary:

A key insight from this table: the Sacred Valley is 600 meters lower than Cusco. Many experienced travelers and tour operators (ourselves included) recommend spending your first night in the Sacred Valley before heading up to Cusco. It gives your body a gentler introduction to the altitude.

Symptoms of Altitude Sickness — What to Watch For

Symptoms typically appear 6 to 12 hours after arriving at altitude, though some people notice them sooner. They range from mild discomfort to serious medical situations.

Mild symptoms (very common, usually resolve in 24–48 hours): headache, mild nausea, fatigue and drowsiness, slight dizziness, shortness of breath during light activity, and difficulty sleeping the first night.

Moderate symptoms (less common, may need attention): persistent or severe headache that does not respond to painkillers, repeated vomiting, noticeable loss of coordination, and feeling confused or unusually irritable.

Severe symptoms (rare but serious — seek medical help immediately): persistent coughing or difficulty breathing while resting, a bluish tint on lips or fingertips, inability to walk straight, and extreme confusion or disorientation. Severe cases may indicate High Altitude Cerebral Edema (HACE) or High Altitude Pulmonary Edema (HAPE), both of which require immediate descent and medical attention.

Most travelers only experience the mild symptoms, and they tend to fade on their own as your body acclimatizes.

How to Prevent Altitude Sickness Before Your Trip

Prevention starts before you board your flight. Here are the most effective steps:

Talk to your doctor about Acetazolamide (Diamox). This is the most well-studied medication for altitude sickness prevention. It works by helping your body acclimatize faster. Your doctor can advise on dosage (typically 125–250 mg twice daily, starting one day before arrival). Note: Diamox is a prescription medication in most countries — get it before you travel.

Stay well-hydrated in the days leading up to your trip. Dehydration worsens altitude symptoms. Start drinking extra water two to three days before you fly to Cusco.

Avoid alcohol and heavy meals the night before arrival. Alcohol dehydrates you and interferes with your body's ability to process oxygen efficiently. Save the pisco sour for day two or three.

Plan your itinerary with acclimatization in mind. If possible, arrange your first day or two in Cusco as rest days — or better yet, start your trip in the Sacred Valley at 2,800 meters before ascending to Cusco.

You do not need to be an athlete. Altitude sickness affects people regardless of fitness level. Marathon runners and casual walkers are equally susceptible. What matters is how quickly you ascend and how much time you give your body to adjust.

Your First 48 Hours in Cusco: A Day-by-Day Acclimatization Plan

This is the plan we recommend to every traveler we work with, and it makes a significant difference.

Day 1 — Arrive and rest. After landing in Cusco, head to your hotel and take it easy. Walk slowly, avoid stairs if possible, and resist the urge to explore the city right away. Drink coca tea (mate de coca), which will likely be waiting for you at the hotel reception. Eat light meals — soups and simple carbohydrates work well. Drink at least 3 liters of water throughout the day. Go to bed early. If you have a mild headache, that is normal.

Day 2 — Gentle exploration. If you feel better (and most people do), take a slow walk through the historic center. Visit the Plaza de Armas, San Pedro Market, and the surrounding streets. Keep your pace relaxed — there is no rush. Continue drinking water and coca tea. Pay attention to how you feel: if symptoms are improving, you are acclimatizing well. Avoid intense physical activity.

Day 3 — Ready for more. By day three, most travelers feel significantly better. You can comfortably take a day tour to the Sacred Valley, visit nearby ruins like Sacsayhuamán, or explore further from the city. This is also when your body is typically ready for moderate hikes.

Alternative approach — Sacred Valley first: If your schedule allows, fly into Cusco and transfer directly to the Sacred Valley (about 1.5 hours by road). Spend one or two nights at 2,800 meters, then move up to Cusco at 3,400 meters. This gradual ascent mimics how your body prefers to adjust and reduces the chance of altitude symptoms considerably.

Local Remedies That Actually Work

Cusco has been a high-altitude city for centuries, and its residents have developed effective ways to cope. These are the remedies we trust and recommend:

Coca tea (mate de coca). This is the most traditional remedy in the Andes. Made from dried coca leaves steeped in hot water, it has been used for centuries to ease altitude symptoms. Coca tea acts as a mild stimulant and helps relieve headaches, nausea, and fatigue. It is legal, widely available, and offered at virtually every hotel in Cusco.

Sorojchi Pills. These are an over-the-counter medication available at any pharmacy in Cusco without a prescription. They combine aspirin, caffeine, and salophene (a mild pain reliever). Many travelers find them effective for headaches and general altitude malaise. A box costs just a few soles. Ask for "Sorojchi Pills" at any farmacia — the pharmacists know exactly what you need.

Muña tea. Another Andean herb tea, muña (a local mint) helps with digestion and is traditionally used alongside coca tea. You will find it at restaurants and markets throughout Cusco.

Hydration above all. This cannot be overstated: drink 3 to 4 liters of water per day during your first days in Cusco. The dry mountain air and increased breathing rate dehydrate you faster than you realize. Carry a water bottle everywhere.

Eat light. Your digestive system works more slowly at altitude. Stick to soups, bread, rice, and easily digestible foods for the first day or two. Cusco has wonderful cuisine — you will have plenty of time to enjoy hearty meals once you have acclimatized.

Avoid alcohol for 48 hours. Alcohol intensifies the effects of altitude and dehydrates you. We know it is tempting to celebrate your arrival, but your body will thank you for waiting.

When to Seek Medical Help

Most altitude sickness cases resolve on their own, but it is important to know when to get help.

See a doctor if: your headache does not improve after 24 hours despite hydration and medication, you are vomiting repeatedly and cannot keep fluids down, you feel increasingly confused or disoriented, you have difficulty breathing while resting (not just during activity), or your symptoms are getting worse rather than better after 48 hours.

Where to find medical help in Cusco: Cusco has several clinics experienced with altitude-related cases. Clinica Pardo and Hospital Regional are both centrally located. Many hotels also have oxygen available for guests — do not hesitate to ask. Pharmacies (farmacias) are plentiful throughout the city center and can provide basic medications without a prescription.

Travel insurance is essential. We strongly recommend purchasing travel insurance that covers altitude-related illness and emergency evacuation before your trip. Medical care in Cusco is affordable, but evacuation to Lima or international repatriation can be extremely expensive without coverage.

Planning Your Cusco Itinerary Around Altitude

The smartest way to beat altitude sickness is to build acclimatization into your travel plan. Here is the approach we recommend:

Recommended itinerary flow: Lima → Sacred Valley (1–2 nights at 2,800m) → Cusco (2–3 nights at 3,400m) → Day tours and treks → Higher altitude excursions (Rainbow Mountain, Lake Titicaca) last.

What to avoid: Flying into Cusco and immediately departing for a high-altitude trek. Your body needs at least 48 hours above 3,000 meters before attempting anything above 4,000 meters. Rainbow Mountain at 5,036 meters should ideally be scheduled on day 4 or later.

Multi-day tours with built-in acclimatization: Our Cusco & Machu Picchu 4-Day Tour is specifically designed with altitude in mind — it starts in the Sacred Valley before ascending to Cusco and Machu Picchu. For travelers who prefer a more gradual pace, our 11-Day Peru Vacation Package includes ample time for acclimatization across different elevations.

Frequently Asked Questions

How long does altitude sickness last in Cusco?
For most travelers, mild symptoms appear within 6 to 12 hours of arrival and gradually improve over 24 to 48 hours. By day three, the majority of visitors feel well. If symptoms persist beyond 72 hours or worsen, consult a doctor.

Can I take Diamox without a prescription in Peru?
Acetazolamide (Diamox) is available at pharmacies in Peru, though availability can be inconsistent. We recommend getting a prescription from your doctor at home before traveling so you can start taking it one day before arrival, as recommended.

Is Machu Picchu higher than Cusco?
No — Machu Picchu sits at 2,430 meters (7,972 feet), which is nearly 1,000 meters lower than Cusco at 3,400 meters. Many travelers actually feel better at Machu Picchu than in Cusco because of the lower altitude.

Why does coca tea help with altitude sickness?
Coca leaves contain alkaloids that act as a mild stimulant and vasodilator, improving blood flow and oxygen delivery. The tea also provides gentle relief from headaches, nausea, and fatigue. It has been used in the Andes for thousands of years and is considered a standard welcome drink throughout the Cusco region.

Should I fly or take a bus from Lima to Cusco?
Flying takes about 1 hour, while the bus takes approximately 20 to 22 hours. The bus route passes through varying altitudes, which gives your body some time to start adjusting — but 20+ hours of travel is exhausting on its own. Most travelers prefer to fly and then dedicate their first day in Cusco to rest and acclimatization. A middle-ground option is flying to Cusco and immediately transferring to the Sacred Valley at 2,800 meters for your first night.

Can children get altitude sickness?
Yes, children are susceptible to altitude sickness just like adults. In fact, younger children may not be able to clearly describe their symptoms, so parents should watch for irritability, loss of appetite, unusual sleepiness, and vomiting. The same prevention strategies apply: hydration, gradual acclimatization, and avoiding overexertion. Consult your pediatrician before traveling to high altitude with young children.

Enjoy Cusco Without Worry

Altitude sickness should not scare you away from one of the most extraordinary places on Earth. Thousands of travelers visit Cusco every week and have an incredible time. The key is simple: give your body time, stay hydrated, drink coca tea, and plan your itinerary wisely.

At K Cusco Tours, we design every itinerary with acclimatization built in, because we know from experience that a well-rested traveler enjoys Cusco ten times more. If you want help planning a trip that takes altitude into account from day one, get in touch with us — we would love to help you experience the best of Cusco and Peru.

Related reading: Learn more about how weather conditions interact with altitude in our article on Soroche and Storms: Does Humidity Impact Your Oxygen Levels at High Altitude?