Altitude Sickness in Cusco (Soroche): How to Prevent It — a Medical Guide
Altitude Sickness in Cusco (Soroche): How to Prevent It — a Medical Guide
Soroche (Quechua for "altitude drunkenness") is the acute mountain sickness that hits 1 in 4 visitors arriving in Cusco (3,400 m / 11,150 ft) from sea level. In most cases it is mild and passes within 24–48 hours. But ignored or handled badly, it can escalate to pulmonary or cerebral edema — potentially fatal conditions. This guide tells you exactly what to do.
What is soroche and why does it hit you?
At 3,400 m there is ~65% of the oxygen you breathe at sea level. At 5,200 m (Rainbow Mountain), only ~50%. Your body responds by raising your breathing and heart rate and producing more red blood cells — but that process takes days. In the first 24–48 hours, the imbalance causes the symptoms.
Mild symptoms (90% of cases)
- Moderate headache (forehead or back of the neck)
- More fatigue than usual climbing stairs
- Loss of appetite
- Slight nausea
- Trouble sleeping deeply
- Dizziness when standing up fast
These are normal for the first 24–48 hours. Rest, hydrate, do not push, and they pass on their own.
Severe symptoms (seek medical help NOW)
- Intense headache that does not respond to painkillers
- Repeated vomiting
- Loss of coordination when walking (like being drunk)
- Mental confusion, extreme drowsiness
- A "bubbling" feeling in the chest when breathing
- Persistent dry cough with foam or pink sputum
- Bluish lips or nails
With any of these, descending is the only safe solution. Have your hotel take you to a clinic, or request oxygen immediately.
Prevention: the 10 rules that actually work
1. Arrive progressively
Coming from Lima (sea level) or an intercontinental flight, schedule nothing demanding on day one. Your body needs 24–48 hours of passive adaptation.
2. Hydrate like an athlete
3–4 liters of water a day from day one. Andean air is dry and dehydrates you faster than you feel. Skip sugary sodas (they dehydrate).
3. Zero alcohol for the first 48 hours
Alcohol doubles soroche symptoms. The Cusqueña beer will still be there on day 3.
4. Eat light, favor carbs
Soups, rice, potatoes, chicken, pasta. Avoid heavy red meat, fried food and rich desserts the first days. Digestion consumes oxygen your body needs to adapt.
5. Coca tea and coca leaves
This is traditional Andean medicine and it works. Coca contains alkaloids that mildly improve oxygenation and reduce fatigue. Chew a small wad (3–5 leaves) through the day or drink 3–4 coca teas daily. Free at virtually every Cusco hotel. Note: cocaine is synthesized from coca, but the leaf itself is not a drug and is not addictive. It is legal in Peru.
6. Coca candies for quick relief
Ideal for day trips — Rainbow Mountain, Humantay, the Inca Trail. Pack a box.
7. Diamox (acetazolamide), only if your doctor approves
Prescription only. It is the most-used drug for soroche prevention. Typical dose: 125–250 mg every 12 hours, starting 1 day before ascending. Side effects: tingling hands/feet, more frequent urination, odd taste in carbonated drinks. Do not take if: sulfa allergy, pregnancy, kidney failure.
8. Sleep lower if you can
If your itinerary allows it, sleeping in the Sacred Valley (2,800 m) the first 2 nights beats Cusco (3,400 m). Your body acclimatizes better sleeping lower.
9. Do not smoke
Tobacco reduces oxygenation further. If you smoke regularly, cut to a minimum in Cusco.
10. Sleep with your head raised
If you wake up short of breath at night, raise the head of the bed 20–30 cm with extra pillows.
What to pack
- Ibuprofen or paracetamol (not aspirin if you take Diamox)
- Diamox, if prescribed
- Coca leaves or coca candies (buy them on arrival at Cusco airport, US$2–5)
- Anti-nausea tablets (Dramamine)
- A small thermometer
- A fingertip pulse oximeter (US$20 online) — measures oxygen saturation. Normal in Cusco is 88–92%. Below 85% at rest, see a doctor.
Your exact "Day 1," hour by hour
8 am — Land in Cusco: breathe easy, walk slowly to the taxi. Do not haul heavy bags.
9 am — Hotel: order a coca tea, rest lying down for an hour. Do NOT nap — just rest.
11 am — Light breakfast: quinoa soup, whole bread, fruit. Skip strong coffee (it can worsen the headache).
12–3 pm: a VERY slow stroll around the Plaza de Armas. Do not climb to Sacsayhuamán yet. If you tire, go back to the hotel.
3 pm: hotel rest. Constant hydration. Read, watch TV, no exertion.
6 pm — Dinner: rice, grilled chicken, hot soup. Avoid heavy dairy.
8 pm — Bed: early. You will sleep badly the first night — that is normal. A chamomile tea with honey helps.
Next day: you are ready for the Sacred Valley or the Cusco city tour. Do NOT schedule Rainbow Mountain or the Inca Trail yet.
When you should NOT travel to altitude
See your doctor first if you have:
- Cardiovascular disease (prior heart attack, arrhythmia, uncontrolled severe hypertension)
- Severe anemia
- Chronic respiratory failure (COPD, fibrosis)
- High-risk pregnancy or third trimester
- Recent major surgery (< 6 months)
With stable asthma or controlled hypertension, travel is generally fine with maintenance medication plus preventive Diamox.
If soroche hits mid-trek (Inca Trail, Salkantay)
Mild symptoms: descend 200–500 m if possible. Hydrate, rest 2–4 hours. Portable oxygen if available.
Severe symptoms: immediate evacuation to lower altitude. Serious operators (Danfer Tours included) carry an oxygen tank, satellite radio, and an evacuation plan with horse + transfer to Aguas Calientes or Cusco.
Common myths
- "Drinking alcohol beforehand helps": FALSE. It makes everything worse.
- "Cold showers speed up acclimatization": FALSE. They just add stress.
- "Young, fit people don't get it": FALSE. Altitude does not care about age or fitness.
- "Eating lots of potatoes or quinoa helps": partly true — Andean carbs digest easily, but overeating backfires.
The golden rule
Listen to your body. Worse than yesterday? Go lower. Better? Continue with care. No Rainbow Mountain photo is worth a pulmonary edema.
Traveling to Cusco? Also read:
Or book your tour with Danfer Tours — we carry an oxygen tank on every high-altitude trip and our guides are trained in mountain first aid.
