Altitude sickness, or “soroche”, is a common concern for those visiting Peru, but there is one fact that surprises many travelers: Machu Picchu is located at 2,430 meters above sea level, significantly lower than Cusco (3,399 m) or the Sacred Valley (average 2,800 m). This means that the risk of altitude sickness in the citadel is lower than in other parts of your trip.
Where should you really worry about altitude sickness?
The main challenge is not Machu Picchu, but rather Cusco and the higher areas:
- Cusco city: 3,399 m
- Rainbow Mountain viewpoint: 5,200 m
- Lake Titicaca (Puno): 3,812 m
- Sacsayhuamán and other archaeological sites: 3,700 m
Symptoms of altitude sickness
Symptoms usually appear between 6 and 12 hours after arriving at altitude:
- Persistent headache
- Nausea or dizziness
- Extreme fatigue without exertion
- Loss of appetite
- Difficulty sleeping
Effective prevention strategies
Before you arrive:
- If your flight arrives directly in Cusco, consider spending the first nights in the Sacred Valley (Urubamba, Ollantaytambo), which is at a lower altitude.
- Avoid red-eye flights that arrive very early; exhaustion makes symptoms worse.
First 24–48 hours at altitude:
- Stay hydrated at all times (3–4 liters of water per day).
- Eat light; avoid heavy meals and alcohol.
- Rest on the first day, without intense physical activities.
- Coca tea helps with mild discomfort (it is legal and traditional in Peru).
Medication:
- Acetazolamide (Diamox) is effective if you take it 24 hours before arriving at altitude. Consult your doctor before traveling.
- Bring common painkillers for headaches.
The ideal itinerary to minimize altitude sickness
The best strategy is gradual acclimatization:
Day 1–2: Arrival in Cusco → immediate transfer to the Sacred Valley (sleep lower).
Day 3: Tour of the Sacred Valley (you go up and down during the day).
Day 4: Visit Machu Picchu (you are already partially acclimatized).
Day 5 onwards: Return to Cusco with better adaptation.
This order allows you to enjoy Machu Picchu when your body is already adapting and then face Cusco city with better preparation.
When should you be concerned?
Mild altitude sickness is normal and manageable. Seek medical attention if you experience:
- Severe difficulty breathing at rest
- Cough with froth or blood
- Confusion or disorientation
- Symptoms that worsen after 24 hours
