Air sickness at Cusco and Machu Picchu?

Old May 16th, 2019, 01:50 PM
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Air sickness at Cusco and Machu Picchu?

We are considering a pre-cruise trip from Lima to Cusco and on to Machu Picchu. I have mild asthma that comes and goes. I have always wanted to see Machu Picchu. We would be flying from Lima into Cusco within one morning, so the change in altitude would not be gradual. Does anyone have advice for this dilemma? If we are, are there any precautions to take? We will be there in March of 2020. Any other concerns or issues we should be aware of traveling there?
Thank you.
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Old May 16th, 2019, 02:14 PM
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You need to discuss this with you doctor. The altitude affectes everyone differently. There are meds such as Acetazolamide that are often prescribed prior to high altitude trips.

It is generally advised to go down to the Sacred Valley immediately after flying in to Cusco since it is a much lower altitude, and acclimate there.
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Old May 16th, 2019, 06:27 PM
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By all means discuss with your heath care provider, as I did. This information from CDC is helpful.
i recently did this same trek (Lima to Cusco in one day, on to Sacred valley and Macu Picchu) and took acetazolamide (brand name Diamox) twice per day starting a day before and for three days at elevation, then one dose at night the rest of the time at altitude. I also consumed plenty of the coca tea that is ubiquitous in hotel lobbies. Did not experience the headaches and insomnia, did have to pace myself especially walking uphill (and there is lots of that!) I also purchased at a local pharmacy pills for <<soroche>> as it is called in Peru. They contain aspirin, caffeine and something metabolized to acetaminophen, and did seem to offer additional help.

Absolutely plan to ascend MP gradually. Walking sticks also offer some assistance, just a point of support as you climb. I picked up a pair for less than $10 at a market in Cusco and am glad I did.

Keep in mind that admission is by timed ticket. You take a 25 minute bus ride from Agua Calientes up to the entrance and climb from there.

I had a great trip with every detail handled through Tour Guide Peru in Lima and throughout my stops in Peru. Aaron and his team (Luis, Pilar, and Ana Maria) were first rate, knowledgeable and kind, and I didn't have to worry about any of the details. If you tell him what you want to do he can put together an itinerary for you, and I found his rates a lot lower than other such services. It really is a bucket list experience, and you have plenty of time to make your plans - enjoy!
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Old May 16th, 2019, 10:51 PM
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Lots of info on altitude and how to deal with it here @ . Asthma is an added complication, so as suggested by Janisj above, best to consult your GP. A prescription for Acetazolamide may help but needs to be taken strictly according instructions. If expensive in your home country, you can buy it easily at reputable pharmacies in Lima like MiPharma, very cheaply.

I would avoid the soroche pills marketed as a remedy all over Peru. Basically they are just aspirin and caffeine( and who knows what else.) . A cup of coffee and an aspirin will have the same effect and is more enjoyable!

It is the altitude at which you SLEEP which is the key factor. If you do want to go, primarily to see Machu Picchu then on arrival at Cusco airport, I would head straight to Ollantaytambo which is at a lower altitude than Cusco and consequently allows for a Moreno gradual acclimatisation. Spend a night or two there and then get the train to MP. It is perfectly possible to see MP in a day trip from Ollantaytambo but many prefer to stay a night in Aguas Calientes from where the buses depart for MP. AC is and uninspiring place that I feel is easily missable.

After Machu Picchu you will get the train back to Ollantaytambo. From there it is very easy to arrange transport to do a taxi tour of the key Sacred Valley sights like Moray , Maras and Chinchero on the way back to Cusco - takes 4-6 hours compared with the straight trip of two hours. Well worth the time.

If you can spare a couple of days, do spend some time in Cusco. By the time you get there, you should be well acclimatised to the altitude.

Some detail and photos of our time in the Sacred Valley/Ollantaytambo/ Cusco can be found on our blog @ . Unfortunately, I never got around two writing about our time at Machu Picchu!

Ideally you should allow a week for Cusco, the Sacred Valley and Ollantaytambo. It is possible to take less time but, bearing in mind the altitude issues, I wouldn’t consider it with less than 4 days.

Do bear in mind that you need to book, trains and MP tickets in advance but March is the low season so you probably won’t need to book too far ahead.
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Old May 17th, 2019, 08:59 AM
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I've been to MP/Cusco twice. Machu Picchu is not especially high but Cusco in particular is on the edge of where many people start to have more dramatic effects other than always feeling out of shape walking up hill. Here are some tips and my recommended itinerary.

Since your excursion would be pre-cruise, I'd recommend allowing at least 5 days as follows. But if you had a week or 8 days you'd be able to fill the time easily.

Day0 Fly into Lima. If your arrival is early enough, and you aren't too jetlagged or dehydrated, fly onward to Cusco. Most tickets from the US can be bought with Cusco included (within 24 hours) at minimal extra cost. If you miss your flight, there are many daily flights, so you should get on within the next day, but allow for a day's worth of travel delays.

Day 1 Fly to Cusco, then a transfer to the Sacred Valley (Ollantaytambo is most convenient) and no scheduled activities other than possibly some walking in the afternoon if you are feeling fine. Otherwise just rest. Remind yourselves to walk slowly (always a struggle for me getting off the plane), let someone else lift your luggage and have a prearranged ride waiting. Pick a hotel that has vehicle access (not all of them do). Have an Advil and some water handy for the drive in case you start to get a headache. It can take a few hours to creep up on you. Drink about 2L of water per person per day. I like hotels near the train station if you are leaving early to MP, especially the one on the platform (El Albergue). I prefer a hotel actually IN Ollantaytambo..many are on the outskirts. is a recommended transfer service, and many hotels in Ollantaytambo can also work out your transfers.

Day2 Local sightseeing in the Sacred Valley, and then another night at Hotel#1. Personally I have only done MP as a day trip but some people would go to Aguas Calientes for one or more overnights. It doesn't really matter. Although if you want to do a morning trip to the citadel on Day 3, take an afternoon train from Ollantayambo to Aguas Calientes and spend the night there for an early start. In March, still rainy season it's probably best to go in the morning.

Day3 If you haven't already arrived in Aguas Calientes the night before, take the train from Ollantaytambo to Aguas Calientes, bus up to the citadel and Half Day at Machu Picchu. There are no longer full day tickets, but you could also have an option to to buy another half day ticket either that day or the next. There isn't a whole lot to do in Aguas Calientes. When I went once in January, I was able to shift my entry and train times with enough notice based on weather forecasts (24hr notice was needed but check the fine print).

Day4 Train back to Ollantaytambo, taxi back to Cusco with some sightseeing such as Moray and the Salineras. Afternoon sightseeing in Cusco. Night in Cusco. Try to get a hotel on the flats near the Plaza de Armas to reduce uphill walking. Or again, one with vehicle access (again, not all hotels have that).

Day5 Morning sightseeing in Cusco and fly back to Lima the Day before your cruise. Even better, fly back TWO Days before the cruise and do a day's worth of Lima sightseeing.

Day6 Departure day for cruise. Morning in Lima (lots to see there). My favorite neighborhood is Barranco. For first-time visitors you can't beat the helpful desk staff at

I have never needed Diamox since I've always gone straight to Ollantaytambo and saved Cusco for the end. But if you have asthma, do talk to your doctor about what else you might need. I like the coca tea and eschew soroche pills. I take Pepto Bismol tabs as a tummy problem preventative, so Diamox and aspirin are out.

Many problems with altitude happen at night, and another tip is to avoid a big evening meal and alcohol. For dinner I'd have something like a cheese sandwich or quinoa soup. Big meal in the middle of the day. Bring some refillable water bottles since plastic trash is a huge problem and you'll be needing to drink bottled water. Some hotels have the big carboys for you to refill. (I even brush my teeth with bottled water other than in Lima).

One misconception that many visitors have is that they think they should stay in Cusco first, to acclimatize..that isn't the best approach for those not doing the Inca Trail. And many travel agencies are based in Cusco so by default if you go with a local agent, they often base you there. You can stay at lower elevations such as Ollantaytambo and Agua Calientes (they are still high, but not as high as Cusco). The Machu PIcchu archaeological site is about 1000 feet lower in elevation than Ollantayatambo, so staying at "Olly" does help you acclimate gradually with less stress than Cusco.
If you want, this is an easy enough trip to book yourselves. Especially in low season, there isn't any reason to send off money to a third party. All of the hotels are on etc, if they don't have their own websites.Peru Rail has outlets at both airports and at the Larcomar Plaza in LIma if you can't get their website to work from overseas. People do often have trouble with Peruvian websites when using US Visa credit cards, I've had better luck with Mastercard.

As you get closer to booking your trip..sure to browse Fodor's Trip Reports (kja's is quite detailed) as well as Tripadvisor (now that Fodors is so dead). You probably are too early to book anything now other than your cruise and airfare.

Last edited by mlgb; May 17th, 2019 at 09:34 AM.
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Old May 18th, 2019, 01:24 PM
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Thank you for your suggestions. I notice that people on this forum quote you many times!
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Old May 18th, 2019, 01:24 PM
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Thank you. All of your advice is very helpful
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Old May 18th, 2019, 01:25 PM
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Thank you. The suggestion to look at the CDC was very helpful
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