Machu Picchu sits at 2,430 meters (7,970 feet). High, but not extreme. The city that actually causes altitude trouble is Cusco at 3,400m (11,200 feet), where almost every Machu Picchu trip starts. Here are the practical levers.

1. Gradual acclimatisation


Two to three nights above 2,500m before the citadel. Cusco at 3,400m works; the Sacred Valley at 2,800m works better because the lower sleeping altitude helps overnight recovery. Peruways routes most first-timers through the valley for exactly this reason.

2. Hydration


3 to 4 litres a day. Avoid alcohol in the first 48 hours. Caffeine is fine — it’s not actually a meaningful dehydrator at normal doses.

3. Light meals


Small and frequent beats large and heavy. Carbs are easier to process than fat at altitude. The traditional Andean diet — potato, quinoa, light soups — is actually well-matched to the altitude for exactly this reason.

4. Pace day 1


Slow walks, no stairs taken at speed, early night. Save the walking tours and the heavy sightseeing for day 2 and 3.

5. Acetazolamide (Diamox)


The pharmaceutical option. Prescription in most countries. 250mg twice daily starting 24 hours before ascent is the standard protocol. Talk to a doctor; don’t self-medicate.

6. Supplemental oxygen


Several Cusco and Sacred Valley hotels now stock bedside oxygen cylinders for guests. If symptoms escalate (severe headache, nausea, confusion), use the oxygen and descend to a lower altitude.

7. Coca tea


Mate de coca is a traditional Andean remedy — mild vasodilator, mild stimulant. It genuinely helps with light symptoms. Legal and widely available in Peru. Don’t try to take any home — it’s illegal to export.

8. Monitor symptoms


Headache, nausea, dizziness, fatigue, shortness of breath. If symptoms get worse rather than better after 48 hours, descend. Severe AMS can progress to HAPE (fluid in the lungs) or HACE (brain swelling), both of which are medical emergencies.

Handle the altitude up front and the Machu Picchu day runs cleanly. Ignore it and you’ll spend day 2 in a hotel room.

Book your Machu Picchu day with the altitude pacing built in here.