Forget what you read on generic travel blogs. Here is how locals in Cusco actually handle altitude — what works, what doesn't, what's a tourist myth, and exactly how to prepare for the Choquequirao trek.
The reality check
Cusco sits at 3,400 m (11,150 ft). Choquequirao at 3,106 m. The Apurímac canyon descends to 1,500 m at the river. The Choquequirao trek is actually a lower-altitude trek than most Cusco itineraries — much of it is below Cusco's altitude.
That said, altitude affects almost every traveler arriving from sea level. Headaches, fatigue, poor sleep, and shortness of breath are normal in the first 48 – 72 hours. Knowing what to do (and what not to do) helps a lot.
Day 1 in Cusco — the most important day
What experienced trekkers and locals actually do on the day they arrive in Cusco:
- Move slowly. Treat the airport-to-hotel transfer like a recovery from surgery. No rushing, no stairs, no heavy bags.
- Hydrate aggressively. 3 – 4 liters of water on day 1. Altitude is dehydrating because you breathe faster and the air is dry.
- Eat light. Heavy meals make altitude symptoms worse. Soups, fruit, light carbs, small portions.
- Sleep early. Your body needs rest to start producing more red blood cells.
- Skip alcohol entirely for the first 48 hours. This is the rule that travelers most often break and most often regret.
What locals actually do (and what they don't)
Coca tea — actually works
Mate de coca is offered at every Cusco hotel. It genuinely helps mild altitude symptoms — increases alertness, slightly opens airways, and traditional use in the Andes goes back thousands of years. Drink it. It is not a drug, it will not show up on drug tests (it's the same plant but processed entirely differently from cocaine), and locals drink it daily.
Chewing coca leaves — also fine
Mostly used by porters and people doing physical work at altitude. You can buy a bag at the San Pedro market. Stuff a small wad between your cheek and gum. It tastes like grass and won't get you high — it will give you a mild boost of energy.
Sorojchi Pills — yes, but understand what they are
Sold over the counter in any Cusco pharmacy. The active ingredients are acetylsalicylic acid (aspirin), caffeine, and salophen. It's basically a headache pill marketed for altitude. Works for headaches, but it's not a magic acclimatization drug.
Diamox (acetazolamide) — useful for some, not everyone
Prescription medication that speeds up acclimatization. Often recommended by Western travel clinics. Locals generally don't use it. If you have a history of struggling with altitude or you only have 1 – 2 days before a trek, ask your doctor about it before traveling. Common side effect: tingling fingers and increased urination.
What doesn't work (despite the marketing)
- "Altitude bracelets" and oxygen-infused water — no evidence.
- Heavy garlic supplements — folk remedy with no real effect.
- Pre-trip "altitude training" at low elevation — won't acclimatize you. Cardio fitness helps in general but doesn't substitute for time at altitude.
How many days in Cusco before the trek?
Our honest recommendation: at least 2 full days in Cusco before starting any trek. Three is better.
Travelers who fly in from sea level and start the trek the next morning frequently struggle on day 1. Travelers who give themselves 2 – 3 days to acclimatize in Cusco — light sightseeing, hydration, sleep — almost always feel fine on the trail.
A sensible 3-day pre-trek schedule
- Day 1 (arrival): rest. Walk around the Plaza de Armas slowly. Eat light. Hydrate. Coca tea. Sleep early.
- Day 2: a half-day city tour or visit to Qoricancha and the cathedral. Light walking. Big lunch optional. Continue hydration.
- Day 3: a half-day visit to the Sacred Valley (Pisac, Ollantaytambo — both at lower altitude than Cusco). This is excellent acclimatization.
- Day 4: start the Choquequirao trek.
Warning signs to take seriously
Mild altitude symptoms are normal. These ones are not, and require descent:
- Confusion, slurred speech, or difficulty walking straight (suspected HACE — high altitude cerebral edema)
- Persistent dry cough with shortness of breath at rest, gurgling in the chest (suspected HAPE — high altitude pulmonary edema)
- Severe headache that doesn't respond to ibuprofen + rest + hydration
- Vomiting that prevents fluid intake
If any of these happen, descend immediately. Both HACE and HAPE are medical emergencies. Our guides carry oxygen and are trained to identify these symptoms early.
The good news about Choquequirao
Compared to the Inca Trail (max 4,215 m), Salkantay (4,650 m) or Ausangate (5,000+ m), Choquequirao is gentle on altitude. The hardest part of this trek is your legs, not your lungs.
If you've handled Cusco's 3,400 m comfortably for 2 days, you'll handle Choquequirao.
Questions about your specific situation? Pre-existing condition? Already in Cusco and feeling rough? Send us a message — our team has handled almost every scenario.