Quick answer: Quito sits at 2,850 m (9,350 ft), high enough that many visitors feel mild soroche in the first 24 to 48 hours: headache, breathlessness on stairs, poor sleep. Prevent it by taking day one easy, skipping alcohol for 48 hours and waiting two or three days in Quito before hiking above 4,000 m.
Updated September 2026 by our local guides in Quito.
| Altitude sickness in Quito: key facts | As of 2026 |
|---|---|
| Quito’s elevation | 2,850 m (9,350 ft), Old Town |
| When symptoms usually start | 2 to 12 hours after arrival, often during the first night (CDC) |
| How long mild symptoms last | Usually 24 to 48 hours with rest |
| Safe ascent above 3,000 m | Raise your sleeping altitude by no more than 500 m per day, rest day every 3 to 4 days (Wilderness Medical Society) |
| Prescription option | Acetazolamide, prescription only: talk to your doctor before the trip |
| Coca tea | Not shown to prevent altitude sickness (Wilderness Medical Society 2024) |
| Emergency number in Ecuador | 911 (ECU 911) |
What Is Soroche (Altitude Sickness)?
Soroche is the local name for acute mountain sickness (AMS), the reaction your body has when it has not yet adjusted to the lower oxygen pressure at high elevation. In Quito it is usually mild and temporary, but it can affect anyone regardless of age or fitness, and it tends to hit hardest on the first one to two days after arrival.
Quito is not a borderline case. The CDC Yellow Book puts the risk threshold at a sleeping elevation of about 2,450 m (8,000 ft) and notes that roughly 25% of visitors sleeping above that level in Colorado get AMS. You sleep 400 m higher than that on your first night here, usually after flying in from sea level.
Two rarer and more serious forms exist: high-altitude pulmonary edema (HAPE, fluid in the lungs) and high-altitude cerebral edema (HACE, swelling of the brain). They are uncommon at Quito’s elevation but become a real concern on day trips and climbs above 4,000 m, which is why the order of your itinerary matters.
Common Symptoms to Watch For
The typical signs of soroche are a headache plus at least one other symptom, appearing within hours of arrival. Our guides see the same pattern every week with new arrivals:
- Headache, often worse in the morning or when you bend over
- Fatigue or shortness of breath during light activity, such as the stairs up to the BasĆlica
- Nausea or loss of appetite
- Dizziness or difficulty sleeping, including waking up short of breath
Use this table to decide what to do. It is a guide for travelers, not a diagnosis.
| What you feel | What it probably is | What to do |
|---|---|---|
| Mild headache, tiredness, light nausea, poor sleep | Mild AMS (soroche) | Rest, eat light, avoid alcohol, do not go higher until it clears |
| Headache that does not ease with rest and a painkiller, vomiting, strong fatigue | Moderate AMS | Stay put, cancel high-altitude plans, see a doctor if no improvement within 24 hours |
| Breathless while resting, persistent cough, frothy or pink spit, tight chest | Possible HAPE | Get medical help now and descend |
| Confusion, stumbling or poor balance, extreme drowsiness | Possible HACE | Emergency: call 911 and descend |
How to Prevent Altitude Sickness
The single most effective way to prevent altitude sickness is to go up slowly, and in Ecuador that mostly means not rushing from the airport to a 4,000 m volcano. The rest of the habits below help you feel better while your body adjusts.
- Hydrate sensibly: drink regularly (2 to 3 liters a day is a reasonable target in Quito’s dry air), skip alcohol for your first 48 hours, as the CDC advises, and go easy on coffee. Water will not prevent soroche on its own, but dehydration makes headaches worse.
- Eat carbohydrates: potatoes, rice, quinoa and bread are easy to digest and sit well when your appetite is low. A bowl of locro de papa is the local answer.
- Take it slow: plan a light first day, such as a short walking tour rather than a strenuous hike.
- Acclimatize gradually: if you are heading up to Cotopaxi or other high-altitude sites, spend two or three nights in Quito first rather than going straight up.
- Talk to your doctor beforehand: some travelers use prescription medication like acetazolamide to help acclimatization. It is prescription-only, it is not right for everyone, and the decision on whether and how to take it belongs to your doctor, ideally a travel clinic, before you fly.
Above 3,000 m, the Wilderness Medical Society 2024 guidelines recommend raising your sleeping elevation by no more than 500 m per day and adding a rest day every three to four days. Day trips are different: you can go high and come back to sleep in Quito, which is exactly how our Cotopaxi and Quilotoa tours work.
Does coca tea help with soroche?
Coca tea is not a proven prevention. The Wilderness Medical Society lists coca leaves, coca tea and other coca products among the measures that have not been shown to help. It is also far less common in Quito than in Peru or Bolivia, it can produce a positive drug test, and you should not try to carry coca leaves home, since they are illegal in the US and many other countries. A warm herbal tea like hierbaluisa (lemon verbena) is easy to find here and is a pleasant, harmless way to stay hydrated.
Local tip: Most hotels and hostels in the Old Town have stairs and no elevator. Ask for a lower floor for your first night, carry your big bag up slowly, and do not judge your fitness by how you feel on the first flight of stairs. By day three, the same climb feels normal.
What to Do If Symptoms Appear
If symptoms appear, stop going higher and rest at the same altitude until they clear. Hydrate, eat something light and avoid strenuous activity. According to the NHS, over-the-counter painkillers such as paracetamol or ibuprofen and anti-sickness medicine can ease the symptoms. Most mild soroche fades within 24 to 48 hours as your body adjusts.
The one rule our guides never bend: do not sleep higher while you still have symptoms, however minor they seem. The CDC gives the same advice. If you feel unwell the evening before a Cotopaxi or Quilotoa trip, tell us and we will move your date. A headache at 4,800 m is a very different day from a headache in the Old Town.
When to Seek Medical Help
Seek medical help right away if you have confusion, loss of balance, chest tightness, a persistent cough, frothy or bloody spit, blue or gray lips, or shortness of breath while resting. These can be signs of HAPE or HACE, and the NHS lists them as reasons for immediate care. They are rare in Quito but should never be ignored or slept off.
In Ecuador, dial 911 for the ECU 911 emergency service. Quito has well-equipped private hospitals, such as Hospital Metropolitano, and your hotel can call a doctor to your room. At high sites, descent is the most important treatment: our guides turn a group around at the first sign of serious symptoms. Travel insurance that covers medical evacuation is worth having if you plan to climb.
Planning Your First Days in Quito the Smart Way
The smartest way to plan your first days in Quito is to put low-effort, low-elevation activities first and save the 4,000 m sites for day three or later. A gentle introduction to the city works in your favor both for acclimatization and for getting your bearings. Many travelers start with a relaxed walking tour of the Historic Center before moving on to higher-altitude adventures like Cotopaxi.
Our one-day Old Town itinerary is paced for a first day, with the Mercado Central for lunch and a taxi up El Panecillo rather than a steep walk. If you are arriving late at night, plan nothing before 10:00 the next morning.
How high are the places you will visit from Quito?
Most classic day trips from Quito are either lower than the city or more than 1,000 m higher, and knowing which is which makes planning easy. Elevations below are approximate and rounded, as of 2026.
| Place | Elevation | Compared with Quito | Our advice |
|---|---|---|---|
| BaƱos de Agua Santa | 1,820 m | About 1,000 m lower | Easy on the body, a good place to recover |
| AlausĆ (Devil’s Nose train) | 2,340 m | About 500 m lower | No altitude concern once you have been in Quito |
| Mitad del Mundo (San Antonio de Pichincha) | About 2,440 m | About 400 m lower | Ideal day-two outing |
| Otavalo | 2,530 m | About 300 m lower | Fine from day two |
| Quito Old Town | 2,850 m | Baseline | Sleep here your first 2 to 3 nights |
| TelefƩriQo, Cruz Loma top station | 3,945 m | About 1,100 m higher | Day two or three; you ride up and walk slowly |
| Quilotoa crater rim (lake about 3,500 m) | About 3,900 m | About 1,050 m higher | Day three or later; the climb back from the lake is the hard part |
| Cotopaxi, JosƩ Rivas refuge | 4,864 m | About 2,000 m higher | Only after 2 to 3 nights in Quito |
| Chimborazo, Carrel and Whymper refuges | About 4,800 m and 5,000 m | 2,000 m or more higher | Only once well acclimatized |
The low destinations are a gift for new arrivals. Our Mitad del Mundo guide and Otavalo market guide cover two relaxed day-two options, and the Devil’s Nose train and BaƱos both sit well below Quito.
What does a 3-day acclimatization plan from Quito look like?
A good three-day plan keeps you sleeping in Quito every night while each day’s high point climbs a little, following the classic “climb high, sleep low” approach.
- Day 1, Old Town at an easy pace (2,850 m): join a morning walking tour, eat lunch at the Mercado Central, rest in the afternoon and go to bed early without alcohol.
- Day 2, go lower or stay level (2,440 to 2,530 m): Mitad del Mundo or the Otavalo market. You spend the day below Quito and come back to sleep at 2,850 m.
- Day 3, a short high visit (3,945 m): ride the TelefƩriQo to Cruz Loma in the morning, walk slowly for an hour, and come back down to sleep in Quito. If you feel fine that evening, you are ready for bigger days.
- Day 4 onward: Quilotoa Crater Lake or Cotopaxi Bike & Hike, both day trips that return you to Quito for the night. If you prefer to go on your own, read how to travel to Cotopaxi independently.
Local tip: Go up the TelefĆ©riQo early. The cable car opens at 08:00 on Fridays and weekends and at 10:00 Monday to Thursday, and clouds usually close in on the ridge by early afternoon. Bring a warm layer: it is often 10Ā°C colder at the top than in the Old Town.
Free Walking Tour Quito Ā· Free (tip-based) Ā· 3 hours Ā· MonāSat 10:30 & 14:30, Sun 10:30
The easiest possible first day at altitude: a flat-paced walk through the Old Town’s plazas and colonial churches with a chocolate tasting and a market stop, led by our Ecuadorian guides in English. Meet 10 minutes early at Pedro FermĆn Cevallos N6-78 y Olmedo.
Once you are acclimatized, the Cotopaxi Bike & Hike (from USD 63, Wednesday, Friday, Saturday and Sunday) takes you toward the JosƩ Rivas refuge and lets you ride down to Limpiopungo Lagoon, so you spend very little time at the highest point. For quick numbers on Ecuador, see our Ecuador travel facts and figures 2026, the Ecuador travel glossary and about Community Adventures Ecuador.
Related guides
- One Perfect Day in Quito: The Ultimate Old Town Itinerary
- How to Travel to Cotopaxi Independently
- The Complete Ecuador Packing List: Andes, Amazon, Coast and GalƔpagos
- Is Ecuador Safe to Travel in 2026? A Practical Guide
- Hiking in Ecuador
Plan it with us
We are a team of Ecuadorian guides based in Quito’s Old Town, and we plan first days at altitude every week. Tell us your arrival date and what you want to see, and we will put the low and high days in the right order. Visit our office at Pedro FermĆn Cevallos N6-78 y Olmedo, message us on WhatsApp at +593 97 953 3832, or email info@communitytravel.ec.
Frequently asked questions
Is 2,850 meters high enough to cause altitude sickness?
Yes. The CDC places the risk threshold for acute mountain sickness at a sleeping elevation of about 2,450 m (8,000 ft), and Quito sits at 2,850 m. Many visitors notice a mild headache, shortness of breath on stairs or poor sleep during the first one or two nights. Serious altitude illness is rare at Quito’s elevation, and most people feel normal within 48 hours.
How long does it take to acclimatize to Quito’s altitude?
Most people feel noticeably better within 24 to 48 hours, and fully comfortable after two to three days. That is why we recommend sleeping at least two or three nights in Quito before day trips to places above 3,800 m, such as Quilotoa or the JosƩ Rivas refuge on Cotopaxi. People who arrive tired, dehydrated or after a long flight usually need the full three days.
Can you get altitude sickness at Cotopaxi if you feel fine in Quito?
Yes. The JosƩ Rivas refuge on Cotopaxi is at 4,864 m, about 2,000 m higher than Quito, so even acclimatized visitors feel the thin air there. Day trips reduce the risk because you spend only a few hours high and return to Quito to sleep. Walk slowly, drink water, and tell your guide at once if you get a strong headache, dizziness or confusion.
Should I take acetazolamide before visiting Quito?
That is a decision for your doctor. Acetazolamide is a prescription medicine that can help acclimatization, and whether it suits you depends on your health and other medications. The safest approach is to talk to your own doctor or a travel clinic before you leave home, explain your itinerary and elevations, and follow their advice. Do not borrow pills from other travelers or rely on advice from tour sellers, including us.
Does coca tea work for altitude sickness in Ecuador?
There is no good evidence that it does. The Wilderness Medical Society’s 2024 guidelines list coca tea and coca leaves among measures not shown to prevent or treat altitude illness. Coca tea is also much less common in Ecuador than in Peru or Bolivia, can cause a positive drug test, and coca leaves are illegal to bring into the US and many other countries.
Should I fly into Quito or Guayaquil to avoid altitude sickness?
Either works. Flying into Quito means two or three easy days at 2,850 m before heading higher, which fits most itineraries. Starting in Guayaquil or on the coast and traveling up by road over a day lets you ascend more gradually, but it adds travel time. What matters most is not jumping straight from sea level to a 4,000 m volcano.
Quick reference: Ecuador travel facts and figures 2026 Ā· Ecuador travel glossary Ā· About Community Adventures Ecuador
