Almost 50 years ago, when on our honeymoon(!), I experienced mountain sickness in Cusco, Peru. Horrible experience, one I'd rather not repeat! Quito, where COPA is taking us (that's the connection to this forum) next week, is pretty high. Anybody suffer that malady in Quito? (Yeah, I know, coca tea is the answer to everything, but I was thinking about taking a few days of diamox.) Will up and down to elevation in short period of time, going to and from Amazon cruise and Galapagos tour, make any difference in terms of equilibration?

I've been to each several times. Quito is 2800 m elevation, while Cuzco is 3500 m. I'm mid-50's and overweight, and on my visits to Quito the altitude I find far less noticeable than Cuzco. In Quito, I just huff and puff going up hill. In Cuzco, I feel lightheaded and can feel out of breath even sitting for the first day, not to mention waking in the night in a panic gasping for air. I think you'll be OK in Quito.

Coca tea is great... I drank it like water in La Paz (pushing 4000 m), but provided no relief whatsoever.

There are mountain passes in the USA higher than 2,800 metres and they don't have warnings and such about driving through them. But it is a risk. Cusco adds 3,000 feet to that. Take it slow, maybe have Diamox handy, or ask your MD and start it prophylactically. Rent an oxygen concentrator, take taxis for a few days vs. hill climbing, rest appropriately.

The pressure altitude in the plane might be close to the same, do you handle that reasonably well on a long flight?

Have a budget allowing escape to a lower city. The OP did not say if it's a connection, a day or a week.

My wife mentioned possibility of going up into "mountains" for the experience of "cloud forests." Don't knoes to rx for me. (Diamox is probably very cheap, though.)

I only had experience of coca tea once and it did nothing for me. I still got the excruciating headache after going to bed that night. I'm not going to be subjected to any drug screening since left the Army Reserves years ago, but wonder if coca tea would cause a "positive" and for how long after. Anyone know?

Never thought about an airline flight as a "depressurized" challenge and I have never had trouble in a plane or going over passes in CO.

Thanks for the advice. Any suggestions for short stay in Quito?

Most people feel the altitude in Quito, but don't usually suffer any serious problems other than getting out of breath more easily. But of course, no-one can give guarantees about how any one individual will react. One common problem is that people arrive dehydrated off the flight, and then don't drink enough to counter the dehydrating effects of altitude, so it just keeps getting worse. The symptoms are similar. Some people do take Diamox for a short visit. You would need to bring it with you though, it's not easy to find in Quito although the Fybeca in the basement of QuiCentro Norte sometimes has it. Personally, I think it's overkill below 3,000m, but if you are very worried about it, it might be worth it. You might want to avoid the Teleferico as well.

Moving between the Amazon, Galapagos and Quito won't make much difference unless you are staying a few days in Quito, then going down to sea level and then coming back up for a few days. In which case you will lose any acclimatization you had in between. From Quito, cloud forest trips are usually to Mindo, which is much lower than Quito (less than 1,300m). Altitude wouldn't be an issue there.

Coca tea will trigger a positive for cocaine. There have been a few studies on it, and I can probably dig some references out if you are really interested. As far as I can recall, one cup led to a positive for about 20-30 hours, 2 cups were still positive after 52 hours, which was the longest period they tested.

I was there last summer. As previously mentioned, you may feel winded or have a slight headache (similar to a hangover) the first day. I would not take Diamox, unless there is a medical reason and your doctor feels it is warranted.

I've hiked in Ecuador up to 15,000 ft and still did not need or use Diamox.

Just to add a data point: Quito‘s airport is just 2400 m. If you want to visit the city, you‘d obviously have to travel up to 2800 m, but if you are just connecting (e.g. to Galapagos), you can also stay at that lower level. The Wyndham airport hotel is very good - perhaps one of the best airport hotels I‘ve ever seen.

I agree with the posters above in both respects. Drink coca tea! Many times to CUZ and UIO and the elevation difference is critical for many people. UIO is much more manageable it is closer to the threshold trigger for soroche for many people but CUZ is well above. Also CUZ airport is at 3400m but much of Cuzco is located higher like the HGI. The extra 200 or 300m makes a big difference.

Also at such altitud dehydration is an issue but simply drinking more does not always work. The body adapts to lower partial O2 pressure by expelling water and the capacity to absorb h20 also diminishes. If I drink large volume of water at such altitud it exits almost immediately! More readily absorbed liquid forms are good for me actually eating foods with high water content like pasta is a way to counter this problem because absorption is slower and more constant during daily life.

I've had good experiences at Hotel Quito and Hotel Stubel. Other than that, Spanish language skills would be necessary.