How to Prepare for Medication Needs during Pilgrimages and Treks

When you’re heading up a mountain for a pilgrimage or a long trek, your body doesn’t just need food and water-it needs the right meds, stored properly, and used correctly. Many people assume that if they’re healthy, they’ll be fine at high altitudes. But altitude sickness doesn’t care how fit you are. At 12,000 feet, even seasoned hikers can feel dizzy, nauseous, or breathless. And if you’re diabetic, have heart issues, or take daily prescriptions, the risks multiply fast. The good news? Almost all serious problems can be avoided with smart prep.

Know Your Altitude Risks

Altitude sickness isn’t a myth. It’s a real, measurable threat. Above 8,000 feet, about 25% of people start feeling symptoms. By 17,500 feet-like at Everest Base Camp-that number jumps to 43%. The main culprits are Acute Mountain Sickness (AMS), High Altitude Pulmonary Edema (HAPE), and High Altitude Cerebral Edema (HACE). These aren’t just headaches. HAPE can fill your lungs with fluid. HACE can swell your brain. Both can kill within hours if ignored.

Most people climb too fast. You don’t need to be an athlete to get sick-you just need to go from sea level to 12,000 feet in a single day. That’s what happens when you fly into Lhasa or take a bus to a mountain shrine. Your body doesn’t get time to adjust. Medications can help, but they’re not magic pills. They work best when paired with slow ascent, hydration, and rest.

Essential Medications to Pack

Here’s what you actually need to carry, based on real-world medical guidelines:

• Acetazolamide (Diamox): The go-to for preventing AMS. Take 125 mg twice a day, starting one day before you climb and continuing for three days after reaching high altitude. Side effects? More peeing and tingling fingers. That’s normal. It’s not dangerous-it’s your body adjusting.
• Dexamethasone: A steroid used for treating HACE. Don’t use it to prevent illness. Use it only if someone starts showing confusion, loss of coordination, or vomiting at high altitude. Dose: 8 mg first, then 4 mg every 6 hours until you descend.
• Nifedipine (extended-release): For HAPE. If someone’s gasping for air, coughing up frothy sputum, and their lips turn blue, give them 20 mg every 12 hours. This opens up blood vessels in the lungs. It’s life-saving.
• Diarrhea meds: Up to 60% of trekkers get sick from dirty water. Pack azithromycin (500 mg once daily for 3 days) or rifaximin. Also carry oral rehydration salts. Don’t just rely on loperamide-it stops symptoms but doesn’t treat infection.
• Pain and fever relief: Ibuprofen (400 mg) works better than acetaminophen for altitude headaches. It reduces inflammation in the brain.
• Antihistamines: Diphenhydramine (25-50 mg) helps with allergic reactions or sleep issues. Don’t use it as a sleep aid unless you’ve tested it at home first.
• Topicals: Antibiotic ointment, hydrocortisone cream, and blister pads. Blisters are the #1 reason people quit treks. Treat them early.

And don’t forget your own prescriptions. If you take blood pressure pills, insulin, or thyroid meds, bring double what you think you’ll need. Cold temperatures can ruin them.

Storage Matters More Than You Think

Medications don’t handle extreme cold or heat well. Insulin degrades fast. At 14,000 feet, if your insulin sits in a backpack overnight at 10°F, it can lose 25% of its strength in 24 hours. Glucometers give wrong readings below freezing. One trekker on Reddit lost $4,200 to an evacuation because their insulin failed.

Here’s how to protect your meds:

• Use insulated, waterproof cases. Some are made for travel with gel packs that stay cool for 24 hours.
• Keep insulin close to your body-inside your jacket, not in an outer pocket.
• Store pills in their original bottles with labels. Airport security and border agents may ask.
• Avoid leaving meds in a car or tent. Sunlight and temperature swings destroy potency.

Pre-Trip Medical Checkup Is Non-Negotiable

Don’t skip this. The CDC says the pre-travel visit is your best chance to prevent disaster. A 2023 study found that 83% of serious altitude complications could’ve been avoided with a simple checkup.

Your doctor should:

• Review your meds and check for allergies (especially sulfa, which makes acetazolamide unsafe for 3-6% of people)
• Test your heart and lungs if you’re over 40 or have a history of asthma or high blood pressure
• Write a letter for controlled substances (like strong painkillers or ADHD meds) if you need them
• Confirm your vaccinations-typhoid, hepatitis A, and tetanus are common for these trips

Go at least 4-6 weeks ahead. Some meds need time to start working. And if you’re flying into high altitude, your doctor might suggest starting acetazolamide before you even leave home.

What to Do If Someone Gets Sick

Altitude sickness doesn’t always show up on day one. Sometimes it hits after a long day of walking. Here’s what to do:

1. Stop climbing. Don’t go higher until symptoms fade.
2. Hydrate. Drink 4-5 liters of water a day. Dehydration makes everything worse.
3. Take acetazolamide if you didn’t start it before.
4. Use oxygen if you have it. Even a small portable canister helps.
5. Descend. This is the only cure that always works. Even 1,000 feet lower can make a huge difference.
6. Call for help. If someone is confused, can’t walk straight, or turns blue, don’t wait. Start dexamethasone and get them down.

Many remote areas have health posts, but 89% of them in Nepal didn’t stock essential meds like acetazolamide or nifedipine in 2013. Don’t rely on local pharmacies. Bring your own.

Special Cases: Diabetics, Pregnant Women, and Elderly

Diabetics: Test your blood sugar often. Cold weather affects readings. Carry extra batteries and test strips. Keep insulin in a warm pocket. Consider a travel insulin cooler.

Pregnant women: Avoid acetazolamide and dexamethasone. The safest option is slow ascent and rest. Talk to your OB-GYN. Most experts advise against high-altitude trekking past 20 weeks.

Elderly travelers: Your body adapts slower. You’re more likely to have heart or lung issues. Get clearance from your doctor. Bring extra meds. Don’t push yourself.

What Not to Do

• Don’t take aspirin or ibuprofen as a daily preventative. It doesn’t prevent altitude sickness.
• Don’t drink alcohol or smoke. Both make oxygen use harder.
• Don’t sleep during ascent. Rest only after you’ve stopped climbing for the day.
• Don’t assume you’re fine because you’ve been to high altitude before. Your body changes.
• Don’t wait until you’re on the trail to ask about meds. Pharmacies at base camps are unreliable.

Final Checklist

Before you leave, tick these off:

• ✅ Got a doctor’s visit 4-6 weeks out
• ✅ All meds in original bottles with labels
• ✅ Extra supply of every prescription (at least 20% more than needed)
• ✅ Insulin and glucose monitor stored in insulated case
• ✅ Acetazolamide, dexamethasone, nifedipine, azithromycin, ibuprofen, and rehydration salts packed
• ✅ Physician’s letter for controlled substances (if needed)
• ✅ Emergency contact info and insurance card copied and stored digitally and on paper
• ✅ Travel insurance that covers high-altitude medical evacuation

Over 76% of trekkers now buy pre-packaged medical kits. But you don’t need to pay for one. With this list, you can build your own for less than $100-and save your life.

Why This Matters Now

Pilgrimages to places like Mount Kailash, Amarnath, and Machu Picchu are growing fast. Nepal alone sees 50,000 Everest Base Camp trekkers a year. The global adventure travel market hit $683 billion in 2022. But the medical infrastructure hasn’t kept up. Most local clinics still don’t have the right meds.

That’s why your preparation isn’t just smart-it’s essential. You’re not just packing pills. You’re packing safety, dignity, and the ability to finish what you started.