How to Prepare for Medication Needs during Pilgrimages and Treks

Thousands of people climb to high-altitude sacred sites every year-Mount Kailash, Everest Base Camp, Lhasa, Gosainkunda Lake-each journey a mix of faith, endurance, and risk. Many don’t realize how dangerous it can be to show up at 12,000 feet without preparing their medications properly. The air is thin. Water is scarce. Pharmacies are miles away. And if your insulin freezes, your inhaler runs out, or your headache turns into something worse, help could be 48 hours away. This isn’t just about feeling tired. It’s about survival.

Know Your Risk Zone

Altitude sickness doesn’t wait for you to be ready. It hits fast, and it doesn’t care if you’re 25 or 65. Once you hit 8,000 feet (2,438 meters), your body starts struggling to get enough oxygen. By 14,000 feet, nearly half of all trekkers will experience symptoms like headaches, nausea, dizziness, or shortness of breath. At 17,500 feet-where Everest Base Camp sits-43% of people develop moderate to severe symptoms, according to Mosaic Adventure’s field data.

Most pilgrims fly or drive straight into high-altitude zones. That’s the problem. Your body needs time to adjust. Climbing too fast is like sprinting a marathon without training. The medical community calls this acute mountain sickness (AMS). Left untreated, it can become high altitude pulmonary edema (HAPE)-fluid in the lungs-or high altitude cerebral edema (HACE)-fluid in the brain. Both are life-threatening.

There’s no way around it: if you’re heading above 10,000 feet, you need a plan. Not just a pill. A full system.

Essential Medications to Pack

You’re not just packing bandages and painkillers. You’re carrying tools that could save your life-or someone else’s. Here’s what you absolutely need:

• Acetazolamide (Diamox): The gold standard for preventing altitude sickness. Take 125 mg twice a day, starting one day before ascent and continuing for three days after reaching your highest point. It helps your body breathe faster and adjust to lower oxygen. Side effects? More frequent urination and tingling fingers-both normal. About 67% of users report these, but they’re not dangerous.
• Dexamethasone: A steroid used for treating HACE. If someone’s confused, stumbling, or vomiting uncontrollably, give 8 mg immediately, then 4 mg every 6 hours. This isn’t for prevention. It’s for emergency stabilization until descent is possible.
• Nifedipine (extended-release): Used for HAPE. Take 20 mg every 12 hours. It opens up constricted blood vessels in the lungs. Critical if someone’s coughing up frothy sputum or can’t catch their breath even while resting.
• Ibuprofen (400 mg): Reduces headache and inflammation. Often more effective than acetaminophen at high altitudes. Keep at least 10 tablets.
• Azithromycin (500 mg): For traveler’s diarrhea. Around 60% of trekkers get sick from dirty water. One 500 mg tablet daily for three days usually clears it up.
• Diphenhydramine (25-50 mg): For allergic reactions or severe itching. Useful if you get stung or react to unfamiliar plants or food.
• Antibiotic ointment and hydrocortisone cream: Small wounds heal slower at altitude. Infections spread faster. Don’t skip these.

And if you have a chronic condition? Bring extra. Double your usual supply. Insulin? Glucometers? Blood pressure pills? All of it. The Wilderness Medical Society says 22% of medical evacuations from high-altitude treks happen because someone ran out of medication-or it got ruined by cold or heat.

Storage Matters More Than You Think

Medications don’t survive extreme cold or heat well. Insulin loses 25% of its potency in just 24 hours if it drops below 32°F (0°C). Glucometers give wrong readings at 14°F (-10°C)-error rates jump to 18%. That’s not a glitch. That’s a death sentence for a diabetic.

Here’s how to protect your meds:

• Use insulated, waterproof cases. Some have gel packs that stay cool for hours.
• Keep insulin close to your body-inside your jacket, not in your backpack.
• Avoid leaving pills in direct sun. Even in the shade, temperatures inside a backpack can hit 120°F on a sunny day.
• Store all medications in their original bottles with pharmacy labels. Customs and border agents ask for them. So do local clinics.

One Reddit user, u/HimalayanTrekker, lost control of their diabetes at 14,000 feet because their insulin froze. They had to be evacuated. The cost? $4,200. A $15 insulated case would’ve prevented it.

Pre-Trip Doctor Visit Is Non-Negotiable

The CDC says the pre-travel consultation is your best chance to avoid disaster. Yet, only 68% of trekking companies required it in 2023. That number is rising fast-by 2027, 95% will make it mandatory because of insurance rules.

Don’t wait until the week before. Go 4 to 6 weeks out. Your doctor needs to:

• Check for heart or lung conditions that make altitude dangerous.
• Prescribe and explain how to use acetazolamide or dexamethasone.
• Write a letter for controlled substances (like strong painkillers or ADHD meds). Some countries require this.
• Confirm your prescriptions are legal in the country you’re visiting.

According to the Himalayan Rescue Association, 83% of serious altitude complications could’ve been avoided with a simple checkup. That’s not a suggestion. That’s a statistic you can’t ignore.

What Not to Do

People make the same mistakes every year. Don’t be one of them.

• Don’t rely on local pharmacies. A 2013 survey found 89% of health camps along pilgrimage routes didn’t have acetazolamide, dexamethasone, or nifedipine. You can’t trust them to have what you need.
• Don’t take someone else’s medication. Dexamethasone isn’t a miracle cure. It’s a steroid. Misuse can cause seizures, psychosis, or adrenal crash.
• Don’t sleep during ascent. If you’re climbing and feel tired, rest-but don’t lie down. Sleep slows your breathing. That’s dangerous when oxygen is already low.
• Don’t ignore early symptoms. A headache? Drink water. Rest. Don’t push. If it gets worse, descend. No pilgrimage is worth your life.

Special Cases: Diabetics, Asthmatics, and Pregnant Travelers

Some people need extra planning.

Diabetics: Test your blood sugar more often. Cold weather skews readings. Carry glucose tablets. Tell your group where your insulin is stored. Have a backup plan if your pump fails.

Asthmatics: Bring two inhalers. One in your pocket, one in your pack. Cold, dry air triggers attacks. Altitude makes breathing harder even for healthy people. Don’t assume your usual dose will be enough.

Pregnant women: Most experts advise against high-altitude travel after 20 weeks. Acetazolamide isn’t recommended during pregnancy. If you’re going anyway, consult a high-risk OB-GYN. The risks of AMS are higher, and emergency care is limited.

Emergency Tools Beyond Pills

Medications help, but sometimes you need tech.

A hyperbaric bag (like a Gamow Bag) simulates lower altitude by pressurizing air around the person. It’s not a cure-but it buys time. Less than 5% of health camps have one, but if you’re leading a group, consider renting one. Some trekking companies now include them in premium packages.

Also carry:

• A satellite messenger (Garmin inReach or Zoleo) to send SOS signals.
• A portable oxygen canister (1-2 liters). Not a replacement for descent-but helpful for short-term relief.
• A small notebook with your meds, allergies, and doctor’s contact info. Paper doesn’t die when batteries do.

Final Checklist Before You Leave

Use this. Print it. Stick it on your fridge.

• ☐ See your doctor 4-6 weeks before departure
• ☐ Get prescriptions for acetazolamide, dexamethasone, nifedipine, azithromycin
• ☐ Double your medication supply
• ☐ Store all meds in waterproof, insulated containers
• ☐ Carry original pharmacy labels and doctor’s letter for controlled drugs
• ☐ Pack a first aid kit with ointments, antihistamines, ibuprofen, bandages
• ☐ Bring a backup power bank for glucometers or pumps
• ☐ Tell at least two people in your group where your meds are
• ☐ Know the signs of AMS, HAPE, and HACE
• ☐ Have a plan to descend if symptoms worsen

What Happens If You Get Sick?

If someone in your group starts showing signs of severe altitude sickness-confusion, coughing up pink foam, inability to walk straight-act immediately.

Step one: Stop climbing.

Step two: Give dexamethasone (8 mg) or nifedipine (20 mg) if you have them.

Step three: Start descending. Even 1,000 feet helps. Don’t wait for a helicopter. Don’t hope it gets better. Descend now.

And if you’re alone? Use your satellite messenger. Don’t wait until you’re unconscious.

There’s no shame in turning back. The mountain will still be there next year. Your life won’t.