Most trekkers think about medication twice: in a panic the week before they fly, and again at 4,000 m with a headache. Both are too late to do it well. Vaccines need weeks to work, prescriptions need a doctor's appointment, and the right time to discover that a tablet disagrees with you is at home, not at Dingboche.
This guide lays out the whole sequence, from two months before departure to two weeks after you return, and links to a detailed article on each part. It covers what healthy trekkers commonly carry and why. It cannot tell you what you personally should take — that is a conversation for your own doctor.
This article is general information for trip planning, not medical advice. Doses mentioned are those commonly published in travel and altitude medicine guidance; your doctor should confirm what is right for you, especially if you have a medical condition, are pregnant, or take regular medication.
The Timeline at a Glance
| When | What to do |
|---|---|
| 8 weeks before | Book a travel clinic or doctor's appointment. Start vaccine courses that need more than one dose |
| 6 weeks before | Medical check-up if you have a long-term condition, are over 50, or have had altitude illness before. Dental check |
| 4 weeks before | Get prescriptions: altitude medication, a stand-by antibiotic, plus enough of your regular medicines for the trip and a week over |
| 2 to 3 weeks before | Trial dose of acetazolamide at home if you plan to use it. Finish vaccines. Assemble the medical kit |
| Arrival in Kathmandu or Pokhara | Fill any gaps at a reputable pharmacy. Health briefing with your guide. Declare conditions and medication |
| On the trek | Take preventive medication as prescribed. Report symptoms early. Treat small problems before they grow |
| Walking out | Stop altitude medication once you have descended. Keep taking any antibiotic to the end of the course |
| First 2 weeks after | Rest, rehydrate, eat. Watch for fever, persistent diarrhoea or cough |
| Up to 3 months after | See a doctor promptly for any fever, and mention that you have been in Nepal |
Before the Trek: Vaccines and Check-Ups
Two appointments do most of the work. A travel clinic handles vaccines and prescriptions; your own doctor reviews any existing condition against the demands of altitude.
- Vaccines. Hepatitis A and typhoid are recommended for most visitors to Nepal, on top of up-to-date routine vaccines. Rabies, hepatitis B and Japanese encephalitis depend on your route and length of stay. Full detail in vaccinations for trekking in Nepal.
- Check-up. Tell your doctor the maximum altitude, how many nights you will sleep above 3,000 m, and that evacuation from most routes is by helicopter only. See the pre-trek medical check-up.
- Existing conditions. Asthma, diabetes, high blood pressure and many others are compatible with trekking when well controlled, but each needs a plan. See trekking with a medical condition.
- Insurance. Declare every condition and medicine, and check that helicopter evacuation is covered to the maximum altitude of your route — see our insurance guide.
The Medicines Trekkers Carry
A personal kit for a teahouse trek weighs 300 to 400 g. Your guide carries a larger group kit; yours covers the things you will want at 2 am without knocking on anyone's door.
| Category | Typical contents | Purpose |
|---|---|---|
| Altitude | Acetazolamide (Diamox), on prescription | Speeds acclimatisation on high or fast routes |
| Pain and fever | Paracetamol; ibuprofen | Headache, sore muscles, fever |
| Stomach | Oral rehydration salts; loperamide; a stand-by antibiotic on prescription | Diarrhoea and dehydration |
| Nausea | An anti-sickness tablet, on prescription | Vomiting from stomach illness or altitude |
| Colds and cough | Throat lozenges; a decongestant; saline nasal spray | The dry cough and blocked nose of high altitude |
| Allergy | A non-drowsy antihistamine | Hay fever, bites, mild reactions |
| Feet and skin | Blister plasters, zinc oxide tape, antiseptic, antifungal cream | Blisters, cuts, chafing |
| Sun and cold | SPF 50 sunscreen; SPF lip balm | Sunburn at altitude is fast and severe |
| Water | Purification tablets or drops as a back-up | Safe drinking water |
| Personal | All regular prescription medicines, in original packaging | Whatever you take at home |
The full list, with quantities and what to adjust for remote, monsoon and winter routes, is in our trekking first aid kit guide. Where to buy what you have forgotten is in buying medicine in Kathmandu and Pokhara.
Altitude Medication in Brief
Three drugs matter at altitude, and they do very different jobs.
| Drug | Role | Who carries it |
|---|---|---|
| Acetazolamide (Diamox) | Prevention: speeds the body's own acclimatisation. Also used to treat mild altitude sickness | Trekkers, on prescription |
| Dexamethasone | Emergency treatment for severe altitude sickness and brain swelling (HACE). Buys time for descent | Guides and expedition medics |
| Nifedipine | Emergency treatment for fluid in the lungs (HAPE). Buys time for descent | Guides and expedition medics |
The commonly published preventive dose of acetazolamide is 125 mg twice a day, started the day before going above about 3,000 m. It is a prescription medicine with real side effects and some important exclusions, including sulfonamide allergy — all covered in our guide to Diamox.
No tablet replaces a sensible ascent. A well-paced itinerary with rest days is the treatment that actually works; medication supports it. The principles are in altitude sickness in Nepal.
Medicines to Avoid or Use with Care at Altitude
- Sleeping tablets and sedatives. Many suppress breathing during sleep, when oxygen levels are already at their lowest. Do not take them above 3,000 m unless a doctor who understands altitude has approved it.
- Strong opioid painkillers and codeine. The same problem: they depress breathing. Codeine-based cough medicines included.
- Alcohol. Not a medicine, but it behaves like a sedative, dehydrates you and wrecks sleep at altitude.
- Sedating antihistamines. Choose a non-drowsy one.
- Anti-inflammatories on an empty stomach or when dehydrated. Ibuprofen and similar drugs are hard on the stomach and kidneys. Take with food and drink plenty.
- Anti-diarrhoeal tablets with fever or blood. Loperamide slows the gut and should not be used when there is high fever or blood in the stool.
- Anyone else's prescription. A fellow trekker's leftover antibiotics are not a treatment plan.
- Emergency altitude drugs taken in order to continue upward. Dexamethasone hides symptoms while the underlying problem worsens.
After the Trek: What to Finish and What to Watch
Post-trek medication is mostly about stopping things correctly and noticing what has not gone away.
- Acetazolamide: stop once you have descended. There is no need to taper and no rebound.
- Antibiotics: finish the course as prescribed, even if you feel better.
- Antimalarials, if you were prescribed them for the lowlands: continue for the full period after leaving the risk area. Stopping early is the commonest reason they fail.
- Painkillers: you should not need them for more than a few days. Pain that persists needs a diagnosis, not more tablets.
- Regular medicines: return to your normal routine and time zone schedule.
| Symptom after return | Possible cause | Action |
|---|---|---|
| Fever, at any time up to three months later | Many, including typhoid, dengue and malaria | See a doctor promptly; say you have been in Nepal |
| Diarrhoea lasting more than two weeks | Giardia or another parasite | Stool test; specific treatment |
| Cough lasting more than three weeks | Lingering airway irritation or infection | Medical review |
| Swollen, painful calf | Possible blood clot after long flights | Urgent medical attention |
| Numb toes or fingertips | Mild cold injury | Usually resolves over weeks; see a doctor if skin changes |
More on each of these is in post-trek recovery and illness after a trek: symptoms you should not ignore.
Getting Medicine and Care in Nepal
Kathmandu and Pokhara have well-stocked pharmacies and clinics that specialise in travel medicine, and most common medicines can be bought there cheaply. Above the road head, supply thins quickly: a few villages have health posts, and seasonal aid posts run by volunteer doctors operate at Pheriche on the Everest route and Manang on the Annapurna Circuit. Beyond those, what you and your guide carry is what there is.
That is the reason to arrive prepared. Bring anything on prescription from home, bring more than you need, and split it between two bags. Details in buying medicine in Kathmandu and Pokhara.
We Provide This Service: Pre- and Post-Trek Health Support
Green Compass Treks provides health support before, during and after every trek we run. We are trek organisers, not doctors — we do not prescribe or diagnose — but we make sure the practical side is covered so that you and your own doctor are not planning in the dark.
- Before you travel: the altitude profile of your itinerary — maximum height, sleeping altitudes, rest days — to take to your doctor, and a kit list matched to your route.
- On arrival: a health briefing with your guide, a check of your personal medical kit, and help filling gaps at a reputable pharmacy or travel-medicine clinic in Kathmandu or Pokhara.
- On the trek: guides trained in first aid and altitude illness, carrying a group medical kit and a pulse oximeter on high-altitude routes, with twice-daily oxygen readings above 4,000 m and emergency oxygen on high passes and climbing trips.
- If something goes wrong: coordination of descent, helicopter evacuation with your insurer, and hospital admission.
- After the trek: a check-in before you fly, a clinic appointment arranged if you have symptoms, and recovery days added if you need them.
Tell us about any medical condition and regular medication when you book — it stays confidential and it changes how we plan. Contact us with questions about a specific route; we reply within 24 hours.
