Travel Medicine · Peru · Destination
Only for the Amazon, not for Machu Picchu. The CDC recommends malaria pills for travel below 2,500 m (8,200 ft) east of the Andes, which includes the Amazon basin and cities like Iquitos and Puerto Maldonado. For the classic Cusco, Sacred Valley, Machu Picchu, and Lake Titicaca route, there is no malaria, so no pills are needed; the real concern up there is altitude sickness. Both doxycycline and Malarone work for the Amazon, and we can prescribe either. CDC guidance checked June 19, 2026.
| Destination | Malaria pills? | Why |
|---|---|---|
| Amazon basin: Iquitos, Puerto Maldonado, Manu, Tambopata, jungle lodges (below 2,500 m east of the Andes) | Yes | CDC lists this as a malaria area. Doxycycline or Malarone are both appropriate. |
| Cusco, Sacred Valley, Inca Trail, Machu Picchu | No | Too high for malaria mosquitoes. Altitude sickness is the real risk here. |
| Lima, Pacific coast, Arequipa, Lake Titicaca and Puno | No | No malaria transmission. |
So a trip that is only Lima plus Cusco and Machu Picchu needs no malaria pills at all. You only need them if you are adding the Amazon, for example an Iquitos cruise or a jungle lodge in Tambopata or Manu.
For Peru's Amazon, the CDC lists atovaquone-proguanil (Malarone), doxycycline, mefloquine, and tafenoquine as options. Two of those, doxycycline and Malarone, we prescribe for a flat $45, sent to your own pharmacy. Doxycycline is the budget option (often under $20 as a generic) but you start it before travel and continue 4 weeks after; Malarone costs more but you stop just 7 days after leaving. See doxycycline vs Malarone to choose.
Cusco sits at about 11,150 ft (3,400 m), higher than the rim of most Colorado 14er trailheads, and many travelers feel it on day one. The CDC advises talking to a clinician about preventing altitude sickness for high destinations like Machu Picchu. Acetazolamide, started the day before you go up, is the standard prevention, and we prescribe it. See altitude medicine for Cusco and our altitude sickness page.
I am Bidwell Cranage, a nurse practitioner and Member of the International Society of Travel Medicine. I have had altitude sickness on Colorado 14ers and summiting Acatenango in Guatemala, so on a Peru trip the part I would plan for hardest is not malaria, it is the Cusco and Machu Picchu altitude. Get the altitude medicine sorted, and only add malaria pills if you are heading into the Amazon.
We do not give vaccines. We refer you to a travel clinic for those and can still handle your malaria pills, altitude medicine, or a standby antibiotic online. See online travel medicine vs a travel clinic.
Stomach trouble is common in Peru, from street food to Amazon lodges. Many travelers carry a standby azithromycin course so they can treat a bad case on the road instead of losing days of the trip. We can include it with your visit.
For one flat $45 visit, sent to your own pharmacy with no markup, we can cover the prescription side of a Peru trip: malaria pills (doxycycline or Malarone) if you are going to the Amazon, altitude medicine for Cusco and Machu Picchu, and a standby antibiotic for traveler's diarrhea. We refer you to a travel clinic for yellow fever, typhoid, and hepatitis A shots, and for mefloquine or pregnancy.
No. There is no malaria transmission in Cusco, the Sacred Valley, the Inca Trail, Machu Picchu, or Lake Titicaca, because they sit too high for the mosquitoes that carry malaria. The CDC does not recommend malaria pills for those areas. The real concern on that route is altitude, since Cusco is about 11,150 feet, so plan for altitude sickness instead.
Yes. The CDC recommends malaria prevention for travel below 2,500 meters (8,200 feet) east of the Andes, which includes the Amazon basin and cities such as Iquitos and Puerto Maldonado, and jungle lodges in Manu and Tambopata. Both doxycycline and atovaquone-proguanil (Malarone) are appropriate options there.
It is not required to enter Peru. The CDC recommends the yellow fever vaccine for travelers going to Amazonian areas below 2,300 meters, but not for Cusco, the Inca Trail, or Machu Picchu. Yellow fever is a shot given at an authorized vaccination center, so we refer you to a travel clinic for it and can still handle your malaria pills or altitude medicine online.
Yes, for an Amazon or jungle itinerary, because the CDC lists doxycycline and Malarone as options for Peru and we prescribe both for a flat $45, sent to your own pharmacy. We refer you to a travel clinic if your clinician specifically wants mefloquine or tafenoquine, which we do not prescribe online, or if you are pregnant. If you are only visiting Cusco and Machu Picchu, you do not need malaria pills at all, and we can help with altitude medicine instead.