Should I take Diamox before I arrive?

Talk to your doctor. Many travelers start taking it 24 hours before ascending, but it is a prescription medication with side effects.

Is Quito too high to start?

At 2,850 meters, Quito is high, but not extreme. It is a good staging ground for further travel, provided you take the first two days slow.

How to beat altitude sickness in the Ecuadorian Andes

Spend your first 48 hours in Quito at a lower elevation or rest significantly before heading higher. Stay hydrated with at least 3 liters of water daily and prioritize acclimatization over a packed itinerary.

Choose your arrival strategy. If flying into Quito (2,850m), do not plan strenuous hikes or high-altitude travel for the first 2 days. Allow your body to adjust to the lower oxygen levels before heading to Cotopaxi or Quilotoa.
Hydrate aggressively. Drink 3 liters of water per day. Alcohol, caffeine, and tobacco exacerbate symptoms; avoid them entirely for the first 3 days of your trip.
Eat light, carb-heavy meals. Digestion slows down at high altitudes. Stick to simple carbohydrates like potatoes, rice, and bananas. Avoid heavy, fatty meats that take hours to process.
Manage symptoms with local remedies. Drink coca leaf tea (mate de coca) or muña tea, which are widely available in cafes and hotels. These help with headaches and mild nausea.
Know when to descend. If you experience severe confusion, wet cough, or a headache that doesn't subside with painkillers, descend at least 500 meters immediately. This is the only reliable cure for HAPE or HACE.

Should I take Diamox before I arrive?: Talk to your doctor. Many travelers start taking it 24 hours before ascending, but it is a prescription medication with side effects.
Is Quito too high to start?: At 2,850 meters, Quito is high, but not extreme. It is a good staging ground for further travel, provided you take the first two days slow.