Altitude Sickness and Health in Bhutan

Most towns on a standard route are between 1,200 and 3,000 metres. Here is a typical route from west to east, with rounded heights from our destination pages.

• Paro About 2,200 m Most travellers land here.
• Thimphu About 2,320 m The capital.
• Punakha About 1,240 m A lower and warmer valley.
• Phobjikha About 3,000 m Cold at night, even in autumn.
• Trongsa About 2,200 m A day’s drive from Punakha.
• Bumthang About 2,580 m Jakar is the main town.
• Chele La pass 3,988 m The highest road pass, on the drive from Paro to Haa.

It is rare on a standard cutlure tour, because most travel is by vehicle through valleys below 3,000 metres. It can still happen. The International Society of Travel Medicine says the risk starts at about 2,500 metres and rises with a faster climb and greater height. Being fit does not lower it, so you cannot tell in advance who will feel it. Paro (about 2,200 m) and Thimphu (about 2,320 m) sit just below that line, and Bumthang and Phobjikha are above it.

• Mild Headache, tiredness, dizziness, nausea It can start within a few hours of arriving high.
• Serious Severe headache, vomiting, confusion, unsteady walking, breathlessness, blue lips or nails Needs urgent medical care.
• What to do Do not go higher. Rest and tell your guide If symptoms get worse, go down.

• Go slowly Take it easy for the first 2 days Avoid hard exercise early in the trip.
• Drink water Bottled or filtered Stay hydrated.
• Skip alcohol Especially on the first nights Avoid it while your body adjusts.
• Ask your doctor Before you travel Ask about altitude medicine, such as acetazolamide (Diamox).

Most travellers arrive in Paro, at about 2,200 metres, so the first nights are already above 2,000 metres. Give yourself time to adjust before the higher stops.

The monastery sits at about 3,120 metres, which is above the 2,500 metre line where altitude illness can start. The walk takes about 5 hours return.

• Timing Not on your first day Spend a night or two at about 2,200 m first.
• Pace Slow and steady Stop when you need to, and drink water.
• If you feel unwell Tell your guide Rest, do not go higher, and turn back if it gets worse.

Read our Tiger’s Nest guide for the walk itself.

Bring every medicine you take, enough for the whole trip, in its original packaging and in your hand luggage. Check the rules for carrying medicines before you fly. Ask your doctor about altitude medicine, because we cannot advise on the dose.

• Your own medicine Full supply Carry the prescription too.
• Altitude medicine Ask your doctor Before you travel, not on arrival.
• Small items Insect repellent and hand sanitiser See our guide to what to pack for Bhutan.

Please follow the advice of your own doctor or travel clinic on which vaccinations to take before you travel to South Asia. Bhutan does not ask visitors for proof of vaccination to enter.

The malaria risk to travellers is low, and antimalarial tablets are not usually advised. Dengue is a risk that changes by season, region and height, and the mosquitoes that carry it bite mainly in the day. Use insect repellent, wear long sleeves and trousers around dawn and dusk, and ask a travel clinic if you are unsure.

Drink only bottled or filtered water. Never drink tap water. Travellers’ diarrhoea is the most common illness, so wash your hands or use sanitiser before you eat.

• Water Bottled or filtered Not from the tap.
• Food Cooked or peeled Peel fruit before you eat it.
• Hands Wash or sanitise Before every meal.

Tell your guide first.

• Emergency numbers 112 ambulance, 110 fire, 113 police From the Department of Tourism FAQ.
• Hospital Jigme Dorji Wangchuck National Referral Hospital In Thimphu. The main option for urgent care.
• Outside the towns Care is limited Medical evacuation is likely for a serious illness.

Basic healthcare is available in Thimphu and Paro, but quality varies across the country. For a problem with your trip, you can also contact the Department of Tourism.

It is not required. Bhutan lifted the rule on 23 April 2024, and the Department of Tourism still advises every traveller to buy cover. Pick a policy that covers medical evacuation and hospital stays, and check that it covers the height you will reach. Trekkers should check that it includes helicopter rescue.

• Sun Strong at this height Sunscreen and sunglasses. Take your hat off at temples.
• Stray dogs Do not touch them After a bite or scratch, wash the wound with soap and water and get medical care at once.
• Monsoon June to September Floods and landslides can slow roads and services.