The Ultimate Nepal Travel Guide: 5 Things a Liverpool Pharmacist Wants You to Know Before You Fly

**1. Altitude is the headline risk on this trip, and there is no vaccine for it.**

We should say this before anything about needles. On the Everest Base Camp route you will sleep somewhere around 4,000-5,000m and stand at roughly 5,364m. On the Annapurna circuit you cross the Thorong La at about 5,416m. Acute mountain sickness is common at those heights - a large minority of trekkers get some form of it - and its two severe forms, high-altitude cerebral oedema and high-altitude pulmonary oedema, are uncommon but can kill within hours.

There is no injection that prevents any of this. That is an uncomfortable thing for a clinic to lead with, and it is exactly why we do. The thing most likely to end your trek, or hurt you badly, is the one thing we cannot vaccinate you against.

What you are watching for is a headache that will not settle, nausea, poor appetite, dreadful sleep, and being breathless at rest rather than just on the climb. The rules that actually save people are unglamorous: do not ascend to sleep higher while you have symptoms, and if you are getting worse, go down. Descent is the treatment. Nothing in your rucksack is a substitute for it.

**2. Your ascent profile is the real prescription, so bring the itinerary.**

Once you are above roughly 3,000m, the number that matters is how much higher you sleep each night, not how high you walk during the day. A gain of around 300-500m per night, with a rest day every third or fourth night or every 1,000m, is the shape of a profile that usually works. Trips get people into trouble when they are compressed to fit annual leave.

This is why we ask for the day-by-day plan rather than just the destination. Flying into Lukla puts you at about 2,860m before you have taken a step. Flying into Jomsom, or being driven high on the newer roads around the Annapurna circuit, does something similar from the other direction. Two treks that both say Nepal, 16 days on the brochure can carry very different amounts of risk.

If your operator has sold you a fixed itinerary you cannot change, say so at the appointment. It changes what is worth discussing, including whether medication has a place.

**3. Altitude prevention medication is a conversation, not a default.**

There is a prescription medicine used to reduce the chance of acute mountain sickness. In the UK it is prescribed off-label for that purpose, which is legitimate and routine but means it should come with a proper explanation rather than being handed over with the vaccines.

It is worth discussing when the ascent profile cannot be made gentle enough - a fixed group departure, a flight straight to a high start, a short trip - or when you have had altitude illness before. It is assessed individually: your kidney function, allergies, other medicines and pregnancy status all matter, and it has real side effects, including tingling in the fingers, passing more urine and a metallic taste to fizzy drinks. Several people every season decide, once they understand it, that they would rather fix the itinerary.

What it is not is a licence to climb faster, and it is not a treatment for the severe forms. If you develop cerebral or pulmonary oedema, the answer is descent and medical help, not another tablet.

**4. Kathmandu and the hills are not the Terai - and that split decides two vaccines.**

Japanese encephalitis is where we most often talk trekkers out of a vaccine. The mosquitoes that carry it breed around rice paddies and pig rearing, and in Nepal the risk sits in the southern lowlands, the Terai, mainly through the monsoon and into autumn. For a Kathmandu-plus-trek itinerary staying in the valley and the hills, it is generally not indicated. For a month in Chitwan or Bardia, a rural placement, or repeated long stays in the lowlands in the wet season, it moves onto the table - and because it is a two-dose course over 28 days, with an accelerated option for adults, it needs to be decided early rather than the week before you fly.

Malaria splits the same way. Nepal's malaria risk is low and concentrated in the Terai districts near the Indian border. There is essentially no malaria transmission at trekking altitudes, so the trek itself is not a malaria trip. For most Nepal itineraries the sensible answer is bite avoidance rather than tablets, and if anyone recommends antimalarials for Nepal without asking whether you are going to the lowlands and in which month, that is not a risk assessment.

One more geographic point: Nepal has no yellow fever of its own. A certificate can be asked for if you are arriving from or transiting a country with a risk of transmission, which catches a few people routing through Africa or South America. Yellow fever vaccine can only be given at a NaTHNaC-designated Yellow Fever Vaccination Centre - we will tell you if your route needs one and point you to the official register. Requirements change, so we check your exact route at the appointment.

**5. Rabies and the food-and-water basics matter more when help is days away.**

Nepal has a real rabies risk, and the exposures we hear about are the ordinary ones: dogs around Kathmandu and the villages, and monkeys at the temple sites where people stop to take photographs. The pre-exposure course does not make you immune. What it does is remove the need for rabies immunoglobulin after a bite, which can be very hard to obtain quickly in Nepal, and reduce the follow-up treatment to two doses. On a trek that is not an abstract convenience - you may be several days' walk and a weather-dependent flight from a clinic that can help.

Hepatitis A and typhoid are the baseline for almost every Nepal itinerary. You will be eating teahouse food and drinking treated water for weeks, and both infections travel by that route. Check your records first, though; plenty of people who have travelled before are already covered and do not realise it.

Worth adding: make sure your tetanus, diphtheria and polio booster is current, because trekking involves falls and cuts, and check you have had two documented doses of MMR. And plan how you will treat water. Travellers' diarrhoea ends more treks than any exotic infection, and dehydration at altitude makes everything else worse.

**The practical bit**

For a trek, come in 6-8 weeks before you fly if you can. Rabies and Japanese encephalitis are courses rather than single doses, and the altitude conversation is better had while your itinerary can still be changed. If you are closer than that, come anyway - accelerated schedules exist, and hepatitis A and typhoid begin working quickly.

Bring the day-by-day itinerary with sleeping altitudes, your internal flights, your travel insurance document so we can look at whether it actually covers trekking altitude and helicopter evacuation, your vaccination records, a list of your regular medicines, and any history of altitude illness. The clinic is run by an Independent Prescriber, so where medication is appropriate it is assessed, prescribed and dispensed in the same visit rather than sending you back to a GP. We are open weekdays to 6pm and Saturday mornings, and same-day appointments are usually possible with about two hours' notice.

This guide is written and reviewed by the pharmacists who run the clinic, against current NaTHNaC and UKHSA Green Book guidance. It is general information, not a personal recommendation - your own risk assessment happens at the consultation.

Guidance we work from

Frequently Asked Questions