Large cardamom contributes significantly to the household and regional economies in the Eastern Himalayas of the Indian sub-continent, and to the national economy as well. This paper aims to assess the dynamics of large cardamom production, marketing, and trade in Bhutan, Nepal, and India. The assessment is based on data compiled through several government statistics and publications. A brief field visit was also conducted in Birtamod, Nepal, in September 2017. Nepal and India are suffering a loss in their cardamom yield due to disease infestation, poor crop management (including aged plantation), and changing climate. India has a fairly organized market for large cardamom facilitated by the Spices Board India, where its price is set through auction. The system of advance payment to the farmers would cause stress for farmers to sell their produce at a lower price. Price volatility remains the major concerns in the marketing and trading of large cardamom. Differential provisions in inter-country trade is restricting the market and trade of large cardamom produced in the region. Similarly, the adulteration of large cardamom with “false cardamom” remains the major threat to large cardamom production in the Eastern Himalayas. The product-specific data suggests more than 80 percent of large cardamom exported from India goes to Pakistan, suggesting Pakistan to be the biggest global market for the large cardamom produced in the Indian sub-continent. Production constraints—specifically, diseases; poor agronomic practice and inefficient curing in traditional way; marketing constraints through price supports and packaging with geographical indications; and trading constraints, such as custom and phytosanitary barriers in inter-country trading, improper identification of the international market, and adulteration issues need to be addressed urgently for the sustainability of large cardamom production in the Eastern Himalayas. This will be critical for improving the welfare of thousands of small households in the region.