This paper presents a new correlation of Late and Middle Pleistocene fluvial sedimentary sequences in Greek, Libyan and Spanish river basins and evaluates river response to climate change over the Last Interglacial–Glacial Cycle. Over the past 200,000 years there have been at least 13 major alluviation episodes in the Mediterranean, although the amplitude, frequency and possibly, duration of these events varied significantly across the region. Parts of Oxygen Isotope Stage (OIS) 5 appears to have been periods of pronounced landscape change in many Mediterranean catchments with major river aggradation occurring at ~109–111 ka (during OIS 5d) and most notably at ~88 ka (OIS 5b/5a boundary). Other parts of OIS 5 appear to have been periods of relative fluvial inactivity. OIS 2 and 3 were both characterised by an apparent increase in the number of alluviation events, and this record of river behaviour parallels many other palaeoenvironmental records in the region which also show more frequent climate fluctuations between ~12 and 65 ka. There is evidence for a high degree of synchrony in major river aggradation events across the Mediterranean in catchments with very different sizes, tectonic regimes and histories. Climate-related changes in catchment hydrology and vegetation cover over the last 200 ka would appear to be the primary control of large-scale (catchment wide) sedimentation over time periods of between 10³ and 104 years.