Climate change poses critical threats to water-related safety and sustainability in the Mekong River basin. Hydrological impact signals from earlier Coupled Model Intercomparison Project phase 3 (CMIP3)-based assessments, however, are highly uncertain and largely ignore hydrological extremes. This paper provides one of the first hydrological impact assessments using the CMIP5 climate projections. Furthermore, we model and analyse changes in river flow regimes and hydrological extremes (i.e. high-flow and low-flow conditions). In general, the Mekong's hydrological cycle intensifies under future climate change. The scenario's ensemble mean shows increases in both seasonal and annual river discharges (annual change between +5 and +16 %, depending on location). Despite the overall increasing trend, the individual scenarios show differences in the magnitude of discharge changes and, to a lesser extent, contrasting directional changes. The scenario's ensemble, however, shows reduced uncertainties in climate projection and hydrological impacts compared to earlier CMIP3-based assessments. We further found that extremely high-flow events increase in both magnitude and frequency. Extremely low flows, on the other hand, are projected to occur less often under climate change. Higher low flows can help reducing dry season water shortage and controlling salinization in the downstream Mekong Delta. However, higher and more frequent peak discharges will exacerbate flood risks in the basin. Climate-change-induced hydrological changes will have important implications for safety, economic development, and ecosystem dynamics and thus require special attention in climate change adaptation and water management.