We present the longest-duration directly dated terrestrial palaeoclimate record from the western Mediterranean region: a flowstone speleothem from Gitana Cave, southeast Spain. The main phase of growth was 274 to 58 ka, dated by multi-collector inductively coupled plasma mass spectrometry (MC-ICPMS) U-series methods. Effective precipitation, which we consider primarily responsible for flowstone calcite δ13C variations, measured at 300 μm resolution, was higher during interglacials associated with marine oxygen isotope stages (MIS) 7 and 5, and lower during glacial MIS 6. There is a close correspondence between speleothem δ13C and sea surface temperature (SST) estimates from adjacent Atlantic Ocean cores during MIS 6, which implies that oceanic conditions are critical in controlling the western Mediterranean terrestrial moisture balance during glacial periods. Other features of our record, such as the sequence of termination II warming/moistening between approximately 133 and 127 ka, including a "pause" around 130–128 ka, and the lagged termination of MIS 5 warm intervals (5e, 5c and 5a) are similar to other terrestrial records within the Mediterranean basin, indicating climate synchroneity along the northern Mediterranean coast. The Gitana cave region also may have been a refugium for temperate species during short-lived cold/arid periods during MIS 5.