The Koshi river basin is a sub-basin of the Ganges shared among China, Nepal, and India. The river system has a high potential for investment in hydropower development and for irrigation in downstream areas. The upper part of the basin contains a substantial reserve of freshwater in the form of snow and glaciers. Climate variability, climate change, and climate extremes might impact on these reserves, and in turn impact on systems that support livelihoods, such as agriculture, biodiversity and related ecosystem services. Climatological variability and trends over the Koshi river basin were studied using RClimDex. Daily temperature data (20 stations) and precipitation data (50 stations) from 1975 to 2010 were used in the analysis. The results show that the frequency and intensity of weather extremes are increasing. The daily maximum temperature (TXx) increased by 0.1 °C decade−1 on average between 1975 and 2010 and the minimum (TNn) by 0.3 °C decade−1. The number of warm nights increased at all stations. Most of the extreme temperature indices showed a consistently different pattern in the mountains than in the Indo-Gangetic plains, although not all results were statistically significant. The warm days (TX90p), warm nights (TN90p), warm spell duration (WSDI), and diurnal temperature range (DTR) increased at most of the mountain stations; whereas monthly maximum and minimum values of daily maximum temperature, TX90p, cool nights (TN10p), WSDI, cold spell duration indicator (CSDI), DTR decreased at the stations in the Indo-Gangetic plains, while the number of cold days increased. There was an increase in total annual rainfall and rainfall intensity, although no clear long-term linear trend, whereas the number of consecutive dry days increased at almost all stations. The results indicate that the risk of extreme climate events over the basin is increasing, which will increase people's vulnerability and has strong policy implications.