This study investigates the long-term trends (1992–2022) of nitrogen and phosphorus loadings exported by the River Po to the Adriatic Sea, to better analyse how changes in hydrology are affecting the timing and magnitude of river nutrient loads. We used 30 years of monitoring data in order to (a) identify the main temporal patterns and their interactions at a decadal, annual and seasonal scale, (b) estimate precipitation effects on load formation and evaluate whether and to which extent the hydrological regime affects nutrient export across the years and (c) analyse the nutrient export regime at a monthly scale and the main transport dynamic of N and P chemical species (hydrological vs. biogeochemical control). The long-term analysis shows a general decrease of both P and N loadings, but the trends are different between the elements and their chemical species, as well as undergoing different seasonal variations. We found a statistically significant relationships between precipitation and loads, which demonstrates that precipitation patterns drive the exported load at the intra- and interannual time scales considered in this study. Precipitation-induced load trends trigger seasonal changes in nutrient deliveries to the sea, peaking in spring and autumn. The nitrogen decrease is mainly concentrated in the summer dry period, while total phosphorus diminishes mainly in spring and autumn. This mismatch of N and P results in variable molar N:P ratios within the year. The effects of extreme drought and flood events, along with the progressive decrease in the snowmelt contribution to water fluxes, are expected to exacerbate the variability in the N and P loadings, which in turn is expected to perturbate the biodiversity, food webs and trophic state of the Northern Adriatic Sea.