We investigated the fate of Sb and As downstream of the abandoned Su Suergiu mine (Sardinia, Italy) and surrounding areas. The mined area is a priority in the Sardinian remediation plan for contaminated sites due to the high concentrations of Sb and As in the mining-related wastes, which may impact the Flumendosa River that supplies water for agriculture and domestic uses. Hydrogeochemical surveys conducted from 2005 to 2015 produced time-series data and downstream profiles of water chemistry at 46 sites. Water was sampled at: springs and streams unaffected by mining; adits and streams in the mine area; drainage from the slag heaps; stream water downstream of the slag drainages; and the Flumendosa River downstream from the confluence of the contaminated waters. At specific sites, water sampling was repeated under different flow conditions, resulting in a total of 99 samples. The water samples were neutral to slightly alkaline. Elevated Sb (up to 30 mg L⁻¹) and As (up to 16 mg L⁻¹) concentrations were observed in water flowing from the slag materials from where the Sb ore was processed. These slag materials were the main Sb and As source at Su Suergiu. A strong base, Na-carbonate, from the foundry wastes, had a major influence on mobilizing Sb and As. Downstream contamination can be explained by considering that: (1) the predominant aqueous species, Sb(OH)₆ ⁻ and HAsO₄ ⁻², are not favored in sorption processes at the observed pH conditions; (2) precipitation of Sb- and As-bearing solid phases was not observed, which is consistent with modeling results indicating undersaturation; and (3) the main decrease in dissolved Sb and As concentrations was by dilution. Dissolved As concentrations in the Flumendosa River did not generally exceed the EU limit of 10 µg L⁻¹, whereas dissolved Sb in the river downstream of the contamination source always exceeded the EU limit of 5 µg L⁻¹. Recent actions aimed at retaining runoff from the slag heaps are apparently not sufficiently mitigating contamination in the Flumendosa River.