Trimetazidine is an anti-ischaemic drug used for angina pectoris treatment. Recently, it has been shown that trimetazidine protects against hepatic ischaemia reperfusion injury. Several hypotheses have been proposed to explain the exact hepatoprotective mechanisms but they still remain unclear. This review assesses the possible mechanisms responsible for the increase of the liver’s tolerance against ischaemia-reperfusion injury with special emphasis on: (1) the prevention of oxidative stress and protection of mitochondrial function; (2) the generation of vasoactive mediators such as nitric oxide and endothelins; and finally (3) the preservation of liver energy metabolism.