Trigonelline is a bioactive pyridine alkaloid that occurs naturally in high concentrations in coffee (up to 7.2 g/kg) and coffee by-products (up to 62.6 g/kg) such as coffee leaves, flowers, cherry husks or pulp, parchment, silver skin, and spent grounds. In the past, coffee by-products were mostly considered waste and discarded. In recent years, however, the use of coffee by-products as food has attracted interest because of their economic and nutritional value and the environmental benefits of sustainable resource use. Their authorization as so-called novel foods in the European Union may lead to increased oral exposure of the general population to trigonelline. Therefore, the aim of this review was to assess the risk to human health of acute and chronic exposure to trigonelline from coffee and coffee by-products. An electronic literature search was performed. Current toxicological knowledge is limited, with few human data available and a lack of epidemiological and clinical studies. There was no evidence of adverse effects after acute exposure. No conclusion can be drawn on chronic exposure to isolated trigonelline due to the lack of data. However, trigonelline ingested as a component of coffee and coffee by-products appears to be safe for human health, based on the safe traditional use of these products.