MXenes, representing a new class of two-dimensional nanomaterial, have attracted intense interest in a variety of fields as supercapacitors, catalysts, and sensors, and in biomedicine. The assessment of the safety of MXenes and related materials in biological systems is thus an issue that requires significant attention. In this review, the toxic effects of MXenes and their derivatives are summarized through the discussion of current research into their behaviors in mammalian cells, animals and plants. Numerous studies have shown that MXenes have generally low cytotoxicity and good biocompatibility. However, a few studies have indicated that MXenes are toxic to stem cells and embryos. These in vitro and in vivo toxic effects are strongly associated with the dose of material, the cell type, the mode of exposure, and the specific type of MXene. In addition, surface modifications alter the toxic effects of MXenes. The stability of MXenes must be considered during toxicity evaluation, as degradation can lead to potentially toxic byproducts. Although research concerning the toxicity of MXenes is limited, this review provides an overview of the current understanding of interactions of MXenes with biological systems and suggests future research directions.