The trypanosomatid-induced diseases are considered as neglected, because the countries where they kill people are not important markets for western big pharmaceutical companies. However, recently some effort has been made to translate the use of already known drugs to neglected infectious disease. Although many metals are essential to life, many disorders affecting metal homeostasis and bioavailability are responsible for several human diseases. Metals can be toxic even at very low concentrations and semimetals are classified as toxic and dangerous for the environment. However, metal- and metalloid-based therapeutic drugs have existed for centuries. Some of them, as antimony and arsenic compounds, are still the first line drugs used for the treatment of leishmaniasis and trypanosomiases in developing countries. Other metal complexes (as those of Ag, Pt, Pd and Au), already present in the market for cancer therapies or to cure bacterial infection or for anti-inflammatory treatments, have been proposed also against the vector-borne infections caused by trypanosomatids. The use of novel approaches based on nanotechnologies, allowing selective targeting, may represent a promising strategy to decrease the toxicity of these drugs.