The Mediterranean Sea is the biggest marginal sea of the Earth and is at the centre of the life for several millions of people. Seafood is consumed widely in this region, with an average of 16.5 kg/capita/year, and one-fourth of the seafood supply comes from aquaculture activities. The Mediterranean aquaculture sector has expanded in recent decades. Production increased by 77% over the past decade reaching about 1.3 million metric tonnes in 2009. The total value of production was around 3700 million US dollars, representing 3.4% of the value of global aquaculture production. The growth of seafood demand in the Mediterranean is expected to increase in the future, especially in southern countries. Yet, during the 21st century, the Mediterranean basin is expected to observe: (i) an increase in air temperature of between 2.2°C and 5.1°C; (ii) a decrease in rainfall of between 4% and 27%; (iii) an increase in drought periods related to a high frequency of days during which the temperature would exceed 30°C; and (iv) an increase of the sea level of around 35 cm and saline intrusion. Moreover, extreme events, such as heat waves, droughts or floods, are likely to be more frequent and violent. This paper reviews the present status of Mediterranean aquaculture (e.g. production trends, main farmed species, production systems, major producing countries), the most relevant impacts of climate change on this sector (temperature, eutrophication, harmful algae blooms, water stress, sea level rise, acidification and diseases) and proposes a wide range of adaptation and mitigation strategies that might be implemented to minimize impacts.