The bioregeneration of activated carbon (AC) in biological activated carbon (BAC) systems is limited by sorption-desorption hysteresis and transport between the adsorbent and biomass. In this study, we investigated these limitations and whether a biofilm covering the AC surface is required. Consequently, BAC reactors were operated at different shear stress and AC surface smoothness, since this may affect biofilm formation. The experiments were carried out in BAC and blank reactors treating synthetic wastewater containing the pharmaceutical metoprolol. After start-up, all reactors removed metoprolol completely; however, after 840 h the removal dropped due to saturation of the AC. In the blank reactors, the removal dropped to 0% while in the BAC reactors removal recovered to >99%, due to increased biological activity. During the initial phase, the metoprolol was adsorbed, rather than biodegraded. At the end, the AC from the BAC reactors had higher pore volume and sorption capacity than from the blank reactors, showing that the AC had been bioregenerated. At high shear (G = 25 s(-1)), the rough AC granules (R-a = 13 mu m) were covered with a 50-400 gm thick biofilm and the total protein content of the biofilm was 2.6 mg/gAC, while at lower shear (G = 8.8 s(-1)) the rough AC granules were only partly covered. The biofilm formation at lower shear (G = 8.8 s(-1)) on smooth AC granules (R-a = 1.6 mu m) was negligible. However, due to the presence of suspended biomass the reactor performance or bioregeneration were not reduced. This showed that direct contact between the AC and biomass was not essential in mixed BAC systems. The microbial analyses of the suspended biomass and the biofilm on AC surface indicated that metoprolol was mainly biodegraded in suspension. (C) 2017 Elsevier B.V. All rights reserved.