The removal of Tricaine Methanesulfonate from water in a fixed-bed column packed with pyrolysed paper mill sludge was evaluated for application in Recirculating Aquaculture Systems. Breakthrough adsorption curves were determined for this pharmaceutical, under different operating conditions. In a laboratory-scale approach, with synthetic effluent, a bed adsorption capacity of 125mgg−1 was obtained under a flux of 56Lmin−1m−2, with 400mgL−1 of MS-222 with 4.5cm bed depth. The performance of the continuous adsorption in a column packed with biological paper mill sludge-based carbon, using real aquaculture wastewater as matrix, was not significantly affected. Then, scale-up was carried out and the bed depth service time model was applied and provided good predictions. Finally, the thermal regeneration of the exhausted adsorbent was assessed, which revealed satisfactory results for one cycle reusability after saturation; however, considering the nature of its precursor, the use of new adsorbent could be more profitable than its regeneration, functioning also as an additional option for the management of such wastes.