Fettuccine with Creamy Tomato Italian Sausage Sauce

Photography Credit: Elise Bauer

All I had to do was read the ingredient list of this recipe and my father was half-way out the door to the store to buy the fettuccine. Normally either one of “a pound of Italian sausage” or “a cup of whipping cream” is enough to pique his interest. Both together and the recipe takes on its own gravitational force. “Make me… make me..”

My father found this recipe in a back issue of Bon Appetit. It is rich, it is not for every day, but my oh my is it good, and so easy to make! The sauce comes together quickly with sweet and spicy Italian sausage, first cooked through then simmered with tomatoes and cream.

Fettuccine with Creamy Tomato Italian Sausage Sauce Recipe

  • Prep time: 6 minutes
  • Cook time: 45 minutes
  • Yield: Serves 6


  • 2 Tbsp olive oil
  • 3 shallots, chopped
  • 2 large garlic cloves, chopped
  • 1/2 pound sweet Italian sausage, casings removed
  • 1/2 pound spicy or hot Italian sausage, casings removed
  • 1 cup whipping cream
  • 2 14.5-ounce cans diced tomatoes in juice
  • 1 Tbsp dried sage
  • 3/4 pound fettuccine
  • 1/2 cup grated Parmesan cheese


1 Put a large pot of salted water on to boil (1 Tbsp salt for every 2 quarts of water). While the pasta water is heating, prepare the sauce in the next step.

2 Heat olive oil in a large sauté pan on medium heat. Add the shallots and garlic and cook, stirring frequently, until beginning to soften, about 3 minutes. Break up the sweet and spicy Italian sausages as you add them to the pan. Toss with the shallots, increase the heat to medium high, and cook until no longer pink, about 5 minutes. Stir in the cream and simmer for 5 minutes. Stir in the tomatoes, their juices, and the sage. Simmer for about 15 minutes, stirring occasionally, until the sauce thickens.

3 The pasta water should be boiling by now. After the sauce has simmered for about 5 minutes, add the pasta to boiling salted water and cook, uncovered at a rolling boil, until the pasta is al dente, cooked through but still a little firm to the bite. Reserve 1/2 cup of the pasta water and drain the pasta.

4 Toss the pasta with the sauce and add a little of the reserved pasta water if dish seems dry.

Season with salt and pepper and sprinkle with cheese to serve.

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Showing 4 of 77 Comments

  • Sylvia Cheng

    First time using your recipes. Substituted half & half for whip cream cause I had none. Simple to make and delicious! Look forward to trying others. Thanks!!

  • Sara

    Elise – I’ve been making this recipe for a few years! It really is the closest thing to my favorite pasta dish from a little Italian place in Portland from years and years ago. LOVE IT!

    I just wanted to post here because I found a trick when I make it last night that I wanted to share… I had 1/2 a pound of raw plain ground pork on hand leftover from another dish. It was just the 2 of us and I wanted to make this pasta so instead of going out and buying more sausage, I found a trick:

    I divided the raw (unflavored) pork into 2 bowls and sprinkled both with salt, pepper, garlic powder and onion powder. Then I made 1 bowl into spicy sausage (red pepper flakes, paprika, freshly ground fennel seeds, a pinch of cumin) and 1 sweet (basil, marjoram, oregano).

    The pork was pretty dense so I mashed each bowl with a fork along with olive oil for the spicy sausage and balsamic vinegar for the sweet until the spices were distributed evenly and the sausage had broken up.

    Then I cooked the 2 ground sausages for a few minutes separately before proceeding with the recipe.

    It worked perfectly, was a good use of what we already had on hand, and made a smaller portion than the full recipe! Just in case one doesn’t have both sausages on hand and can’t run to the store… :)

  • Cheryl Hanson

    Amazingly delicious! I had a similar dish in a restaurant years ago and haven’t found anything comparable since then. This is even better and I can make it myself. Can’t wait to prepare it for guests. I followed the recipe completely although I was curious about the use of sage–had only used it in Thanksgiving turkey stuffing. I took a risk and will never try to find a substitute. We love this!!

  • Noelle

    This was fantastic! Another hit from Simply Recipes. I can always count on SR for a great recipes. I made a few tweaks to it. I used one small onion instead of shallots and fresh basil instead of sage. I used a little over 1 pound of mild Italian sausage. I got rave reviews on it! I will definitely keep this recipe because it is quick, easy and just a few ingredients–mostly which I have in the pantry anyway. It is rich so it would be good for a special occasion dinner. My boyfriend said he can’t wait for me to make it again! I paired it with some homemade garlic bread and salad and it was perfect!

  • Roberta L

    I found this in a magazine a few years back and it’s been a big hit ever since,it’s quick, easy and absolutely delicious! I gave the recipe to my sister because she was looking for something different one nite for her and her husband and now she makes it all the time AND I gave it to a new bride for her bridal shower recipe! My husband & I are meat heads so I add an extra 1/2 lb of sausage and an extra clove or two of garlic. Yum!!

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