Fettuccine with Creamy Tomato Italian Sausage Sauce

Fettuccine pasta with a rich and creamy, tomato and Italian sausage sauce. Absolute crowd pleaser.

  • 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.

Click on the comments you'd like to print with your recipe. Grayed out comments will not print.


  • Stephenie

    I made this dish for my boyfriend, who is somewhat weary of any dish that is too heavy. He loved this dish! So did I for that matter. I was told from my roommate, who had the leftovers, that the dish looked and tasted like something that she gets from the Italian restaurant she works in. I’ll be making this again for sure!

  • Lisa Forsyth

    My Husband loved this! He had the leftovers for lunch the following day and he hates leftovers. Excellent!

  • Chip

    As the lucky beneficiary of this sausage-cream gravitational force, I can vouch for its goodness (and for its affinity with full-bodied red wine, several glasses of which do tend to make me talk more than usual about stone fruit). I’ll look forward to a pluot tart recipe this summer.

  • Nicky

    Delectable dish! I used a pound of ground sweet Italian sausage for a milder flavor, and it was superb. Grilled asparagus and White Merlot rounded out the goodness. Great site!

  • Denise

    This is one of my “signature” dishes and everyone who has tried it, LOVES IT!!! I got it from allrecipes.com a few years ago. I sometimes add “italian” seasoning to the mix and it comes out great! Another WINNER Elise! Keep them coming!!!

    p.s. Love you, your family and your site! :-)

  • Trig

    While the French make food beautiful through complexity, the Italians make it more beautiful through simplicity. Tonight on BBC’s Masterchef programme the likely winner Hannah, who had cooked over-elaborate dished in previous rounds, was sent to an Italian restaurant to learn how to cook a great dish with only four ingredients. Truly inspirational!

  • Mojohand

    I’d be worried about the garlic burning. Wouldn’t you cook the sausage first, moving it the edge of the pan and then adding first the shallots, and then the garlic? Just quibbles, tho, this looks like a great recipe; I bought the ingredients yesterday.

  • Jan

    I made this recipe Saturday afternoon and it is wonderful! I did make it without the garlic, as my boyfriend is a garlic-hater. It is absolutely, without a doubt, the easiest and most flavorful dish I have made in a very long time. From this moment forward, this fettuccine will be one of my signature dishes. Thank you, thank you, thank you!!!

  • Cristina

    I am not a huge fan of fetuccine, so I substituted penne and it was divine. Your recipes are always so easy and so good!

  • Jen Gonzalez

    I made this dish for my fiance, who is the world’s pickiest eater. He took one bite, looked at me and said, “I knew I was marrying you for a reason!” It is absolutely delicious, and makes great leftovers. Thank you, thank you, thank you!

  • Sandy

    This is so easy and sinfully delicious. My daugher-in-law made it for dinner and everyone asked for the recipe. It’s a keeper!! Even the little ones gobbled it up.

  • Linda

    Your website has become my cooking bible. I just recently moved in with my significant other and have had to do a crash course approach to cooking dinner. thank you for this recipe – it was delicious! the only thing was that there was a little water-y; if I had added the pasta water, this would’ve been too water-y. Any ideas why it came out so water-y?

    Thank you!

  • Elise

    Hi Kevin – regarding changing the proportions of spicy to sweet sausage, go for it! Reduce the amount of spicy sausage if you don’t want the result to be as spicy.

    Hi Mojohand – cook the garlic anyway you want. This recipe is a guideline, not a hard and fast rule. We had no problem with cooking the garlic and shallots first.

    Hi Linda – If the sauce was too watery, it just needed to be simmered longer, until enough water evaporated from the cooking so that the sauce had thickened.

  • Tawnia

    This was wonderful. I did not have cream on hand but I did have sour cream, so I used that with a dab of milk and…..oh yeah, this was great. My ten year old son is somewhat picky and he proudly announced this as a keeper. Thanks.

  • bob groove

    This turned out great! I use your site all the time for new ideas. Thanks so much and please keep it up!

  • Jeeves

    I just made this and it was great!
    It’s such an elegant flavour without hours of work. I went with the sweet sausage mostly, but now I wish I had put more spicy sausage in.

  • Jim

    Oh-my-god! This was so good, I almost cried! I used one can of Mexican style tomatoes and 1 can of Italian style tomatoes, 3 cloves of garlic. The sage, the sage, the sage…

  • Gloriana

    Love this recipe. Have made it twice to rave reviews…my boyfriend can’t get enough of this! The first time I had no shallots so I used onion instead. The second time I did have shallots so I used those and also added mushrooms and a bit of wine. Wow! Thanks again, Elise for ANOTHER great recipe. You make me look good :)!

  • Christopher

    I absolutely love this recipe! I have made it about 6 times and each time I add my own little flavor.

    One tip that I will say about this recipe is DO NOT FORGET THE SAGE! You will notice that it is missing and it adds that little extra “zing”.

    I always double up on this recipe as well since there is never any left. When I double up, I have some leftovers for lunch the next day (yummy).

    I tend to leave out the shallots as they are pretty potent and cannot chop them up. I end up crying for 3 hours, lol!

    Another thing I like to do is get the “flavored” diced tomatoes. The Italian is superb with this dish and really brings out the flavor. And I only use the spicy sausage.

    For some extra flavor, try adding spices to your noodles while they boil! I like sea salt with garlic.

  • Joanne

    I saw this recipe too and ran out to buy the ingredients. It was absolutely DELICIOUS!! I added a cup of spinach for some extra colour and umph!! Kids loved it! Just used mild tho!

  • Amber

    Yum. Can’t wait to eat this again for lunch tomorrow.

  • Miguel

    Just cooked it again this weekend, loved it. Better this time around as it simmered for a longer time, reducing the sauce does make a difference. Having leftovers tomorrow for lunch :)

  • Dev

    I loved this recipe so much that I made it twice in one weekend. The only change was that I used only sweet sausage and light cream. Yum!

  • Stephen

    Anything with Italian sausage (hot or sweet) and heavy cream and pasta is a must try. I’ve made a similar recipe and have added grilled eggplant as a side dish (which ended up being mixed in with the sauce from the pasta/sausage/heavy cream recipe).. Add a bit of hot pepper flakes for a real “bite”

  • Cristina

    Wow!! Yummy Yummy in my tummy!!!! A+

  • Martina

    I made this tonight with your bruschetta and it was YUM-MY! Even my mother who hates sausage really liked it. I substituted the shallots for a large sweet onion and I used all sweet sausage instead of 1/2 sweet and 1/2 spicy. This one’s definitely a keeper! Thanks a bunch!

  • Connie G.

    INCREDIBLE!! I use fresh sage (even the Utah winters cannot seem to completely kill off my sage). It takes the recipe one step further, if possible! I have just recently started to follow this site and I LOVE it! Thanks!

  • Lindsay

    I made this the other night, it was delicious but I had to do the shallots/garlic twice because they burned the first time. Any tips on avoiding this? Start out on a lower heat perhaps? And what kind of pan is best? I think my pot might’ve been a part of the problem. It was amazing though and so easy! Thanks!

    I burn garlic all the time. I think the best thing to do is to pay attention while cooking and not look away. You can also lower the heat. ~Elise

  • cynthia

    Wow! My family loved it. A bottle of wine, Kalamata bread & tomatoes & mozzarella salad goes beautifully with this dish!

  • Shigeru

    This looks fantastic! I have a question though, since I’m not familiar with sausages, but is it possible to make it with only sweet sausages? I have some people who can’t eat spicy and I’m not sure if they’d be able to take spicy sausages :)

    Sure, if you don’t like spicy sausage, use sweet. ~Elise

  • Lynae

    I just made this earlier today for my fiance’s parents, as a quick lunch. It was great! I had leftover spaghetti noodles so I used that instead. I also added a bit more cream than called for, threw in some mushrooms, and used 1/3 of an onion instead of shallots. I didn’t have any sage, but I did have some fresh oregano–I was going to add just a pinch, but accidentally added much more and couldn’t fish it out. I was worried it would ruin the flavor, but it was delicious!

  • Bronn

    I’ve raved about this recipe to many people I work with at a big grocery store, and it has become a massive hit. One of my bosses calls it “crack in a pan”, and I agree. Its a favorite around here, and I have to resist making it more, or it will lose that “special dinner” feel.

    I also gave a link to this to a friend in the US (I’m in Canada) and when his girlfriend showed it to him, he “tried to drown himself in drool”. They’ve since made it multiple times and love it.

    While I wouldn’t want to change a thing, the only question I have would be if you’ve tried it with a lighter cream and turkey italian sausage to lower the fat content, and how it may have affected the taste.

    Other than that, I love this recipe. Absolutely delicious!

  • Laine

    Omigosh! I just remembered this recipe and made it tonight for dinner – YUMMM!
    Elise, have you tried freezing this one? I’m thinking it would make perfect weekday lunches if I can freeze it in individual portions…

    Haven’t tried freezing it. If you do, please let us know how it turns out. ~Elise

  • Joanna

    Oh, I am totally okay with archive updates when they look like this! In college, we had a pasta bar at lunch where they cooked the pasta one serving at a time and then topped it with sausage and your choice of a heavy white alfredo-ish sauce and a sort of bland tomato sauce. Neither of the sauces were great on their own, but I always asked for them mixed together, and the combination was great. This creamy tomatoey sausagey sauce looks like the grown up version of my favorite college pasta, I will have to give it a try!

  • grace

    Funny, I made something nearly identical for dinner last night, only using cavatappi, instead of fettuccine. I make “rosa” sauce all the time, except I use canned, evaporated milk in place of the cream. It works beautifully~ with less fat and more affordable than fresh cream. Plus, I always have it on hand.

    I did use turkey sausage in mine, then added a sprinkle of crushed red pepper.

    Love your blog. Thanks for all the inspiration!

  • Regina Barnhart

    Darn you, Elise! I was doing well on my diet before I found your site… since then, I’ve been making all these wonderful foods that I can’t get enough of!!! (Sausage Ricotta and Spinach stuffed shells, anyone?!?!)

    I may have to play with this to see if I can get the calorie count lower – turkey sausage, whole wheat pasta, etc.

    But sausage, cream, and pasta…. yummmmmm

  • The Duo Dishes

    Everything in this dish is just what we like.

  • Denise

    A version of this recipe has been in my repertoire for at least 9 years now. We LOVE it. It is a great comfort type dish to make for family as well as friends. We like ours with Bowties but everything else is the same. The BF is out of town so I’m having some girlfriends over for dinner and I think this is what I’m going to make. :) I promised him that I’d have HMO (great recipe from Elise) ready for him when he comes home – that is his “Elise” favorite right now! Thanks Elise!

  • Hélène

    I made a similar version, last night, and it was delicious. Used only spicy Italian sausage. We like spicy food.

  • Sarah @ Short Stop

    I think I tried to comment on this one, and forgot to post it – so sorry if this is a duplicate.

    This looks FANTASTIC!! I LOVE pasta dishes – just posted my favorite today. Can’t get enough!

    SO glad I found your site. I love finding fellow foodies!

  • Jan

    I make this using penne pasta and I add a
    splash of red wine and use basil instead
    of sage. I will try it with the sage next
    time. Very good recipe.

  • Treehouse Chef

    I have been craving pasta and this looks fabulous!

  • Teresa

    I’m making this for dinner tomorrow night. I just picked up all the ingredients. We’re really looking forward to it. Thanks!

  • Anna

    Oh, anything with sausage looks great to me! I love it when you pull things from the archives because this old favourites deserve the attention too.

  • Morgan Painvin

    Elise, you are my new secret weapon! I cooked this last night for my husband, and he loved it. Yummm! Thanks.

  • Laine

    This is such a great recipe! I found it in the archive back in January, and it was an instant hit with my family. We made it again last week and raved about it at work the next day – so one of our co-workers is making it for his family tonight. Thanks Elise, from both families.

  • Sandra

    This has become a regular star in my lineup since I originally found it a couple of years ago. One recommendation… have on hand a nice chewy slice of french bread for dipping into the sauce and “testing” while you’re cooking. I could eat it like that without the pasta!

  • Dee

    Would turkey sausage be a decent substitute for those of us who do not eat pork? Any suggestions?

    Sure, should work fine. ~Elise

  • Ava Lee

    I have always love this recipe. This is my special “when friends come over” recipe and it is without fail, always a hit.

  • JOAN

    Are you trying to kill us or make us all fat? Yes, it sounds wonderful, but a pound of sausage AND a cup of cream? Oh, and let’s not forget the cheese and the pasta.

    No thanks to this recipe, unless it is an extra special occasion.

    I would say don’t knock it till you’ve tried it. That and don’t eat the whole recipe all by yourself. ~Elise

  • Bug

    A pound of sausage, and a cup of cream etc. among how many servings? The recipe says 6. It’s not like this is for one person. That makes it 2.6 ounces of sausage per serving, and 2.6 tablespoons of cream per serving. Hardly excessive.

    It seems to me that one always has to take servings into consideration and not have fits over the absolute amounts any given recipe calls for.

    Having ranted, I’ll add that I made this last night and it’s delicious! I’m looking forward to leftovers tonight. :)

  • Brenda

    Had my husband make this last night. Big hit! I took half the left overs for lunch today!

  • TM

    I made this yesterday and it was delish. This one goes in the recipe book.

  • Marilyn

    Waited to make this dish on Sunday, it was just wonderful,my husband and another friend were just in from marching in the St. Patrick’s day parade in Boston, not exactly irish faire but they really enjoyed it with a wonderful tossed salad. Used all sweet sausages and skipped the sage and it was just great, will make it often.

  • Reena

    I made this for my husband last night and he gobbled it up! I added 1 serrano chilli to the sausage and ended it with some fresh cilantro as garnish, so it ended up becoming an Indo Italian pasta :). I’m going to make this at least once a month. love it. love it!

  • Charlynne

    Thanks for the wonderful (and super easy and quick) recipe! I made this on a weeknight (using only spicy sausage, as that’s what was on hand) and it was wonderful! This will be a weeknight staple in our household.

  • Emily

    This is a great simple recipe. Thank you! I have made it twice in the last week; the first time a double batch which I shared with a couple of friends, and the second time had friends over to share. Many people have eaten it and they all love it. I added lots of oregano and the last of the basil frozen from the summer.

  • Adam Gibbons

    Hey Elise, I think alot of your recipes are very nice, although with this one, I feel that maybe it would be better with a far richer tomato sauce, similar to a recipe for cream of tom soup but obvious reduced to a thicker consistancy and not pureed.

  • Heidi

    Yum! A solid weekday meal that makes great leftovers, but not something that made me go WOW. Mine wasn’t as colorful as yours seems, perhaps a little tomato sauce and greens would liven it up a bit.

  • Kay

    Thanks for sharing this recipe. I made it tonight and it was simple yet tasty. I added half a sweet pepper to it for more vegetables. Just wondering, what can I use instead of sage? My elder son is not too crazy about the flavor. Probably due to the slight bitter after taste.

    I would try dried basil if he doesn’t like sage. ~Elise

  • Kay

    Hi Elise, one of your readers wondered about using a lighter cream in this recipe. I made the dish again tonight and used half-n-half (10% fat) instead of whipping cream. The sauce didn’t thicken up so I added 1 tsp of cornflour (mixed with 1 tsp water) and it did the trick. Can’t really comment on whether it tastes the same as I used different sausages and herbs this time but it tasted good to me!

    Thanks for letting us know! ~Elise

  • Laine

    Last time I made this, I froze some of the leftovers to see how it would fare (yes there were leftovers, but only because there were only two of us for the first go-round ;-)
    I defrosted by moving the container from the freezer to the fridge the day before I wanted it. It needed a tiny bit of additional liquid. As with most pastas, the fettuccine texture wasn’t quite like the first day it was cooked, but overall this dish was still quite good. Love this recipe, so does everyone else I share it with.

  • Betsy

    I made this tonight and it is such a keeper! Half recipe made enough for four. We both loved it! Thanks, Elise.

  • Christine

    I made it for my fiance and he just loved it! So easy and oh so delish!

  • Elsa

    Extreme deliciousness.

  • Betsy

    I made this for the third time yesterday and brought it to my daughter’s family. They all thought they died and went to heaven! I did not use the extra pasta water, used light cream, and rottini rather than fettucine (easier to serve). Thanks, Elise.

  • athina

    This recipe is divine….I like using orechiette shaped pasta (little ears) as they seem to hold little pools of the wonderful sauce….cream, tomatoes, sausage…so delicious. This is one of my favorite pasta dishes, thanks Elise!

  • athina

    Only change/recommendation I would make, is to add the garlic AFTER the sausage and shallots are browned- nothing worse than browned/burnt garlic!(which really couldn’t be avoided if cooked according to the directions)otherwise, absolutely delicious! One of my favorites.

  • Courtney

    Since making this recipe several months ago, it has become one of my husband’s favorites! I dice up carrots and broccoli (blanch them beforehand) and then throw them in near the end. Makes me feel a little better about getting some veggies…and they add a great crunch!

  • Daniel

    Do you think it may be possible to change the sage with summer savory? Just the aroma of the savory seems it would blend nicely? Dan

    Perhaps. If you try it, please let us know in the comments how it turns out for you. ~Elise

  • Sarah

    Hi Elise,
    Im not a big fan of sweet Italian sausage, so I was wondering if this would still be good if I changed it up a bit, like chorizo instead of Italian sausage and rice instead of fettuccine? Or maybe you know some good variations of this recipe? I’m kind of new to cooking but I just thought I would ask.

    Hi Sarah, everyone’s taste is different. Usually I try to make a recipe as given first, then change it to adapt it to my taste. You should feel free to experiment as much as you want with this recipe, it’s just a guideline. As for chorizo and rice, try it if you want! I love the recipe as is, so wouldn’t make changes personally. ~Elise

  • Sherry

    This recipe was great!!! Thank you. The family enjoyed it. We substituted the Italian sausage with hot & sweet turkey sausage. All in all the meal was great!

  • Amanda

    Delicious recipe! Next time, though, I will add some more spice to it :). Thanks Elise, for a great recipe! My husband thoroughly enjoyed it.

  • Karin

    I made this dish tonight. It was FABULOUS! My 18 month old son loved it.I do have a question about shallots. When you buy one, it has two halves. So is this considered one shallot or two? It is probably a stupid question, but it does make a difference in a recipe. Just love this dish. I have a similiar recipe and it has a bit of vodka in the sauce, but love this one better. Thanks for doing what you do.

    Great question, I would say that each half counts as one. Another way to think about this is assume one shallot = 1 tablespoon of minced shallot. ~Elise

  • Karin

    Tonight I had the leftovers of this dish from a couple of nights ago.Oh my goodness, it was even better. We just loved it. It is a super dish to make for company the day before,and just warm it up before they arrive. Wow! FANTASTIC.

  • Miata

    I am a complete novice when it comes to the kitchen, but thanks to a chemistry degree I can at least follow directions. I made this dish (and the Kahlua brownies) for a potluck dinner at school. Let’s just say it didn’t last long. However, it was a little too creamy for my taste. And, due to my West Indian upbringing, I needed a little more of a punch.

    On my 2nd attempt, I halved the cream, added black pepper (which I completely forgot to do the first time), and added some hot pepper sauce. DELICIOUS!!!!! Definitely a keeper. Thanks, Elise!

  • Rhonda Taylor

    Wow. I loved this. Will definitely make again.

  • Hope

    This turned out exactly as it should have. Delicious. I felt like I had just made a restaurant quality dish-even thought it was incredibly easy to make! I’m new to this site, and have selected it as a source for my recent cooking. What I love is that the directions are perfectly laid out and are simple to follow. I’ve tried to follow many recipes (I am an artist but have no creativity whatsoever in the kitchen) and have failed miserably. This is the 2nd dish (the first was your delicious Chicken Piccatta) I have made and have had complete success with. Thanks for the great recipes!

  • Leighland Dias

    I just made this for my father for Father’s Day! He and my family plus the extended family LOOOOVED it! They’re all true italianos too!! Thanks for the recipe!

  • WL

    I just made this dish tonight, it was fabulous!! My husband who typically doesn’t like tomato-based pasta sauces took one look and HAD to eat it:-) He loved it and so did I. I think the whipping cream made the difference!

  • John

    I made a variation on this and it was astounding! I had the split cherry tomatoes from our long summer’s tomato plant; added a bit of milk since we were short on cream, put a bit of cheese in the sauce, and had pretty-fresh basil on hand and used that instead of sage. NUMMY!

  • Jennifer D.

    I have made this dish probably about 10 times now, and everyone loves it every time. Such a keeper! Thanks so much for posting.

  • 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!!

  • 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!

  • 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!!

  • 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… :)

  • 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!!