Fettuccine with Creamy Tomato Italian Sausage Sauce

Quick and EasyItalian SausagePasta and Noodles

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

Photography Credit: Elise Bauer

Featured in 14 Recipes That Make the Most Canned Tomatoes

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.

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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 tablespoons extra virgin 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 tablespoon dried sage
  • 3/4 pound fettuccine
  • 1/2 cup grated Parmesan cheese


1 Heat water for pasta: 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 Cook shallots and garlic: 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.

3 Add Italian sausage: 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.

4 Stir in the cream and simmer for 5 minutes.

5 Stir in the tomatoes, their juices, and the sage. Simmer for about 15 minutes, stirring occasionally, until the sauce thickens.

6 Cook the pasta: 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.

7 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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Elise Bauer

Elise Bauer is the founder of Simply Recipes. Elise launched Simply Recipes in 2003 as a way to keep track of her family's recipes, and along the way grew it into one of the most popular cooking websites in the world. Elise is dedicated to helping home cooks be successful in the kitchen. Elise is a graduate of Stanford University, and lives in Sacramento, California.

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85 Comments / Reviews

No ImageFettuccine with Creamy Tomato Italian Sausage Sauce

Did you make it? Rate it!

  1. Kara

    I loved it! 3 days later I’m still enjoyng it for lunch, each day I add just a bit of heavy cream to moisten it YUM! I used hot sausage only and put in a shake of Worcestershire sauce. I also used penne pasta. Thank you once again for sharing your recipes!


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  2. Dana

    I’d forgotten about this recipe and was so glad I rediscovered it. Easy and delicious! I used all hot Italian sausage.


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  3. Kathleen Hulsy

    I devised and made this recipe for Bon Appetit in 2000. Thrilled to know it’s been a hit and people are enjoying it. I’ve just made the sauce this morning for my family. Thanks for the accolades – made my day!!.

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  4. Corinne

    Just made your dish for school for my cooking class and I found two issues for me. First was the three shallots, which I looked up and each bulb is 1 shallot (A general rule of thumb is that “one shallot” refers to one shallot bulb, regardless of how many cloves are inside once it has been cut). My second issue was the amount of sage, your recipe called for 1 tablespoon of dried sage which I added to my sauce and unfortunately killed my sauce, it made it too strong. I am no cook so I followed your recipe to a T. After messing it up I was looking at the comments to see if anyone else made the same mistakes and I saw your comment regarding the shallot, you said “I would say that each half counts as one”. In the future you may want to revise your recipe for beginners like me. I will try again in the future as it did look very good.

  5. 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!!

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