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

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 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.

Hello! All photos and content are copyright protected. Please do not use our photos without prior written permission. Thank you!

This post may contain links to Amazon or other partners; your purchases via these links can benefit Simply Recipes. Read more about our affiliate linking policy.

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.

More from Elise

82 Comments / Reviews

No ImageFettuccine with Creamy Tomato Italian Sausage Sauce

Did you make it? Rate it!

  1. Dana

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


    Show Replies (1)
  2. 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!!.

    Show Replies (1)
  3. 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.

  4. 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!!

  5. 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… :)

    Show Replies (1)
View More
Fettuccine with Creamy Tomato Italian Sausage SauceFettuccine with Creamy Tomato Italian Sausage Sauce