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A white individual serving bowl filled with fettuccine with creamy sausage sauce.

Fettuccine with Creamy Sausage Sauce

Course: Entree / Pasta
Cuisine: Italian
Keyword: fresh pasta recipe, how to cook pasta, how to make a creamy sausage sauce
Prep Time: 15 minutes
Cook Time: 1 hour
Total Time: 1 hour 15 minutes
Servings: 6 people
Calories: 682kcal
Fettuccine with Creamy Sausage Sauce is pure Italian pasta heaven. The flavors of this dish just work perfectly together. The sauce can be made up to 4 days in advance. It also freezes beautifully!
Print Recipe


  • Large skillet/saucepan and pot for boiling pasta


  • 2 tbsp olive oil
  • 2 tbsp unsalted butter
  • 1 cup onion chopped
  • 1 cup celery chopped
  • 1 cup carrot peeled and chopped
  • 1 lb Italian sausage sweet, hot, or combo, with casings removed
  • ½ tsp nutmeg grated
  • Kosher salt and fresh ground black pepper
  • 1 cup half and half divided
  • 2 tbsp tomato paste
  • 1 28 oz. can whole tomatoes drained
  • 1 cup beef stock
  • 16 oz. pasta fettuccine or linguine, a mix of spinach and egg is great!
  • Parmesan cheese grated, for serving


  • In a large skillet, heat the olive oil over medium heat until shimmering. Add the butter and stir with a wooden spoon until melted. Add the onion, celery, and carrot and saute until tender, about 4 to 5 minutes.
  • Add the sausage and stir to break into smaller clumps. Sprinkle with the nutmeg and season with ½ tsp salt and ½ tsp pepper. Reduce heat to medium-low and cook until the sausage is almost fully cooked, about 8 minutes.
  • Add ½ cup of the half-and-half, stir well, and cook for 8 minutes, using a wooden spoon to incorporate the half-and-half into the sausage mixture.
  • Stir in the tomato paste. Use your hand to squeeze tomatoes into the sauce, mixing well. Add another ½ tsp salt and ¼ tsp pepper to the sauce.
  • Reduce the heat to low and cook for 45 minutes. Stir occasionally, adding the beef stock in increments to keep the sauce from not drying out. After simmering for 45 minutes, and after you've added all of the beef broth, stir in the remaining ½ cup of half-and-half.
  • Meanwhile, bring a pot of salted water to a boil. Add the pasta and cook until al dente, according to package instructions. If using fresh pasta, it will only need to cook for about 2 minutes. Be sure to save a least a cup of pasta water.
  • Add the pasta to the sauce in the skillet and toss until the strands are well coated with the sauce. Add reserved pasta water to help loosen the pasta and mix with the sauce. Serve at once with grated cheese passed at the table.



You'll need 1 lb of the sausage.  Sometimes this is 3 links, sometimes that's 4 links.  Just use your best judgment.   We love using a combination of hot and sweet sausage, but that's up to you!
Italian sausage can be found in the meat department of most well-stock supermarkets.  Often, they are in the frozen meat area. 
Chicken sausage or turkey sausage are great substitutions.  If not already seasoned, you'll need to season the meat as it cooks with 1/2 tsp of salt, pepper, and 1 tsp of Italian seasonings, such as dried oregano, basil, and fennel. 
We like using half-and-half for the cream, but you can use all whole milk, or heavy cream, or a combination of any of these.  Remember, to use ½ a cup to sauté into to the meat, and then another ½ cup when the sauce is finished simmering.
We love either making fresh pasta or purchasing fresh pasta from the market. Remember that fresh only takes a couple of minutes to cook.  Dried pasta, such a fettuccine, linguine, or spaghetti are all great options.  Follow the instructions on the package for al dente pasta.  Remember to save some pasta water to thin the sauce, if necessary!
The sauce can be made up to 1 week in advance.  Keep in an air-tight container in the fridge.  The sauce also freezes beautifully for up to 2 months. 


Calories: 682kcal | Carbohydrates: 65g | Protein: 24g | Fat: 28g | Saturated Fat: 9g | Cholesterol: 83mg | Sodium: 725mg | Potassium: 691mg | Fiber: 4g | Sugar: 5g | Vitamin A: 3982IU | Vitamin C: 7mg | Calcium: 97mg | Iron: 2mg