I have made this pasta a thousand times. Back when I was twenty and twenty-two, I didn’t have much of a budget for entertaining but still wanted to have my friends over for dinner so I almost always made pasta because it’s an inexpensive way to feed people. Nine out of ten times, I made a variation of my favorite sausage medallion pasta. It’s so easy to make!
The method here is simple: caramelize onions in butter, then pan-fry sausage slices. It’s okay if the pan starts to turn brown. Free flavor! Add canned fire-roasted tomatoes and some pasta water, salt and pepper, a lot of herbs and parmesan, and toss with noodles for the most delicious stress-free dinner. I suppose you could use wine or chicken broth instead of pasta water but I don’t know what to tell you, this is how I always make it and it’s always a hit.
Little known fact about me: I adore sausage and I really love slicing sausage into medallions. I feel like it’s becoming a bit of a signature move of mine. (I can’t, for instance, eat fondue without pan-fried sausage medallions.) I always have sausage packages in my freezer. They thaw quickly (I pull this package out in the morning and it was thawed by dinner) and sausage stays fresh for much longer than other meats, so I think it’s a handy thing to have in the kitchen. Lately I’ve been gobbling up packages and packages of Kiolbassa sausage, handmade by the Kiolbassa family since the 1940s. I used their beef smoked sausage on this particular night and it gave the pasta a wonderful flavor.
This is the perfect thing for beginner chefs to cook because sausage is fully cooked so there’s no “is the chicken done?!” drama. It definitely boosted my confidence in the kitchen and still, a decade later, I cook this several times a month. (And yet somehow, it’s never appeared on The Rose Table until now!) I often add zucchini slices when the onions are almost caramelized. Sometimes I add garlic. Sometimes I use oregano instead of basil. Sometimes I’ll throw in some spinach. But the sausage, tomatoes, onions, and the method is always the same and it’s always delicious.
Without further delay, here is my favorite go-to pasta. I hope you love making this as much as I do!

Sausage Medallion Pasta
3 Tbsp Butter
1 white onion
1/2 box Pasta (penne, farfalle, Cavatappi, or something similar)
2 sausages (I used Kiolbasa polish sausage here)
1 can fire-roasted tomatoes
1/4 cup pasta water (chicken broth or wine is also good!)
1 Tbsp fresh Italian Parsley
1 Tbsp fresh basil
Parmesan
- Cut an onion in half, cut off the ends, and thinly slice the onion. In a large skillet, sauté onions low and slow in butter until nicely caramelized. (Sometimes I’ll rush this in a pinch but I often keep it on low for an hour if I have the time!)
- Boil pasta in salted water according to package instructions.
- While the pasta is boiling, slice sausages. Push the now caramelized onions to the edges of the pan, add a bit of of olive oil to the center (not even half a tablespoon), add sausage medallions, and turn up the head slightly. Cook for a few minutes until browned, then flip and cook for a few more minutes.
- When sausage is browned, add a can of fire-roasted tomatoes. Dip into the pasta water with a 1/4 cup measure and add 1/4 of pasta water to the skillet. (The starch from the water will help the sauce stick to the pasta.) Salt and pepper to taste and add chopped Italian parsley, julienned basil, and parmesan.
- If needed, add another tablespoon or two of pasta water to the skillet to make sure it’s nice and sauce. Drain the pasta. Adjust salt/pepper/parmesan accordingly, then turn off the head and add the cooked pasta to the skillet. Carefully stir in the pasta. Top with more parmesan and a big sprig of basil if you want to be really fancy.
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Happy cooking,
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